盆腔炎性疾病诊断探讨—基于临床病例的分析

Discussion of diagnosis of pelvic inflammatory disease: Analysis based on clinical data

目的分析我院15年间盆腔炎性疾病（PID）的临床特征及变化,对PID的诊断进行探讨。方法回顾性分析1995年至2009年因PID住院治疗的458例患者的临床资料,对发病年龄,与性生活的关系,症状和体征,住院时间及手术率等临床指标进行比对。结果患者平均年龄37.06±14.91岁,呈逐年上升趋势,经两两比较,3个时间段分别为t=2.255,P=0.025〈0.05;t=5.403,P〈0.001;t=2.871,P=0.004〈0.01）;育龄期妇女是高发人群,但比重由第一个5年段的93.57%下降至72.28%,无性生活的PID患者的比重由1.43%上升至2.48%,绝经期患者由5.00%上升至25.25%（χ~2=10.041,P〈0.001）;主要症状包括下腹痛（70.31%）、不规则阴道出血（33.62%）、发热（25.55%）、消化系统症状（15.72%）;主要体征包括附件区压痛（63.98%）、子宫压痛（56.77%）、下腹压痛（48.25%）、反跳痛（17.03%）、宫颈举痛（25.76%）、附件增厚（29.04%）和附件包块（29.69%）,且部分症状和体征阳性率呈逐年降低趋势。平均住院时间为10.34天,无显著变化（χ~2=0.359,P〉0.05）,手术率呈逐年上升趋势（由26.43%升至57.92%,χ~2=19.556,P〈0.001）。结论对于PID的诊断,不能只着眼于性活跃期女性,对于无性生活的女性和绝经期女性,需要注意PID;PID阳性症状和体征比例逐渐下降,但下腹压痛在PID患者中仍呈现高阳性率,建议将下腹压痛放入诊断的最低标准。

Objective To analyze the clinical characteristics and change of pelvic inflammatory disease（ PID） and to discuss the diagnosis criteria for PID. Methods Using retrospective analysis,458 PID cases hospitalized during the period of 1995 to 2009 because of PID were analyzed including onset age,correlation with sexual life,symptoms,signs,hospital stay and operation rate. Results The average age of patients was 37. 06 ± 14. 91 years old,which was rising gradually（ t = 2. 255,P = 0. 025; t = 5. 403,P〈0. 001; t = 2. 871,P = 0. 004 0. 01）. Women of childbearing age were the majority,although with a descending proportion from 93. 57% in the first 5- year period to72. 28%. Proportion of cases without sexual life and that of postmenopausal women increased from 1. 43% to 2. 48% and 5. 00% to25. 25%,respectively（ χ^2= 10. 041,P〈0. 001）. The main symptoms included lower abdominal pain（ 70. 31%）,irregular vaginal bleeding（ 33. 62%）,fever（ 25. 55%）,and digestive system symptoms（ 15. 72%）. Adnexal tenderness（ 63. 98%）,uterine tenderness（ 56. 77%）,lower abdominal tenderness（ 48. 25%）,rebound tenderness（ 17. 03%）,lifting pain（ 25. 76%）,adnexal thickening（ 29. 04%）,and adnexal mass（ 29. 69%） were the main signs when physical examinations were performed. The positive rate of some of these symptoms and signs decreased year by year. Average length of hospital stay was 10. 34 days without significant difference（ χ~2=0. 359,P〉0. 05）,but the rate of operation increased from 26. 43% to 57. 92%（ χ^2= 19. 556,P〈0. 001）. Conclusion As to diagnosis of PID,we should not only focus on sexual-active women,but pay attention to women without sexual life and postmenopausal women. Overall positive rate of symptoms or signs decreases during these years,however,lower abdominal tenderness still shows high positive rate. Thus we recommend lower abdominal tenderness as one of minimum criteria of PID.