子宫内膜异位症伴发盆腔炎患者的风险因素研究

Risk factor analysis in endometriosis patients with pelvic inflammation

目的:探讨卵巢子宫内膜异位症(OE)对子宫内膜异位症(EM)伴发盆腔炎(PID)患者的预后影响。方法:选取因PID住院的116例EM患者为研究对象,根据子宫内膜异位症类型分为两组,以OE伴或不伴腹膜型内异症或腹膜内异症(PE)或深部浸润性子宫内膜异位症(DIE)为观察组(n=59);以非OE为对照组(n=57)。比较两组患者发生严重PID(定义为常规抗生素治疗失败需手术治疗或引流)、输卵管卵巢脓肿、住院天数、宫颈细菌培养或尿液STD PCR检测阳性以及因局部治疗或复发性PID而再入院等不良医学事件的发生率。结果:入院时,与无OE患者相比,OE患者年龄较大(P<0.05),使用宫内节育器(IUD)的比例较小(19.30%vs 5.09%,P<0.05)。与无OE的EM患者相比,OE患者发生急性PID时,对抗生素治疗的反应更低,手术干预或引流的风险增加(调整后OR值为3.5)。OE患者输卵管卵巢脓肿发生率升高(P<0.05)。OE组的再入院率、细菌培养阳性率、住院时间均较高,但组间差异均无统计学意义(P>0.05)。近期取卵术和患者的年龄与严重PID的风险增加无关。结论:PID的OE患者对抗生素治疗的反应较小,手术干预的风险更高。

Objective:To explore the prognostic impact of ovarian endometriosis(OE)on patients with endometriosis(EM)accompanied by pelvic inflammatory disease(PID).Methods:116 EM patients hospitalized for PID were selected as the research subjects,and they were divided into observation group[with or without peritoneal endometriosis or peritoneal endometriosis(PE)or deep infiltrating endometriosis(DIE),n=59]and the control group(non-OE,n=57)according to the type of endometriosis.The incidence of severe PID(defined as the antibiotic treatment failure and the need for surgical intervention or drainage),tubo-ovarian abscess,number of hospitalization days,a positive cervical bacterial culture or urine STD PCR test and readmission due to partially treated or relapsing PID were compared between two groups.Results:At admission,compared to patients without OE,OE patients were older(P<0.05)and had a smaller proportion of using intrauterine device(IUD)(19.30%vs.5.09%,P<0.05).PID in patients with OE was found less likely to respond to antibiotic treatment with increased risk for surgical intervention or drainage compared to EM patients without OE(adjusted OR 3.5).The rate of tubo-ovarian abscess was higher in patients with OE(P<0.05).Readmission rate,positive bacterial culture and hospitalization duration were higher in the OE group,there was no statistically significant difference between the groups(P>0.05).Recent oocyte retrieval and patient s age were not associated with an increased risk for severe PID.Conclusion:Endometrioma patients with PID are less likely to respond to antibiotic treatment and present higher risk for surgical intervention.