急性淋菌性盆腔炎78例报告

目的 探讨提高急性淋菌性盆腔炎正确诊断率的方法。方法 对疑诊为急性淋菌性盆腔炎的患者进行宫颈管分泌物涂片、培养并做淋球菌PCR检测、后穹隆穿刺、B超检查，结合宫腔镜或腹腔镜联合诊断。结果 78例经联合检查明确诊断，经及时治疗全部治愈。结论 淋菌性盆腔炎及时准确诊断，治疗效果是满意的。     

国内7所医院妇科住院患者急性盆腔炎诊治情况调查

目的 了解国内住院患者急性盆腔炎发病情况、诱发因素及诊断和治疗方法.方法 采用回顾性研究方法分析2002年10月到2005年12月全国7所医院住院的444例急性盆腔炎患者临床资料.结果 急性盆腔炎患者年龄(32.95±9.51)岁,主要诱因为流产和宫腔内手术后、阴道出血等.仅115例(25.9%)患者进行了病原体检查,其中细菌培养65例,阳性率44.6%.所有患者治疗均应用广谱抗生素.结论 对于急性盆腔炎患者,应重视病原体检查并行药敏试验,尽可能根据病原进行治疗.     

谈急性盆腔炎、外阴白斑的治疗

目的:分析治疗急性盆腔炎、外阴白斑的有效方法。方法:采用分析方法对18例急性盆腔炎、外阴白斑病进行科学分析。结果:急性盆腔炎占4.8%;外阴白斑发生率占6.27%。结论:应加强妇科保健,对急性盆腔炎、外阴白斑及早治疗,使患者早日康复。     

淋菌性盆腔炎5例的临床病理分析

淋菌性盆腔炎５例的临床病理分析郭东辉刘丽王芝芬李烈明田瑞华张学义淋病双球菌（淋菌）感染所致输卵管粘膜的损坏及盆腔粘连，与不孕症和异位妊娠有关。因此，正确诊断淋菌性输卵管炎及盆腔炎为临床与病理医师所关注。我们对我院手术并经聚合酶链反应（ＰＣＲ）检测证实...     

卵巢妊娠24例临床分析

目的 :探讨卵巢妊娠的发生因素、诊断及治疗方法。方法 :采用回顾性方法对卵巢妊娠的临床资料进行分析。结果 :2 4例卵巢妊娠中 10例置宫内节育器 (IUD) ,3例有盆腔炎史 ,16例有停经史 ,仅 1例有阴道流血史 ,均以急腹症就诊 ,全部行手术治疗。结论 :卵巢妊娠的病因不清 ,可能与IUD有关 ,与盆腔炎症无明显相关。卵巢妊娠术前容易误诊 ,最后确诊有赖于病理诊断。治疗以手术为主。     

急性盆腔炎误诊、漏诊分析

急性盆腔炎是一个常见急腹症，妇科和外科经常误诊、漏诊。因此，笔者对我们两院自1996年1月～2004年12月间误诊、漏诊的急性盆腔炎患者进行回顾性研究，探讨急性盆腔炎误诊和漏诊的原因，以提高该病的术前诊断准确率。     

中西医结合治疗急性盆腔炎的临床疗效

目的：分析与探讨中西医结合治疗急性盆腔炎的临床方法与疗效。方法：选取本院2010年6月至2012年6月期间收治的急性盆腔炎患者共86例，随机将其分为2组，观察组43例，对照组43例，观察组患者采用抗生素联合中药汤剂进行治疗，对照组单纯采用抗生素进行治疗，对比两组患者治疗后的临床疗效。结果：观察组患者治愈共35例，有效共7例，无效共1例；对照组患者治愈共22例，有效共11例，无效共10例。对比两组患者的有效率，P〈0．05。结论：采取中西医结合治疗急性盆腔炎，能给迅速缓解患者的临床症状，提高患者的治疗有效率，因此值得在临床上进行推广与应用。     

急性淋菌性盆腔炎36例临床分析

近年来 ,随着淋病发生例数的增加 ,急性淋菌性盆腔炎也明显增多。现将我院诊治的 36例患者分析如下。1　临床资料1.1　一般资料　 1996年 1月至 1999年 11月我院共收治急性淋菌性盆腔炎 36例 ,18～ 33岁 ,已婚 31例 ,未婚 5例 (有性生活史 ) ,已产 2 8例 ,有人工流产史 2 1例 ,配偶曾有尿道刺激症 2 6例。1.2　症状与体征　 36例均有一侧或双侧急性下腹痛 ,均有不同程度的发热 ,其中 38.5℃以上 19例 ,占 5 2 .8% ,主要症状及体征见表 1。表 1　 36例的主要症状与体征症状与体征ｎ %下腹痛 36 10 0阴道出血 411.1寒战、发热 36 10 0恶心、呕…     

误诊为急性阑尾炎的右侧输卵管积脓2例分析

目的：分析右侧输卵管积脓误诊为急性阑尾炎的临床诊断。方法：回顾分析2例右侧输卵管积脓误诊为急性阑尾炎的临床资料,总结具体的诊断方法。结果：2例患者均经具体诊断治疗后痊愈出院。结论：作为临床医生,一定要详细询问患者妇科相关病史及做妇科检查,做出正确判断,尽量避免误诊。     

足月产后绒癌误诊分析

目的 分析足月产后绒癌常见的误诊原因及其预后。方法对1985年-1996年底本院收治272例绒癌中57例足月产后绒癌的诊断治疗进行分析。结果 ①初诊即确诊为足月产后绒癌者5例,占8.8％,而52例误诊,误诊率达91.2％;误诊的52例病人中15例死亡,死亡率28.8％。②临床期别:88％病人就诊时已为晚期高危患者,多伴有肺、脑、肝、肠、膀胱等远处转移。③确诊时间及转归:59.6％病人是在产后3-6个月确诊的。结论 重视足月产后绒癌,对于产后阴道不规则出血病人或年轻经产妇出现其它系统疾患如急性呼吸系统或神经系统症状患者,应常规行血(或尿)绒毛膜促性腺激素(hCG)及β-bCG测定及胸片检查,诊断方法简单、准确且经济。早期产后绒癌可明显降低误诊率,改善患者的预后。     

Actinomycose pelvienne : est-ce prévisible ?

ObjectivesPelvic actinomycosis is a rare disease that can be diagnosed before, during or after surgical treatment of a suspected ovarian tumor, a suspected bowel obstruction, or acute peritonitis. The possibility of early detection of pelvic or abdominal abscess related to was evaluated through a personal series and literature review.Patients and methodsOur series of 11 cases of severe abdominal or pelvic actinomycosis is related and compared to 58 cases reported in the literature.ResultsSeven patients in this series were diagnosed with pelvic inflammatory disease and acute peritonitis with or without bowel obstruction, and four women were diagnosed after surgical treatment for suspected ovarian cancer. Fifty-two of the 58 cases of reproductive tract actinomycosis reported in the literature review and all our cases were associated with prolonged use of an intrauterine contraceptive device with a mean of eight years. The contribution of pelvic ultrasound and angioscanner in evaluating these patients should not be underestimated and MRI may be useful in some cases as well. Early diagnosis based on Actinomyces-positive cervical smears or abscess aspiration was accomplished only once in our series and was rare in literature. A histopathologic diagnosis during laparoscopy or laparotomy could avoid more difficult and extensive surgery. In our series of 11 patients, five women required abdominal surgery, five required salpingo-oophorectomy and three required hysterectomy. All women required surgical intervention. Effective treatment combined long antibiotic therapy with surgery. Correct preoperative diagnosis is rare but if achieved, long-term treatment with penicillin for at least two months and sometimes up to a year may completely eradicate the infection. Surgery may still be necessary to improve medical treatment or to resolve pelvic abscesses.Discussion and conclusionAny pelvic abscess occurring in a woman with a history of long-term use of an intrauterine device should be considered as possible pelvic actinomycosis. If there is no fever in association with an atypical adnexal tumor, frozen section should be obtained during surgery to rule out the diagnosis of actinomycosis.     

Comparison of endometrial biopsy and peritoneal fluid cytologic testing with laparoscopy in the diagnosis of acute pelvic inflammatory disease

Twenty-seven women with suspected acute pelvic inflammatory disease were studied by laparoscopy and endometrial biopsy. Overall, 67% (18 of 27) of the women had acute salpingitis at laparoscopy, 70% (19 of 27) had plasma cell endometritis, and 67% (10 of 15) had an inflammatory cytologic pattern of the peritoneal fluid. In comparison to laparoscopically detected salpingitis, endometritis detected with biopsy had a sensitivity of 89%, a specificity of 67%, a positive predictive value of 84%, and a false negative rate of 22% in the diagnosis of pelvic inflammatory disease. The corresponding figures for inflammation of the peritoneal fluid were 75%, 67%, 90%, and 25%. This study demonstrates that nonpuerperal endometritis is an entity associated with pelvic inflammatory disease, most likely representing an intermediate stage between cervicitis and salpingitis. Endometrial biopsy as an office procedure is a good alternative to laparoscopy in the diagnosis of acute pelvic inflammatory disease and may in fact detect early cases not yet visible at laparoscopy.     

Pelvic inflammatory disease: trends in hospitalizations and office visits, 1979 through 1988.

OBJECTIVES: We attempted to assess trends in pelvic inflammatory disease occurrence and to describe current antibiotic treatment and use of surgical procedures for pelvic inflammatory disease in the United States. STUDY DESIGN: Analyses of hospitalizations according to the National Center for Health Statistics, National Hospital Discharge Survey for 1979 to 1988, and of office visits to private physicians from the National Disease and Therapeutic Index for 1979 to 1989 were done. RESULTS: From 1979 to 1988, a mean of 181,700 women aged 15 to 44 years were hospitalized each year for acute pelvic inflammatory disease (3.03/1000 women) and 94,400 for chronic pelvic inflammatory disease (0.90/1000), and nearly 400,000 first visits for pelvic inflammatory disease were made each year to private physicians' offices (7.2/1000 women). Mean visit and hospitalization rates for acute pelvic inflammatory disease were highest for women aged 20 to 24 years and for other-than-white women. By 1987 to 1988, however, pelvic inflammatory disease hospitalization rates were highest for teenagers. Surgery was performed during 42% of hospitalizations for acute pelvic inflammatory disease and 90% of hospitalizations for chronic pelvic inflammatory disease. Over this time period, hospitalization rates for acute pelvic inflammatory disease decreased by 36% while office visit rates remained unchanged. CONCLUSION: This decrease in hospitalizations for pelvic inflammatory disease may indicate a true decrease in its incidence, changes in physician hospitalization practices, or a shift in the spectrum of severity of pelvic inflammatory disease.     

性传播盆腔炎性疾病的诊断规范化治疗和预后

性传播疾病病原体与盆腔炎性疾病的相关性日益明显：性传播疾病的流行伴随而来的急性盆腔炎的流行,如延误治疗最终将导致慢性盆腔痛、异位妊娠和不孕等一系列严重后遗症。性传播盆腔炎性疾病需要采用综合治疗方案：抗生素治疗为主,必要时手术治疗,同时患者性伴侣应进行相应的检查与治疗,避免重复感染。     

Pelvic inflammatory disease.

Pelvic inflammatory disease is a common serious complication of the sexually transmitted pathogens Neisseria gonorrhoeae and Chlamydia trachomatis. There are more than 800,000 cases of pelvic inflammatory disease annually accounting for approximately 200,000 hospital admissions for acute and chronic infections. Early accurate diagnosis and treatment are essential to prevent the serious sequelae including ectopic pregnancy, tubal disease infertility, chronic pain, and disability requiring multiple hospitalizations and surgery. Although clinical models to aid in the diagnosis and management of pelvic inflammatory disease have been developed by numerous investigators, all have lacked the sensitivity and specificity to be helpful to the clinician. Laparoscopy, considered by many to be the "gold standard" for diagnosis, is underutilized, and the definition of pelvic infection differs between investigators. Improved patient compliance and safety may be seen if single-agent therapy for acute pelvic inflammatory disease becomes a reality. In a small prospective randomized study, oral ofloxacin was as effective as cefoxitin plus doxycycline for outpatient treatment of chlamydial and gonococcal pelvic inflammatory disease. Treatment of tuboovarian abscess appears to be successful with single agent and combination therapy. Risk factors for developing postabortion endometritis continue to be identified, and the most efficacious prophylactic antibiotic regimen has not been determined to date.     

Beta hemolytic streptococcus group f causing pelvic inflammatory disease in a 14-year-old girl

BACKGROUND: Pelvic inflammatory disease in prepubertal and non-sexually active adolescents is rare and poorly understood. Various organisms have been named as causative agents in adolescent pelvic infections. Early diagnosis and treatment of pelvic inflammatory disease in young girls is imperative to future fertility and long term sequela. CASE: We present a 14-year-old, menarchal, non-sexually active female with a 3-week history of abdominal pain and fever. Surgical exploration and cultures revealed Stage IV pelvic inflammatory disease caused by Beta Streptococcus Group F. CONCLUSION: Various organisms including Streptococcal infections should be considered in the differential diagnosis of pelvic inflammatory disease in young girls without risk factors.     

Laparoscopic treatment of tuboovarian and pelvic abscess

Twenty-five women with pelvic abscess were treated laparoscopically. Following intravenous antibiotic coverage, laparoscopic surgical techniques were utilized to lyse bowel adhesions, drain purulent fluid, and excise acute and necrotic inflammatory adhesions, including tuboovarian adhesions. Treatment during the acute phase and results per second-look laparoscopy were documented in five cases, with photomicrographs revealing relatively normal pelvic anatomy. One postappendectomy abscess with a peritoneovaginal fistula in a 10-year-old girl was also managed laparoscopically. Four of seven women desiring pregnancy conceived, and two women had unplanned pregnancies. The treatment of choice for acute pelvic abscess may be a combination of intravenous antibiotics and an early laparoscopic surgical procedure.     

Objectivized diagnosis of acute pelvic inflammatory disease. Diagnostic and prognostic value of routine laparoscopy

At the University Hospital, Lund, Sweden, laparoscopy has been routinely used as a diagnostic aid in cases for acute pelvic inflammatory disease since 1960. No significant complications have been encountered. The material of the study comprises 905 cases covering an 8 year period, 1960-1967. The operation was always performed under general anesthesia. The laparoscope was inserted in the midline below the umbilicus and a cannula inserted 10 cm laterally to manipulate the pelvic organs. A previous clinical diagnosis was required. In 814 cases acute inflammatory disease was suspected on clinical grounds. In 532 of these cases (65%) acute salpingitis was visually confirmed. Observation through the instrument was seldom difficult or uncertain. In 98 cases (12%) laparoscopy revealed other pathologic conditions. In 184 cases (23%) no pathologic changes were found. In another 91 cases acute salpingitis was found unexpectedly at laparoscopy (or in some cases by exploratory laparotomy) undertaken on other provisional clinical diagnoses. Altogether 623 patients were visually diagnosed as having acute salpingitis. Acute appendicitis was found in 24 cases, ectopic pregnancy in 11 cases, pelvic endometriosis in 16 cases, and several other pelvic disorders occasionally. In the total series of 623 confirmed cases of acute salpingitis 223 (365) were of gonococcal origin. These were mostly in the younger, unmarried, and nulliparous patients. Previous curettage was responsible for most othe r cases. The authors conclude that the diagnosis of acute adnexal inflammation based on commonly accepted clinical criteria was found inaccurate to an unsatisfactory high degree as 12% proved to have other disorders, several of a serious nature. Also 23% had no inflammatory reaction of the tubes or other pelvic structures leaving 65% of cases correctly diagnosed on clinical grounds. The prognosis as to later tubal patency varied with the stage of development of the salpingitis. Later studies show that patency was more frequent in cases of salpingitis diagnosed and treated early before adnexal swelling or mass was diagnosed clinically. Gonococcal cases showed a lower subsequent bilateral occlusion than others. 5 of the salpingitis patients were later operated on for ectopic pregnancy.     

Hormonal contraception and pelvic inflammatory disease

Estrogen-progestogen contraception (OC) is significantly associated with a high prevalence of Chlamydia trachomatis in the lower genital tracts of young women. In contrast, pelvic inflammatory disease is less frequent and is associated with milder pelvic lesions in OC users than in non-users. A recent study suggests that OC use can be associated with silent endometritis and salpingitis. The usual clinical, biological and laparoscopic signs of acute and chronic pelvic inflammatory disease are described. As shown by several cost—benefit analyses, C. trachomatis detection in family planning centers is cost-effective and the eradication of bacteria is obtained in 90% of cases by a new treatment: azithromycin (1 g for 1 day).

Although the data clearly show that C. trachomatis screening is cost-effective, selection of the diagnostic laboratory tests used in such screening programs should be carefully evaluated relative to cost, feasibility, specificity and sensitivity, and should be adapted to the presumed prevalence in screened populations. A systematic screening is indicated in populations susceptible to a prevalence of 5% or more.     

Long-term sequelae of acute pelvic inflammatory disease. A retrospective cohort study.

OBJECTIVE: Our objective was to prospectively assess the frequency and predictors of long-term sequelae of acute pelvic inflammatory disease. STUDY DESIGN: We performed a retrospective cohort study of 140 women admitted for treatment of pelvic inflammatory disease to San Francisco General Hospital in 1985, locating and interviewing 51 women by telephone a median of 37 months later. RESULTS: Twelve (24%) women had pelvic pain for 6 months or more after hospitalization, 22 (43%) had subsequent episode(s) of pelvic inflammatory disease, and 40% were involuntarily infertile. A history of pelvic inflammatory disease prior to admission was associated with infertility (p = 0.05), chronic pelvic pain (p = 0.03), and pelvic inflammatory disease subsequent to hospitalization (p = 0.06). Longer duration of abdominopelvic pain before admission and younger age at the time of first sexual intercourse were associated with both infertility (p = 0.02, p = 0.04) and subsequent pelvic inflammatory disease (p = 0.04, p = 0.0008). CONCLUSIONS: Further studies are needed to more accurately assess the incidence and predictors of long-term sequelae of pelvic inflammatory disease. A reduction in adverse outcome will require more stringent efforts at education and reduction of risk-taking behaviors.