作者感谢成都中医药大学附属医院妇科的温毅医生和其他医务人员的帮助。

本研究的所有程序均按照临床试验注册进行，并已获得成都中医药大学附属医院伦理委员会的批准（备案号：2021KL-004）。本研究中的所有患者都对研究者在试验期间使用数据、图像和相关视频拍摄表示知情同意。
1. 手术前的准备
<ol><li>纳入标准如下：包括符合西医盆腔炎诊断标准 8,9 和中医湿热瘀证型10 的患者，年龄 20-25 岁。</li>
	<li>设定以下排除标准： 盆腔痛或下腹痛的其他原因;过去 6 个月内怀孕、哺乳或准备怀孕;影响心脏、肝脏、肾脏和造血系统的严重疾病，使治疗无法耐受;无法或不愿合作;容易过敏或形成瘢痕疙瘩的个体;上个月有类似药物或物理治疗史。</li>
	<li>准备好以下材料：无菌手套、一次性肠线嵌入针、一次性埋线工具包（治疗托盘、无菌纱布、无菌棉签、碘伏棉签、镊子、“0”肠线、医用贴片; 图 1）。</li>
	<li>让患者仰卧，放松，充分露出腹部和下肢。</li>
	<li>检查目标穴位位置的皮肤状况，如果没有异常，请继续手术。 注意：穴位皮肤有感染、溃疡或疤痕的患者不应进行包埋。如果患者极度饥饿、疲劳或承受巨大的精神压力，则不应立即进行手术。避免对经期患者进行该程序。</li>
	<li>让医生进行常规手部消毒并戴无菌手套。</li>
	<li>检查一次性埋线针芯与针管是否配合顺畅（图 2A）。</li>
	<li>右手拿着镊子，将肠线放入针管中（图 2B）。 注意： 肠线需要完全插入针管中。</li>
</ol>2. 操作步骤
<ol><li>选择以下穴位（国际代码）：中鸡 （RN3）、观元 （RN4）、气海 （RN6）、桂来 （ST29）、自贡 （EX-CA1）、雪哈 （SP10）、祖三里 （ST36）、银灵泉 （SP9） 和三阴角 （SP6; 图 3）。</li>
	<li>进针<ol><li>用左手收紧进针部位的皮肤，用右手的拇指、食指和中指捏住针管。</li>
		<li>以 90° 角快速向下插入针头与皮肤（图 2C、D）。</li>
		<li>当患者出现酸痛、麻木、腹胀等气感（针感）时，停止插针，推动针芯，拔出针管，将肠线留在气接收区。</li>
	</ol></li>
	<li>拔针：左手按压穴皮肤，右手拔出针芯和针筒。 注意：肠线必须完全皮内，不应留在皮下或暴露在皮下注射剂外。</li>
	<li>用消毒过的干棉球压缩针孔 30 秒，并在针孔上涂抹 2 天。</li>
</ol>3. 埋入肠线后的注意事项
<ol><li>确保嵌入的部位在前 48 小时内不与水接触。</li>
	<li>建议患者在手术后 7 天内避免剧烈的体力活动，尤其是在埋线区域周围。</li>
</ol>4. 不良反应和管理
<ol><li>患者不适<ol><li>疼痛<ol><li>告诉患者疼痛是一种常见的不良反应11 并且他们的疼痛会在 5-7 天后大部分消失。</li>
			<li>在手术过程中使用细线嵌入针和肠线体。</li>
			<li>对于对疼痛敏感且没有已知禁忌症的患者，考虑术前口服镇痛药11;如有必要，在嵌入肠线12 之前用利多卡因进行局部麻醉。</li>
		</ol></li>
		<li>针头相关性昏厥 注意：这是指在穴位埋肠治疗期间突然出现头晕、视力模糊、心悸、恶心甚至晕厥。<ol><li>如果患者晕倒，请立即停止肠线嵌入并观察患者的生命体征。对于较轻的情况，请患者躺下一会儿，喝温水或喝含糖饮料。在症状没有缓解的情况下，采用现代急救措施。</li>
		</ol></li>
		<li>出血或局部血肿<ol><li>如果包埋部位出现术后出血，请用干棉签轻轻按压局部部位以止血。</li>
			<li>如果形成血肿，请在 24 小时内进行冷敷，然后在 24 小时后进行热敷以促进血肿吸收。 注意：如果出血持续或大量出血，则可能表明血管损伤，需要手术干预。</li>
		</ol></li>
	</ol></li>
	<li>肠体排斥反应<ol><li>发烧 注意：任何发烧通常会在 1 周内消失。<ol><li>指导患者多喝水。用物理降温或口服解热药治疗持续发热。</li>
			<li>当出现长时间的高热时，请确保外科专家及时冷却并去除嵌入的肠线。</li>
		</ol></li>
		<li>过敏反应<ol><li>寻找过敏症状，例如局部发红、皮疹和瘙痒;提供抗组胺药（如马来酸氯苯那敏、西替利嗪、氯雷他定）或皮质类固醇（如地塞米松）进行过敏管理，必要时从体内清除包埋的肠线。</li>
		</ol></li>
		<li>结节或肿块<ol><li>小结节通常会自行消退。对于局部坚硬的肿块，采用艾灸和穴位注射等方法13。</li>
		</ol></li>
		<li>线程溢出<ol><li>通过修剪或提取挤出的肠线，然后重新嵌入来管理线程溢出。</li>
		</ol></li>
		<li>感染<ol><li>在肠线包埋后的前 5 天内，局部部位可能会出现不同程度的炎症。如果包埋部位有过多分泌物或有脓性变化的迹象，请使用抗生素治疗以控制感染。如有必要，寻求手术干预。</li>
		</ol></li>
	</ol></li>
</ol>5. 观察指标
<ol><li>临床疗效评价14<ol><li>将恢复定义为所有相关症状和体征（如盆腔疼痛）的改善，评分下降 ≥95%。</li>
		<li>将显著效应定义为 70% ≤分数降低< 95%。</li>
		<li>如果 30% ≤评分降低< 70%，则认为治疗有效。</li>
		<li>如果分数降低 <30%，则认为治疗无效。</li>
	</ol></li>
	<li>使用简化的麦吉尔疼痛量表 （SF-MPQ）15 来评估治疗前后的疼痛情绪和严重程度，分数越高表示疼痛越严重。</li>
	<li>使用中医湿热瘀滞证量表对中医证16 分进行评分。分数越高，症状越严重。</li>
	<li>使用盆腔体征量表17 评估治疗前后的腹部压痛或反弹痛、子宫压痛、颈部抬高和摆动痛以及附件压痛。分数越高，骨盆疼痛越严重。</li>
	<li>使用世界卫生组织生活质量 （WHOQOL） - BREF 量表18 对患者的生存质量进行评分，并积极计算领域分数，这意味着分数越高，生活质量越好。</li>
</ol>6. 统计分析
<ol><li>将符合正态分布的测量数据表示为平均值±标准差 （SD）。</li>
	<li>使用独立样本 t 检验进行组比较，使用配对样本 t 检验进行治疗前后的比较。</li>
	<li>将不符合正态分布的数据表示为 M （25%，75%）。</li>
	<li>使用秩和检验进行组比较，并使用配对秩和检验进行治疗前后的比较。</li>
	<li>将计数或序数数据表示为分量比率。</li>
	<li>使用 Fisher 精确概率法或卡方检验执行组比较。</li>
	<li>对前后控制使用配对设计 t 检验。进行双侧假设检验至 α= 0.05;认为 P < 0.05 具有统计学意义。</li>
</ol>

穴位肠埋入术治疗慢性盆腔疼痛

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L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+observation+of+chronic+pelvic+inflammation+of+different+differentiated+patterns/syndromes+treated+with+acupoint+embedding+therapy.">Efficacy observation of chronic pelvic inflammation of different differentiated patterns/syndromes treated with acupoint embedding therapy.</a> Zhongguo Zhen Jiu. 32 (12), 1081-1083 (2012).</li><li>Huang, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+of+the+cost+of+chronic+pelvic+pain+in+women.">A systematic review of the cost of chronic pelvic pain in women.</a> J Obstet Gynaecol Can. 44 (3), 286-293 (2022).</li><li>Wang, X. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+of+adverse+reactions+of+acupoint+catgut+embedding+therapy.">Analysis of adverse reactions of acupoint catgut embedding therapy.</a> Zhongguo Zhen Jiu. 40 (2), 193-196 (2020).</li><li>Xue, H. Q., Ma, L., Zhang, Y. Q., Shi, X. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+of+the+selection+pattern+of+acupuncture+points+for+chronic+pelvic+pain+in+the+sequelae+of+pelvic+inflammatory+diseases+[J].">Analysis of the selection pattern of acupuncture points for chronic pelvic pain in the sequelae of pelvic inflammatory diseases [J].</a> Guangming Traditional Chinese Medicine. 38 (15), 2950-2953 (2023).</li><li>Wu, X. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+electroacupuncture+on+pain+threshold+and+expression+of+pain-related+factors+cyclooxygenase-2,+prostaglandin+E2+and+&#946;-endorphin+in+rats+with+chronic+pelvic+pain+syndrome.">Effect of electroacupuncture on pain threshold and expression of pain-related factors cyclooxygenase-2, prostaglandin E2 and &#946;-endorphin in rats with chronic pelvic pain syndrome.</a> Zhen Ci Yan Jiu. 47 (6), 531-536 (2022).</li><li>Liu, Y. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acupuncture+combined+with+western+medication+on+chronic+pelvic+pain+after+pelvic+inflammatory+disease:+a+multi-center+randomized+controlled+trial.">Acupuncture combined with western medication on chronic pelvic pain after pelvic inflammatory disease: a multi-center randomized controlled trial.</a> Zhongguo Zhen Jiu. 41 (1), 31-35 (2021).</li><li>Xiang, D. F., Sun, Q. Z., Liang, X. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+abdominal+acupuncture+on+pain+of+pelvic+cavity+in+patients+with+endometriosis.">Effect of abdominal acupuncture on pain of pelvic cavity in patients with endometriosis.</a> Zhongguo Zhen Jiu. 31 (2), 113-116 (2011).</li></ol>

作者声明他们没有利益冲突。

古代中医书籍中没有慢性盆腔痛的记载，根据其症状特点，可与“腹痛”、“女性腹痛”、“月经腹痛”等疾病相互参照。根据中医理论，当血管张开时，护理不当可能会导致病原因子的侵袭，如湿热，这些病原因素会在子宫及其通道中停滞，导致病原因素与健康能量的斗争，表现为盆腔炎性疾病。如果盆腔炎性疾病未经治疗或治疗不当，病情可能会持续存在并发展为盆腔炎性疾病的后遗症。盆腔炎性疾病后遗症的核心发病机制是血瘀，阻塞子宫和血管。湿热瘀滞综合征是一种常见的综合征类型。它通常是由于盆腔炎性疾病后期挥之不去的湿热之恶或内脏功能功能障碍引起的。湿热是内生的，阻气气血。湿热与血瘀交会导致挥之不去、难以愈合，因此慢性盆腔疼痛持续存在。
CPP 作为一种慢性、长期和持续性疾病，病因复杂19。疼痛的原因涉及多种机制，包括神经系统、内分泌系统和免疫系统 20,21,22,23,24。针灸在缓解 CPP 疼痛方面的有效性和安全性已被许多临床和实验研究证实，并在治疗慢性疼痛方面显示出优异的效果 21,25,26。既往研究表明，针灸可以通过调节中枢神经递质的分泌来改善沿身体经络疼痛的阈值，达到明显有效的全身镇痛效果 5,27。
穴位埋线作为传统针灸技术的延伸和发展，可以对穴位产生缓慢、柔软、持久、良性的“长效针感效应”，具有持久的镇痛作用28。同时，它可以调节患者的免疫功能和细胞因子水平，增强他们的抗病能力29，其治疗效果优于单纯针灸治疗慢性疼痛30。一些研究表明，每位 CCP 患者的年度医疗保健费用从 1,367 美元到 7,043 美元不等31。肠线嵌入疗法提供了一种具有成本效益的解决方案，具有可靠的疗效和低复发率。与其他非药物治疗方法相比，它降低了多次治疗的医疗费用，从而减轻了患者的经济负担。此外，与传统的针灸方法相比，穴位肠嵌入避免了反复针刺的不适，提高了患者的依从性。操作方法简单、不良反应少，与传统针灸相比，穴位肠埋植术更具临床适用性32。
在穴位埋线过程中，严格遵守操作步骤至关重要。要求医生有无菌意识，患者也应严格遵循术后注意事项（如前所述），避免感染等不良反应（不良反应和治疗已在前面讨论过）;其次，不同穴位的进针角度不同。对于肌肉丰富的区域（如腹部、臀部、腿部等），直接针刺（针头与皮肤成 90°）、斜针（针头与皮肤成 45°）或平针（针头与皮肤成 15°）对于肌肉较浅的区域（如手、脚等）。本研究中的所有穴位均采用直接针刺治疗。最后，穴位埋线是一种侵入性手术，医生在手术过程中应避开血管。
CPP针灸穴位选择模式的文献显示，冠源、三阴角、中鸡、岐海、足三里、桂来、自贡、银陵泉是常用的治疗穴位，累计应用频率为71.51%33。其他研究表明，穴位针灸可以改善 CPP 患者的临床症状和体征34。中鸡、观元和三阴角针灸降低了 CPPS 大鼠的疼痛因子 （COX-2、PGE2） 并增加了疼痛阈值35,36。
本文仅对 SPID 引起的 CPP 进行穴位肠埋葬治疗的临床研究。通过整合中医辨证论证理论，扩大穴位埋线疗法对其他疾病引起的 CPP 的使用，有可能进一步丰富 CPP 的治疗选择，突破治疗瓶颈，提高 CPP 患者的整体生活质量。

慢性盆腔疼痛 （CPP） 是指持续 6 个月以上的盆腔疼痛，是非周期性的，并且对非阿片类药物无反应。最新研究表明，CPP 的全球发病率为 ~5%-26%1。序贯盆腔炎 （SPID） 是导致 CPP 的主要疾病之一，占女性所有慢性盆腔疼痛病例的 23%-30%2。由于现有镇痛药在缓解这种疼痛方面的疗效有限，超过 50% 的 CPP 患者可能会寻求非药物治疗3。目前，主要的非药物治疗包括盆底物理治疗、心理治疗、神经调节和饮食治疗。然而，它们也有局限性，例如疼痛缓解效果不佳和难以实现长期控制。大多数患有 CPP 的 SPID 女性会因反复发作的疼痛而感到焦虑、抑郁和生活质量下降4。因此，寻找一种能够缓解患者疼痛症状的有效治疗方法已成为临床上迫切关注的问题。
针灸是中医中两种主要的外用治疗方法，在治疗与疼痛相关的疾病方面显示出良好的疗效，并已广泛用于临床实践，特别是在缓解慢性疼痛方面，它们的有效性超过了其他非药物治疗 CPP 5,6.在一项关于中医治疗 CPP 的横断面研究中，7.63% 的慢性疼痛患者被选择接受针灸治疗，治疗效果极佳7。本文介绍的穴位肠埋植法是针灸法的延伸和发展。是指使用专门设计的一次性医疗器械，将可吸收的肠线植入相应的穴位，提供持久持续的穴位刺激，达到镇痛效果的一种中医外治技术。作者的团队利用这项技术治疗由 SPID 引起的女性复发性和无法治愈的盆腔疼痛，并产生了积极的结果。它既可以作为独立治疗，也可以作为综合中医治疗计划的重要组成部分或中西医结合。本文以最常见的中医证候（湿热瘀型）SPID 患者为例，对穴位肠埋设程序进行详细演示。

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acupoint catgut embedding for treatment of chronic pelvic pain due to the sequelae of pelvic inflammatory disease

炎症性盆腔疾病后遗症引起的慢性盆腔疼痛是女性盆腔疼痛的常见临床病症。目前，其治疗面临的主要挑战是缓解疼痛的效果有限，症状频繁复发，严重影响患者的生活质量，给患者带来相当大的心理负担。这是一种临床上具有挑战性的疾病。在总结多年的治疗经验后，作者的团队发现，穴位肠线包埋在治疗盆腔炎后遗症引起的慢性盆腔痛方面显示出显著的临床疗效。与现有的西医治疗方法相比，穴位肠埋伏术具有镇痛效果好、复发率低、经济效益好、手术相对简单等优点。本文为将可吸收肠线嵌入患者穴位治疗女性盆腔炎后遗症引起的慢性盆腔痛提供了全面的指南。

在这项临床研究中，最初共招募了 88 名参与者，其中 8 名退出（4 名来自治疗组，4 名来自另一名）。其余 80 名参与者使用随机数字表分为治疗组和对照组，每组 40 名参与者。治疗过程包括每 10 天埋入肠线一次，避免月经，连续持续 3 个月。治疗组患者也每天服用一剂中药，月经期间停药，连续 3 个月。使用的口服中草药是四泥苗石小散的改良配方，包括以下成分： 醋北柴湖 10 克、 红牡丹 15 克、 麸皮炒橙壳 15 克、 麸皮炒白术 10 克、 川牛习 15 克、 薏仁 30 克、 盐黄柏 10 克、 油炸五灵芝 15 克、 生蒲公英 20 克、 金银花藤 20 克、 蒲公英 15 克、 甘草 6 克，煎剂配制，每日一次，分三剂服用。对照组仅用中药治疗，方剂选择、加减法、疗程与治疗组相同。
在这项研究中，两例胃肠道反应，均在对照组，表现为腹泻，可能与服用中草药有关。由于这 2 例患者脾胃虚弱，我们加用 了沙仁 4 g 和 山窑 20 g 以强脾止泻。为这些患者修改草药后，胃肠道反应消退。治疗组 2 例在埋入肠线的穴位出现轻度发红和轻微不适。这归因于对肠线材料的拒绝。建议患者每天对患处进行酒精敷布。在一种情况下，发红在 3 天后消失，而在另一种情况下，发红在 7 天后消退。重要的是，未观察到严重的不良反应。
SPID 引起的慢性盆腔疼痛会给女性带来痛苦;我们发现，与单独使用中药煎剂相比，穴位埋线联合可提高临床治疗的总有效率 （95% vs 85%， P = 0.031，< 0.05， 表 1）。为了进一步评价疗效，我们还对患者在不同时间点（治疗前、治疗第 4 周、第 8 周和第 12 周）的疼痛程度、中医证和盆腔体征进行了评分。结果显示，与对照组相比，治疗组 SF-MPQ 评分、中医证候评分、盆腔征评分均显著降低 （P < 0.05、 表 2、表 3 和 表 4）。此外，我们的研究还显示，与治疗前相比，两组患者的生活质量有所改善，治疗组优于对照组 （P < 0.05， 表 5）。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/66438/66438fig01.jpg"> 图 1：物品准备。 （A） 粘性绷带。（B） “0” 肠线。（C） 一次性埋针。（D） 镊子。（E） 手术托盘。（F） 碘伏棉签。（G） 无菌纱布。（H） 无菌棉签。（I） 镊子。（J） 无菌手套。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66438/66438fig01large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/66438/66438fig02.jpg"> 图 2：埋刺针及其放置肠线后的插入。 （A） 埋刺针。（B） 将一次性肠线放入注射器中。（C，D）进针示意图。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66438/66438fig02large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/66438/66438fig03.jpg"> 图 3：穴位分布图。 （a） 气海 （RN6）：在前中线上，脐下方 1.5 cun。（b） 观元 （RN4）：在前中线上，脐下 3 存。（c） 中鸡 （RN3）：在前中线，脐下 4 cun。（d） 桂来 （ST29）：脐下 4 cun，距前中线 2 cun。（e） 自贡 （EX-CA1）：脐下 4 村，距前中线 3 村。（f） 雪海 （SP10）：髌底内侧端上方 2 寸，在股骨内侧肌的突出处。（g） Zusanli （ST36）：在小腿前外侧，Dubi 下方 3 cun（膝盖屈曲，在膝盖处，髌骨和髌韧带的外侧凹陷处），一个横指（中指）从胫骨前嵴。（h） 阴陵拳 （SP9）：位于小腿内侧胫骨内侧髁缘和胫骨内侧缘之间的凹陷处。（i） 三阴角 （SP6）：胫骨近中缘后方，内踝尖端上方 3 个村。 Cun19 是中医理论中的特殊计量单位;通常等于远端指间关节的长度和食指近端指间关节的长度;根据文献，1 英寸长 ~2.0-2.2 厘米。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66438/66438fig03large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>群</td>
			<td>n</td>
			<td>治愈</td>
			<td>显著效果</td>
			<td>有效</td>
			<td>无效</td>
			<td>总效率</td>
			<td>F</td>
			<td>P</td>
		</tr><tr><td>治疗组</td>
			<td>40</td>
			<td>11 (27.5)</td>
			<td>18 (45.0)</td>
			<td>9 (22.5)</td>
			<td>2 (5.0)</td>
			<td>38 (95.0)</td>
			<td rowspan="2">8.8</td>
			<td rowspan="2">0</td>
		</tr><tr><td>控制组</td>
			<td>40</td>
			<td>5 (12.5)</td>
			<td>11 (27.5)</td>
			<td>18 (45.0)</td>
			<td>6 (15.0)</td>
			<td>34 (85.0)</td>
		</tr></tbody></table>表 1：治疗后两组临床疗效比较 [n （%）]。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td rowspan="2">群</td>
			<td rowspan="2">N</td>
			<td colspan="6">观察时间节点</td>
		</tr><tr><td>以前</td>
			<td>第 4 周</td>
			<td>第 8 周</td>
			<td>第 12 周</td>
			<td>t</td>
			<td>P</td>
		</tr><tr><td>治疗组</td>
			<td>40</td>
			<td>25.63±6.52</td>
			<td>17.15±3.09*#</td>
			<td>10.18±2.75*#</td>
			<td>4.53±2.73*#</td>
			<td>16.87</td>
			<td><0.001</td>
		</tr><tr><td>控制组</td>
			<td>40</td>
			<td>25.70±6.01</td>
			<td>19.15±4.73 元*</td>
			<td>14.33±2.91*</td>
			<td>9.76±5.14*</td>
			<td>13.74</td>
			<td><0.001</td>
		</tr><tr><td>t</td>
			<td rowspan="2"></td>
			<td>0.959</td>
			<td>-2.301</td>
			<td>-6.894</td>
			<td>12.947</td>
			<td colspan="2" rowspan="2"></td>
		</tr><tr><td>P</td>
			<td>0.4</td>
			<td>0.024</td>
			<td><0.001</td>
			<td><0.001</td>
		</tr></tbody></table>表 2：不同观察点（分数，x ̄ ± s）两组治疗之间 SF-MPQ 评分的比较。 *与治疗前相比; #与对照组相比。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td rowspan="2">群</td>
			<td rowspan="2">N</td>
			<td colspan="6">观察时间节点</td>
		</tr><tr><td>以前</td>
			<td>第 4 周</td>
			<td>第 8 周</td>
			<td>第 12 周</td>
			<td>t</td>
			<td>P</td>
		</tr><tr><td>治疗组</td>
			<td>40</td>
			<td>14.45±4.55</td>
			<td>8.10±1.82*#</td>
			<td>6.08±2.18*#</td>
			<td>3.68±2.30*#</td>
			<td>11.5</td>
			<td><0.001</td>
		</tr><tr><td>控制组</td>
			<td>40</td>
			<td>14.40±4.58</td>
			<td>9.63±1.96*</td>
			<td>7.83±2.75*</td>
			<td>5.60±2.80*</td>
			<td>9.45</td>
			<td><0.001</td>
		</tr><tr><td>t</td>
			<td rowspan="2"></td>
			<td>0.01</td>
			<td>-3.606</td>
			<td>-3.153</td>
			<td>3.274</td>
			<td colspan="2" rowspan="2"></td>
		</tr><tr><td>P</td>
			<td>0.961</td>
			<td>0.001</td>
			<td><0.002</td>
			<td><0.001</td>
		</tr></tbody></table>表 3：两个治疗组在每个观察节点的中医证候评分比较（评分，x ̄ ± s）。 *与治疗前相比; # 与对照组相比。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td rowspan="2">群</td>
			<td rowspan="2">N</td>
			<td colspan="6">观察时间节点</td>
		</tr><tr><td>以前</td>
			<td>第 4 周</td>
			<td>第 8 周</td>
			<td>第 12 周</td>
			<td>Z</td>
			<td>P</td>
		</tr><tr><td>治疗组</td>
			<td>40</td>
			<td>7.00 (4.25,10.00)</td>
			<td>4.00 (3.00,4.00)*#</td>
			<td>3.00 (2.00,4.00)*#</td>
			<td>2.00 (2.00,3.00)*#</td>
			<td>-5.4</td>
			<td><0.001</td>
		</tr><tr><td>控制组</td>
			<td>40</td>
			<td>5.50 (4.00,8.00)</td>
			<td>5.00 (4.00,6.00)*</td>
			<td>4.00 (3.00,4.00)*</td>
			<td>3.00 (2.00,4.00)*</td>
			<td>5.05</td>
			<td><0.001</td>
		</tr><tr><td>Z</td>
			<td rowspan="2"></td>
			<td>-1.588</td>
			<td>-3.141</td>
			<td>-2.002</td>
			<td>-2.215</td>
			<td colspan="2" rowspan="2"></td>
		</tr><tr><td>P</td>
			<td>0.112</td>
			<td>0.002</td>
			<td>0.045</td>
			<td>0.027</td>
		</tr></tbody></table>表 4：不同观察点两组治疗盆腔体征评分的比较 [M （25%， 75%）]。 *与治疗前相比， #与对照组相比。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>尺寸</td>
			<td>群</td>
			<td colspan="2">治疗前</td>
			<td colspan="2">治疗后</td>
			<td>Z</td>
			<td>P</td>
		</tr><tr><td rowspan="2">生理领域</td>
			<td>治疗组</td>
			<td colspan="2">20.00 (19.00,21.75)</td>
			<td colspan="2">23.00 (22.00,23.00)</td>
			<td rowspan="2">-3.1</td>
			<td rowspan="2">0.002</td>
		</tr><tr><td>控制组</td>
			<td colspan="2">21.00 (19.00,22.50)</td>
			<td colspan="2">22.00 (21.00,23.00)</td>
		</tr><tr><td rowspan="2">心理领域</td>
			<td>治疗组</td>
			<td colspan="2">18.50 (18.00,19.00)</td>
			<td colspan="2">21.00 (19.50,22.00)</td>
			<td rowspan="2">-3.4</td>
			<td rowspan="2">0.001</td>
		</tr><tr><td>控制组</td>
			<td colspan="2">18.00 (18.00,19.00)</td>
			<td colspan="2">19.00 (19.00,21.00)</td>
		</tr><tr><td rowspan="2">社会关系领域</td>
			<td>治疗组</td>
			<td colspan="2">9.50 (9.00,11.00)</td>
			<td colspan="2">11.00 (11.00,12.00)</td>
			<td rowspan="2">-3.6</td>
			<td rowspan="2"><0.001</td>
		</tr><tr><td>控制组</td>
			<td colspan="2">10.00 (9.00,10.00)</td>
			<td colspan="2">10.00 (10.00,11.00)</td>
		</tr><tr><td rowspan="2">环境领域</td>
			<td>治疗组</td>
			<td colspan="2">24.00 (24.00,29.00)</td>
			<td colspan="2">26.50 (24.00,29.75)</td>
			<td rowspan="2">-2.1</td>
			<td rowspan="2">0.033</td>
		</tr><tr><td>控制组</td>
			<td colspan="2">24.00 (23.00,25.00)</td>
			<td colspan="2">25.00 (24.00,26.75)</td>
		</tr></tbody></table>表 5：世界卫生组织生活质量 （WHOQOL） - 治疗前后两组 BREF18 评分的比较 [M（25%，75%）]。

Read this Scientific Article Protocol about Acupoint Catgut Embedding for Treatment of Chronic Pelvic Pain due to the Sequelae of Pelvic Inflammatory Disease at JoVE.com

作者聚焦：通过穴位肠埋法增强女性慢性盆腔疼痛管理

本文概述了穴位肠埋葬疗法治疗盆腔炎性疾病后遗症引起的慢性盆腔痛。

穴位肠埋葬治疗盆腔炎后遗症引起的慢性盆腔痛

Chronic pelvic pain caused by the sequelae of inflammatory pelvic disease is a common clinical condition of pelvic pain in women. At present, the main ...

我们的研究重点是开发有效的治疗方法，治疗盆腔炎后遗症引起的慢性盆腔疼痛。我们的研究发现，穴位可以改善患者的临床症状和生活质量。与现有的西医治疗方法相比，穴位肠埋伏术具有镇痛效果好、复发率低、经济效益好、手术相对简单等优点。我们将重点研究外用中药缓解女性慢性盆腔疼痛的疗效以及治疗方案的发展。

acupoint-catgut-embedding-for-treatment-chronic-pelvic-pain-due-to

Nanyang Technological University

Research

JoVE Journal

Medicine

Acupoint Catgut Embedding for Treatment of Chronic Pelvic Pain Due to the Sequelae of Pelvic Inflammatory Disease

1.2K 次观看.  Hospital of Chengdu University of Traditional Chinese Medicine. 我们的研究重点是开发有效的治疗方法，治疗盆腔炎后遗症引起的慢性盆腔疼痛。我们的研究发现，穴位可以改善患者的临床症状和生活质量。与现有的西医治疗方法相比，穴位肠埋伏术具有镇痛效果好、复发率低、经济效益好、手术相对简单等优点。我们将重点研究外用中药缓解女性慢性盆腔疼痛的疗效以及治疗方案的发展。

视频: 作者聚焦：通过穴位肠埋法增强女性慢性盆腔疼痛管理

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%1-3, the majority of cases being monocular2. Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.
Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself4,5 . Amblyopia is characterized by both monocular and binocular deficits6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions8. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia9,10 .
Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control13,14 and patient6,9,11 populations.
In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device15.

Amblyopia is a developmental disorder of the visual cortex that is often accompanied by strong suppression of one eye. We present a new technique for measuring and treating interocular suppression in patients with amblyopia that can be deployed using virtual reality goggles or a portable iPod Touch device.

测量和制止在弱视治疗

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current ...

科研

医学

Intraoperative Detection of Subtle Endometriosis: A Novel Paradigm for Detection and Treatment of Pelvic Pain Associated with the Loss of Peritoneal Integrity

Endometriosis is a common disease affecting 40 to 70% of reproductive-aged women with chronic pelvic pain (CPP) and/or infertility. The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surfaces during laparoscopy (L/S) to detect the loss of peritoneal integrity in patients with pelvic pain and suspected endometriosis. Forty women with CPP and 5 women without pain were evaluated in this pilot study. During L/S, concentrated dye was sprayed onto peritoneal surfaces, then aspirated and rinsed with Lactated Ringers solution. Areas of localized dye uptake were evaluated for the presence of visible endometriotic lesions. Areas of intense peritoneal staining were resected and some fixed in 2.5% buffered gluteraldehyde and examined by scanning (SEM) electron microscopy. Blue dye uptake was more common in women with endometriosis and chronic pelvic pain than controls (85% vs. 40%). Resection of the blue stained areas revealed endometriosis by SEM and loss of peritoneal cell-cell contact compared to normal, non-staining peritoneum. Affected peritoneum was associated with visible endometriotic implants in most but not all patients. Subjective pain relief was reported in 80% of subjects. Based on scanning electron microscopy, we conclude that endometrial cells extend well beyond visible implants of endometriosis and appear to disrupt the underlying mesothelium. Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity, allowing menstrual or ovulatory blood and associated pain factors access to underlying sensory nerves. Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP. This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at L/S and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy.

Loss of peritoneal integrity provides a new paradigm to understand and treat chronic pelvic pain in women with mild forms of endometriosis and can be easily detected using intraoperative instillation of dye at the time of laparoscopy.

术中的微妙的子宫内膜异位症的检测：A新型范式为相关联的与的的腹膜的完整性之亏损盆腔疼痛的的的的检测和治疗的

Endometriosis is a  common disease affecting 40 to 70% of reproductive-aged women with chronic  pelvic pain (CPP) and/or infertility. The purpose of this ...

Demonstration of Cutaneous Allodynia in Association with Chronic Pelvic Pain

Pelvic pain is a common condition that is associated with dysmenorrhea and endometriosis. In some women the severe episodes of cyclic pain change and the resultant pain becomes continuous and this condition becomes known as Chronic Pelvic Pain. This state can be present even after the appropriate medical or surgical therapy has been instituted. It can be associated with pain and tenderness in the muscles of the abdomen wall and intra-pelvic muscles leading to severe dyspareunia. Additional symptoms of irritable bowel and interstitial cystitis are common. A common sign of the development of this state is the emergence of cutaneous allodynia which emerges from the so-called viscero-somatic reflex. A simple bedside test for the presence of cutaneous allodynia is presented that does not require excessive time or special equipment. This test builds on previous work associated with changes in sensation related to gall bladder function and the viscera-somatic reflex(1;2).
The test is undertaken with the subject s permission after an explanation of how the test will be performed. Allodynia refers to a condition in which a stimulus that is not normally painful is interpreted by the subject as painful. In this instance the light touch associated with a cotton-tipped applicator would not be expected to be painful. A positive test is however noted by the woman as suddenly painful or suddenly sharp. The patterns of this sensation are usually in a discrete pattern of a dermatome of the nerves that innervate the pelvis.
The underlying pathology is now interpreted as evidence of neuroplasticity as a consequence of severe and repeating pain with changes in the functions of the dorsal horns of the spinal cord that results in altered function of visceral tissues and resultant somatic symptoms(3). 
The importance of recognizing the condition lies in an awareness that this process may present coincidentally with the initiating condition or after it has been treated. It also permits the clinician to evaluate the situation from the perspective that alternative explanations for the pain may be present that may not require additional surgery.

Demonstration of Cutaneous Allodynia in Association with Chronic Pelvic Pain

A demonstration of the bedside test for cutaneous allodynia and its clinical implications.

示范皮肤触感在慢性盆腔疼痛协会

Pelvic pain is a common condition that is associated with dysmenorrhea and endometriosis.  In some women the severe episodes of cyclic pain change and the ...

生物学

Urinary Bladder Distention Evoked Visceromotor Responses as a Model for Bladder Pain in Mice

Approximately 3-8 million people in the United States suffer from interstitial cystitis/bladder pain syndrome (IC/BPS), a debilitating condition characterized by increased urgency and frequency of urination, as well as nocturia and general pelvic pain, especially upon bladder filling or voiding. Despite years of research, the cause of IC/BPS remains elusive and treatment strategies are unable to provide complete relief to patients. In order to study nervous system contributions to the condition, many animal models have been developed to mimic the pain and symptoms associated with IC/BPS. One such murine model is urinary bladder distension (UBD). In this model, compressed air of a specific pressure is delivered to the bladder of a lightly anesthetized animal over a set period of time. Throughout the procedure, wires in the superior oblique abdominal muscles record electrical activity from the muscle. This activity is known as the visceromotor response (VMR) and is a reliable and reproducible measure of nociception. Here, we describe the steps necessary to perform this technique in mice including surgical manipulations, physiological recording, and data analysis. With the use of this model, the coordination between primary sensory neurons, spinal cord secondary afferents, and higher central nervous system areas involved in bladder pain can be unraveled. This basic science knowledge can then be clinically translated to treat patients suffering from IC/BPS.

Approximately 3-8 million people in the United States suffer from interstitial cystitis/bladder pain syndrome (IC/BPS), a debilitating condition characterized in part by pelvic pain. In order to study nervous system contributions to the condition, a physiological model of urinary bladder pain is used in mice and rats.

膀胱胀诱发内脏运动反应为膀胱疼痛小鼠模型

Approximately 3-8 million people in the United States suffer from interstitial cystitis/bladder pain syndrome (IC/BPS), a debilitating condition ...

Transvaginal Mesh Insertion in the Ovine Model

This protocol describes mesh insertion into the rectovaginal septum in sheep using a single vaginal incision technique, with and without the trocar-guided insertion of anchoring arms. Parous sheep underwent the dissection of the rectovaginal septum, followed by the insertion of an implant with or without four anchoring arms, both designed to fit the ovine anatomy. The anchoring arms were put in place using a trocar and an "outside-in" technique. The cranial arms were passed through the obturator, gracilis, and adductor magnus muscles. The caudal arms were fixed near the sacrotuberous ligament, through the coccygeus muscles. This technique allows for the mimicking of surgical procedures performed in women suffering from pelvic organ prolapse. The anatomical spaces and elements are easily identified. The most critical part of the procedure is the insertion of the cranial trocar, which can easily penetrate the peritoneal cavity or the surrounding pelvic organs. This can be avoided by a more extensive retroperitoneal dissection and by guiding the trocar more laterally. This approach is designed only for experimental testing of novel implants in large animal models, as trocar-guided insertion is currently not used clinically.

This protocol describes mesh implantation in the ovine rectovaginal septum using a single vaginal incision technique, with and without the trocar-guided insertion of anchoring arms.

经阴道网格插入在牛模型中

This protocol describes mesh insertion into the rectovaginal septum in sheep using a single vaginal incision technique, with and without the trocar-guided ...

Development of Recombinant Proteins to Treat Chronic Pain

Chronic pain is difficult to treat and new approaches to resolve persistent pain are urgently needed. Anti-inflammatory cytokines are promising candidates for treating debilitating pain conditions due to their capacity to regulate aberrant neuro-immune interactions. However, physiologically they work in a network of various cytokines, and therefore their therapeutic effect may not be optimal when used as stand-alone drugs. To overcome this limitation, we developed a fusion protein of the anti-inflammatory cytokines IL4 and IL10. Here, we describe the methods for production and quality control of IL4-10 recombinant fusion protein and we test the effectiveness of the IL4-10 fusion protein to resolve pain in a mouse model of persistent inflammatory pain.

In this paper we provide details for the methods of production and quality control of an IL4-10 recombinant fusion protein. We also show how to test the effectiveness of this protein to resolve pain in a mouse model of inflammatory pain.

重组蛋白治疗慢性疼痛的研究进展

Chronic pain is difficult to treat and new approaches to resolve persistent pain are urgently needed. Anti-inflammatory cytokines are promising candidates ...

Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery

Acupoint needle-embedding combined with ironing therapy is a non-drug treatment method to release postoperative pain after anal surgery. The practice is guided by traditional Chinese medicine (TCM) syndrome differentiation theory and employs acupoint stimulation and heat to alleviate pain. Although prior research has shown that these are dependable methods for pain relief, the combined effect of the two techniques has not been described. In our research, we found that compared to using diclofenac sodium enteric-coated capsules alone, adding acupoint needle-embedding combined with ironing therapy was more effective for reducing pain levels at different stages after hemorrhoid surgery. Although this technique is efficient and commonly used in clinics, due to its invasive practice, acupoint needle embedding still carries risks relating to hospital-acquired infections and broken needles. Ironing therapy, on the other hand, can result in burns and connective tissue injuries. Therefore, there is an urgent need to develop a standardized protocol for medical staff. Our protocol refines the traditional techniques and provides detailed instructions on patient preparation, operation techniques, and postoperative care to ensure the therapy is carried out safely and efficiently. By standardizing this therapy, this technique is expected to become an important complementary therapy for postoperative pain relief&#160;in hemorrhoids, which will significantly improve patients &#39;life quality after anal surgery.

The high incidence of pain after anal surgery is due to the physiological structure and pathological status of the anus. At present, the use of painkillers cannot provide satisfactory pain relief, which makes complementary therapy important. This paper proposes acupoint needle-embedding combined with ironing therapy to relieve postoperative pain.

穴位嵌入联合熨烫治疗肛门术后疼痛

Acupoint needle-embedding combined with ironing therapy is a non-drug treatment method to release postoperative pain after anal surgery. The practice is ...

<meta charset="utf8"></head><body>穴位嵌入疗法治疗腹部肥胖

Acupoint Catgut Embedding Therapy for Abdominal Obesity Treatment

As the global economy grows and living standards improve, the rise in overweight and obese individuals poses a significant public health challenge. This trend is predominantly linked to lifestyle changes and poor dietary habits, resulting in increased abdominal obesity characterized by fat accumulation in the abdominal region and associated symptoms such as indigestion, constipation, and fatigue. Acupoint embedding therapy uses absorbable sutures inserted into specific acupoints for continuous stimulation, aiding in the treatment of abdominal obesity, metabolic issues, and digestive disorders. Its main goals are to regulate metabolism, improve digestion, and reduce fat. This paper offers a thorough exploration of the comprehensive management of thread-embedding acupuncture for obesity treatment. It meticulously outlines critical aspects of patient management and material preparation and provides precise guidance on acupoint selection, surgical procedures, and postoperative care. This structured treatment protocol aims to ensure procedural safety and efficacy, thereby optimizing clinical outcomes for patients with abdominal obesity and ultimately improving their overall quality of life.

<meta charset="utf8"></head><body>用于腹部肥胖治疗的穴位肠埋入疗法

This study explores acupoint catgut embedding therapy for obesity, covering patient management, material preparation, acupoint selection, surgery, and post-operative care.

用于腹部肥胖治疗的穴位肠埋入疗法

As the global economy grows and living standards improve, the rise in overweight and obese individuals poses a significant public health challenge. This ...

穴位肠埋葬治疗盆腔炎后遗症引起的慢性盆腔痛

副本

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测量和制止在弱视治疗

术中的微妙的子宫内膜异位症的检测：A新型范式为相关联的与的的腹膜的完整性之亏损盆腔疼痛的的的的检测和治疗的

示范皮肤触感在慢性盆腔疼痛协会

膀胱胀诱发内脏运动反应为膀胱疼痛小鼠模型

经阴道网格插入在牛模型中

重组蛋白治疗慢性疼痛的研究进展

穴位嵌入联合熨烫治疗肛门术后疼痛

用于腹部肥胖治疗的穴位肠埋入疗法

用于腹部肥胖治疗的穴位肠埋入疗法

用于腹部肥胖治疗的穴位肠埋入疗法