盆腔脓肿合并子宫内膜异位症38例临床特点分析

Clinical analysis of 38 patients with pelvic abscess and endometriosis

目的:探讨盆腔脓肿合并子宫内膜异位症的临床特点及诊治策略。方法:回顾性收集2014年7月-2019年6月本院妇科收治的盆腔脓肿70例患者临床资料,其中合并子宫内膜异位症38例为观察组、单纯盆腔脓肿32例为对照组,比较两组一般情况、临床表现、病原体、治疗、预后及转归情况。结果:两组年龄、宫内节育器使用情况、盆腔手术史、合并糖尿病,体温、白细胞计数、泌尿系统症状的发生率等均无差异(P>0.05)。观察组和对照组不孕症(42.1%、18.8%)、C-反应蛋白(123.32±73.29mg/l、83.13±80.50mg/l)、盆腔包块直径(7.76±5.70cm、4.25±4.05cm)、消化系统症状(44.7%、18.8%)、发病处于月经期(13.2%、34.4%)均有差异(P<0.05)。病原体阳性观察组3例,分别为多重耐药大肠埃希菌、铜绿假单胞菌和链球菌,对照组2例均为大肠埃希菌。两组体温正常时间、血象正常时间、腹痛好转时间、首次住院天数、急诊手术和盆腔感染复发率均无差异(P>0.05)。观察组二次住院手术率(39.5%)高于对照组(9.4%)(P<0.05)。结论:盆腔脓肿合并子宫内膜异位症感染较重,宜选用广谱抗生素药物,特别是对革兰阴性杆菌敏感药物。对于静脉抗生素药物保守治疗好转的患者亦有较高复发可能,往往需二次手术彻底切除子宫内膜异位症病灶,术后随访应更关注生育情况。

Objective:To investigate the clinical features and strategy of diagnosis and treatment of patients with pelvic abscess and endometriosis.Methods:A retrospective analysis was performed on 70 patients with pelvic abscess from July 2014 to June 2019,which included 38 cases with endometriosis(in observation group)and 32 cases with simple pelvic abscess(in control group).The general condition,clinical characteristics,pathogen,treatment,prognosis,and outcomes of the patients were compared between the two groups.Results:There were no statistic significant differences in age,the situation of IUD used,the history of pelvic surgery,the diabetes situation,the temperature,the value of WBC,and the urinary symptoms of the patients between the two groups(P>0.05).There were statistic significant differences in the proportion of infertility(42.1%vs.18.8%),the levels of CRP(123.32±73.29mg/l vs.83.13±80.50mg/l),the diameter of the pelvic mass(7.76±5.70cm vs.4.25±4.05cm),the incidence of digestive system symptoms(44.7%vs.18.8%),and the incidence of pelvic abscess during menstrual period(13.2%vs.34.4%)of the patients between the two groups(P<0.05).There 3 patients with positive pathogene in the observation group,which were multi-drug resistant Escherichia coli,pseudomonas aeruginosa,and streptococcus.There were two patients with positive pathogene in the control group,which were all escherichia coli.There were no statistic significant differences in the time of returned to normal temperature and normal WBC,the time of abdominal pain disappearance,the hospitalization time,the rates of emergency surgery and recurrence of pelvic infection of the patients between the two groups(P>0.05).The rate of the secondary hospitalization surgery(39.5%)of the patients in the observation group was significantly higher than that(9.4%)of the patients in the control group(P<0.05).Conclusion:The patients with pelvic abscess and endometriosis have severe infection.It is advisable to use broad-spectrum antibacterial drug,especially those antibacterial drug is sensitive to Gram-negative bacilli.The patients cured by conservative treatment with intravenous antibacterial agents also have a high possibility of recurrence,often requiring the secondary surgery to completely remove the endometriosis lesions.It is should pay more attention to fertility situation of the patients during the postoperative following up.