产后严重盆腔感染9例临床分析

Clinical Analysis of 9 Cases of Severe Postpartum Pelvic Infection

目的：探讨与产后严重盆腔感染有关的因素,及其诊断和处理.方法：回顾性分析2005年11月至2012年9月北京大学人民医院产科收治的产后严重盆腔感染9例（7例盆腔脓肿,2例坏死性子宫内膜炎）患者的临床资料.结果：（9例患者中自然分娩1例、剖宫产8例;其中胎膜早破1例;2例伴妊娠期高血压疾病,1例合并系统性红斑狼疮,1例合并子宫肌瘤及妊娠期糖尿病;发生产后出血4例（2例行子宫动脉上行支结扎,2例行子宫动脉栓塞）,出现肠梗阻3例.②9例患者产后均出现发热,最高体温38.9℃～40.0℃;7例伴下腹痛,2例无明显腹痛;2例出现严重子宫内膜炎,1例子宫肌瘤感染变性.③经静脉抗感染治疗均无效,最终引流或清创,清除感染灶后治愈.结论：与严重盆腔感染有关的因素可能包括：剖宫产（术前伴合并症及并发症）、妊娠合并子宫大肌瘤、行子宫动脉栓塞术等.产后体温升高、下腹痛、肠梗阻症状可能是严重盆腔感染的早期症状,警惕严重子宫内膜炎和子宫肌瘤变性坏死.抗生素保守治疗无效时应积极手术治疗.

Objective：To study the risk factors,diagnosis and management of severe postpartum pelvic infection. Methods ：The clinical data of 9 cases of severe postpartum pelvic infection in the Peking University People＇s Hospital from November 2005 to September 2012 were retrospectively analyzed（7 cases of pelvic abscess,2 cases of serious endometritis）. Results：GOne case of nine was delivered vaginally,the others were delivered by cesarean section;One case suffered premature rupture of membranes;Among nine cases, two were complicated with gestational hypertension, one with systemic lupus erythematosus and one with myoma of uterus and gestational diabetes mellitus. There were 4 cases of postpartum hemorrhage, （two of which were performed bilateral ascending uterine artery ligation,and the others were performed uterine artery embolization） ;3 cases suffered intestinal obstruction. GAll of the 9 cases developed fever after delivery, the highest temperature varied from 38.9℃ to 40. 0,7℃ cases were complicated with abdominal tenderness, while the other two cases had no tenderness. Two cases developed serious endometritis and one case developed infection of uterine myoma. （3）Intravenous anti-infection treatment was inefficient, and all of the cases were healed by surgical debridement or drainage ultimately. Conclusions：Cesarean section （with preoperative complications） ,uterine huge myoma and uterine artery embolization may be risk factors of postpartum severe pelvic infection; Postpartum high temperature, abdominal tenderness and intestinal obstruction may be the early symptoms of pelvic infection;Endometritis and infection of huge myoma should be alerted. Surgical treatment should be considered if conservative treatment is invalid.