妇科重症感染8例病例报道并文献复习

Severe pelvic inflammatory disease: a report of 8 cases and review of literatures

目的:探讨妇科重症感染的临床表现及诊治经验。方法:回顾分析2000年1月至2016年9月于北京协和医院就诊的8例妇科重症感染病例资料并复习相关文献。结果:8例患者临床表现以发热、腹痛、盆腔包块为主,4例(50.0%)出现感染性休克,4例(50.0%)感染病灶累及肠道。急诊手术6例(75.0%),囊肿剔除及脓肿引流2例,患侧附件切除3例,全子宫患/双侧附件切除3例。术后1例切口感染,1例发生小肠穿孔、应激性心肌病,1例肺栓塞。随诊率87.5%(7/8),随诊2~74个月,1例术后8个月盆腔炎复发,保守治疗好转。结论:盆腔脓肿延误诊治及脓肿破裂可引起严重并发症,应及时手术干预。妇科重症感染患者多合并子宫内膜异位症,感染病灶易累及肠道,需多科合作。术后并发症凶险,围手术期严密监护十分重要。

Objective： To discuss the clinical characteristics,diagnosis and treatments of severe pelvic inflammatory disease.Methods： The clinical data of 8 cases with severe pelvic inflammatory disease in Peking Union Medical College Hospital from Jan. 2000 to Sep. 2016 were studied retrospectively and literatures were reviewed. Results： Fever,abdominal pain and pelvic mass were the main symptoms.The incidence rate of septic shock was 50%（ 4/8）. Intestines were affected in 4 cases.6 emergency surgeries were performed（ 75.0%）.Among the 8 cases,2 underwent cystectomy,3 performed affected-side adnexectomy and 3 received hysterectomy with unilateral or bilateral adnexectomy.After surgery,1 had incision infection,1 had perforation of intestine and stress-induced cardiomyopathy,1 had pulmonary embolism.The follow-up rate was 87.5%（ 7/8） with follow-up time of 2 ~ 74 months.1 case received another conservative treatment for postoperative recurrence of pelvic inflammation after 8 months. Conclusion： Delayed treatment and rupture of pelvic abscess could lead to severe complications. Sugery should be performed in time.Patients with endometriosis are prone to develop severe pelvic inflammatory disease.Multidisciplinary cooperation is needed if intestine is affected. It is very important to strengthen the perioperative care for postoperative complications are dangerous.