240例女性盆腔脓肿的临床研究

Clinical Analysis of 240 Cases of Female Pelvic Abscess

目的:分析盆腔脓肿患者的临床特点,探讨影响盆腔脓肿保守治疗效果的因素。方法:回顾性分析因盆腔脓肿于重庆市6家医院进行住院治疗的240例患者的临床资料,其中保守治疗组73例,手术治疗组167例,比较并分析其临床特点、诊疗经过及治疗效果。结果:保守治疗组患者脓肿直径小,多为单侧病灶(P<0.05),包块直径大于5.8 cm时预测手术干预的敏感性为81.3%;保守治疗组患者自症状加重至入院时间间隔短(P<0.05);而年龄、宫内节育器(IUD)的使用、C-反应蛋白(CRP)水平、盆腔手术史、合并子宫内膜异位症(EMT)等因素与手术治疗组差异无统计学意义(P>0.05)。手术治疗组中17.4%(4/23)的患者子宫颈分泌物和腹腔脓液培养为同种细菌,39.1%(9/23)细菌培养结果不一致。均行降钙素原(PCT)检查的重症患者(19例)较普通患者(34例)的白细胞(WBC)(16.51×10^(9)/L vs 12.00×10^(9)/L)及PCT水平(0.57 ng/L vs 0.14 ng/L)明显升高,差异有统计学意义(P<0.05)。结论:影响盆腔脓肿患者保守治疗效果的因素有脓肿直径、病灶位置与症状加重至入院时间间隔;双侧病灶者可积极选择手术治疗;盆腔脓肿患者子宫颈与盆腔致病微生物的组成可能有所不同,保守治疗效果不佳者应尽量手术取得感染病灶标本进行培养和药敏检测;PCT可监测重症患者疾病发展与转归。

Objective:To analyze the clinical characteristics of patients with pelvic abscess and explore the factors affecting the conservative treatment effect with pelvic abscess.Methods:The clinical data of 240 patients with pelvic abscess admitted to 6 hospitals in Chongqing were analyzed retrospectively.According to the different treatment methods,the patients were divided into the conservative group(73)and the surgery group(167),and their clinical characteristics,diagnosis and treatment process and treatment effect were analyzed.Results:In the conservative group,the diameter of the abscess was small,most of which were unilateral lesions(P<0.05).And the sensitivity of surgical intervention was predicted to be 81.3%when the diameter of the mass was larger than 5.8 cm.In the conservative group,the time interval from symptom exacerbation to hospital admission was shorter(P<0.05).The age,use of IUD,c-reactive protein level,history of pelvic surgery,endometriosis and other factors were not significantly different from those of the surgery group(P>0.05).In the surgical treatment group,17.4%(4/23)of the patients with cervical secretions and abdominal pus culture for the same bacteria,39.1%(9/23)of the bacterial culture results were inconsistent.The WBC of severe patients(19 cases)who underwent PCT examination was higher than that of ordinary patients(34 cases)(16.51×10^(9)/L vs 12.00×10^(9)/L),as well as the PCT level(0.57 ng/L vs 0.14 ng/L)(P<0.05).Conclusions:The effect of conservative treatment of pelvic abscess was influenced by the diameter,location and the time interval from aggravation of symptoms to admission.The patients with bilateral lesions can choose surgical treatment actively.In patients with pelvic abscess,the composition of the pathogenic microorganisms in cervix and pelvic cavity may be different,so specimens of infected lesions should be obtained for culture and drug sensitivity test.Procalcitonin can monitor disease progression and outcome in severe patients.