[outline]
??In the female the reproductive organ and the periphery knot contract when the organization, the pelvic cavity peritoneum has the inflammation, is called the pelvic inflammatory disease (pelvic inflammatory disease). The pelvic inflammatory disease is gynecology department’s common disease. The inflammation may limit to a spot, may also several spots be also taken bad. According to its morbidity process, the clinical manifestation may divide into acute and the chronic two kinds. So that the acute inflammation has the possibility to cause the proliferating peritonitis, the septicaemia the infectious shock and so on serious results; Because the chronic inflammation the long treatment does not recover, manifests suddenly repeatedly. But affects the woman physical and moral integrity, creates the pain to the patient, therefore, must take pelvic inflammatory disease’s prevention.
Because the feminine genital tract in the dissection, the physiological characteristic, has the quite perfect nature defense function, strengthened to the infection defensive power, thus may have certain pathogen existence in the healthy woman vagina, but not necessarily causes the inflammation.
[feminine reproductive organ's nature defense function]
First, the both sides big lip of vulva closes up naturally, covers up the vaginal orifice, the urethral meatus.
?Second, as a result of trough bottom muscle’s function, anti- road junction closed, before the vagina, the behind clings, may prevent the outside the pollution. Is passing through the parturient woman, as a result of the vagina relaxation, this kind of defense function is bad.
?Third, the vagina epidermis under the ovary secretion’s estrogen influence, the proliferation thickens, increases to the pathogen invasion resistance, simultaneously in the epithelial cell includes the rich glycogen, under the vagina bacillus’s function, decomposes into the lactic acid, maintains the vagina normal acidic environment (pH4.2~5), causes to adapt the pathogen which reproduces in the alkalinity environment receives suppresses, is called the vagina automatic depuration the function.
?Fourth, the cervix internal membrane secretes the mucilage forms the mucus hitch, the jamming cervical canal, moreover cervix boring usually shuts tightly, is advantageous in prevents the pathogen invasion. It is reported that the cervix of the uterus mucilage hitch next 1/3 can find out the bacterium, but on 2/3 cannot find out the bacterium.
?Fifth, woman of child-bearing age endometrium periodic cracking-off, is also eliminates the bureaucratic way of talking infection the advantage.
? Sixth, the oviduct mucous epithelium cell’s cilium to uterine cavity direction’s swinging as well as oviduct’s creeping motion, is advantageous to the impediment pathogen invasion.
? [main pathogenesis seedling and to antibiotic sensitivity] mainly causes the pelvic cavity reproductive organ inflammation pathogen is the staphylococcus, the chain coccus, the backwoods coli, the anaerobe.
?First, the chain coccus Gelanshi masculine chain coccus type are many, has the armor, the second grade, the third three kinds. Class B hemolytic chain
Coccus pathogenicity, can produce the hemolysin and many kinds of enzymes, enables the infection easy to proliferate, and causes the septicaemia, the sanies is quite thin, the light red, the quantity are many, but generally not concurrent transferability abscess. Before the antibiotic is published, because of the puerperal infection defeat blood deficiency and related debilities death’s parturient woman, about 75% is infects the result by a race hemolytic class B chain coccus. This fungus is sensitive to the penicillin, after applying the penicillin, the maternal death basically is under the control.
?Second, the staphylococcus Gelanshi masculine gender, after is post-natal, the surgery, the reproductive organ inflammation and the wound infection see much disease germ, often along vagina, womb, oviduct mucous membrane upward infection. Minute golden yellow, the white, the citrine staphylococcus three kinds, have the pathogenicity, is strongest by the golden yellow staphylococcus pathogenicity. Sanies color yellow, the silk is thick, is not smelly, often is accompanied by the transferability abscess, easy to produce to the common commonly used antibiotic bears the medicine, is more ideal according to the medicine sensitive experiment medication. Bears the penicillin golden yellow staphylococcus to the cutting edge mildew element?, the eternal mildew element, the chlorine clean mildew element (clindamycin), the chloromycetin is sensitive.
?Third, backwoods coli Gelanshi negative, for intestinal tract’s normal parasitic fungus, generally not pathogenesis, because but when organism extreme feeble either the flesh wound and so on invades outside the intestines to organize or the organ may cause the serious infection, even has the endotoxin shock, often with other pathogenic bacteria mixed infection. Backwoods coli’s sanies is not smelly, when has the mixed infection, produces the stiff pongee thick sanies and the excrement is smelly. May using the card that mildew element, celebrate the magnamycin, the cutting edge mildew element I, suo animal pen penicillin and so on, but easy to produce bears the medicine strain, should better be able to perform the medicine sensitive experiment, chooses the sensitive medicine. Gelanshi masculine fungus mixed infection serious may also come in handy penicillin G, the ammonia animal pen penicillin, the tetracyclin and so on.
Fourth, because since the anaerobe the anaerobic culture technology’s progress, more and more has noted the anaerobe in the 70s the importance which infects in the pelvic cavity, mainly has digestion chain coccus (peptostreptococcus), digestion coccus (peptococcus) and frail kind of bacillus (bacteroidisfragilis) and so on. These bacterium important source in the colon, rectum, vagina and oral mucosa. Generally the selection and the culture technique are not easy the masculine result. In the past some pelvic abscess’s sanies raised the non-colony to grow, very possible was the anaerobe infection, but because at that time the anaerobic culture technology limited has not obtained the masculine result. According to the literature report 70%~80% pelvic abscess may raise the anaerobe. The pelvic cavity infects the anaerobe to be possible to infect alone, may also with the aerobe mixed infection, therefore, when selects the antibiotic should pay attention to the proper attention to both control anaerobe the necessity. Digestion chain coccus to penicillin, in cutting edge mildew element class (cephalosporins) cephalosporin (cepha 10thin), chloromycetin, armor niter zuo sensitive.
Fifth, the dissemination pathogen like gonococcus, the blister chlamydia, other possibly have the mycoplasma, the herpes virus.
?[ways of infection]
? First, after the lymphatic system spread bacterium after the vulva, the vagina, the cervix and the uterus creates the sores the lymph vessel invasion pelvic cavity knot to contract the organization and in reproductive organ other parts, after is the puerperal infection, the miscarriage, in infection and certain palaces birth control related infection proliferation main way.
?Second, debates the pathogen after the blood circulation biography to invade human body’s other systems first, then passes through the blood circulation infection reproductive organ,
For tubercidin bacillus infection main way.
? Third, along reproductive organ mucous membrane upward spread pathogen invasion vulva, after the vagina, passes through the cervix along the mucous membrane surface, the endometrium, the oviduct internal membrane to the ovary and the abdominal cavity. Staphylococcus, gonococcus along this way proliferation.
??Fourth, in after the direct spread abdominal cavity other internal organs infect, spreads directly to in reproductive organ, if the appendicitis may cause the salpingitis.
Acute pelvic inflammatory disease
[cause of disease]
Causes the acute pelvic inflammatory disease’s main cause of disease to be as follows:
First, after post-natal or miscarriage, after infecting the childbirth, the parturient woman physique is weak, the official throat opening very good has not shut down, if the childbirth creates produces A damage or has the placenta, the fetal membrane remains and so on, the pathogen invasion bureaucratic way of talking, easy to cause the infection; In miscarriage process bleeding time Is long, either remains organized in the uterine cavity, after either the surgery aseptic technique is not strict may have the miscarriage, infects.
Second, in after the bureaucratic way of talking the surgery operates the technique, infects like in the laying aside palace the birth control, the dilatation and curettage, the tubal insufflation, the oviduct womb radiography technique, the bureaucratic way of talking mirror inspection and so on, because before the surgery disinfection not strict or the technique, adapts the card to choose improper, the genital tract original chronic inflammation, disturbs after the surgery causes the ute attack and proliferates. -
Third, the menstrual period health bad monthly period endometrium’s cracking-off surface, has the expansion blood sinus and congeals the blood clot, for bacterium Multiplies good the environment, like does not pay attention to the health, uses the unclean menstruation pad, the menstrual period sexual intercourse and so on may cause the pathogen invasion to cause the inflammation.
Fourth, near organ’s inflammation direct spread like appendicitis, peritonitis and so on.
Fifth, chronic pelvic inflammatory disease ute attack
? [pathology]
? First, the acute womb intimitis and the acute womb myositis sees in the miscarriage, after the childbirth.
? Second, the acute salpingitis, the pyosalpinx, the oviduct ovarian abscess acute salpingitis mainly causes by the eiterbacterien, spreads through the cervix lymph to the womb nearby ties di the organization, first invades and the serosa level, has around the oviduct the inflammation, then implicates the myo- level, but the oviduct tunica intima may not exhaust oneself extremely lightly. Because its lumen Chang Ke the myo- wall accumulation bearing stricts, but still might maintain unobstructed. The pathological change by the oviduct mesenchymal inflammation primarily, the light oviduct only has the mild hyperemia, swelling, slightly increases thickly; Heavy, the oviduct increases obviously thickly, the thinning, the textile fiber natural disposition purulent seeps out much, periphery creates the adhesion.
If the inflammation extends upwardly after the endometrium, first causes the oviduct intimitis, the oviduct internal membrane swelling, the mesenchymal dropsy. The hyperemia and the massive neutral polymorphonuclear white blood cell infiltration, heavy, the epidermis may have the degeneration or Large expanse of falls off, causes the oviduct mucous membrane adhesion, causes the oviduct lumen and the umbrella end is unenlightened, if has the sanies to agglomerate forms the pyosalpinx in the lumen model of domestic virtue.
The ovary are very few becomes inflamed alone, the sclera is a very good defense barrier, the ovary many have around the ovary with inflammation’s oviduct umbrella end adhesion the inflammation, calls the tubo-ovaritis, also calls the adnexitis. The inflammation may form the ovarian abscess through the ovary ovulation broken hole invasion ovary essence, if abscess wall and the pyosalpinx adhesion perforates, namely forms the oviduct ovarian abscess. The oviduct ovarian abscess may occur after the acute tubo-ovaritis first attack, but often is in the chronic adnexitis repeatedly manifests suddenly in the foundation forms. Abscess is located at behind between the womb or the womb, the extravagant ligament later generations and the intestines the adhesion place, but broken enters the rectum or the vagina, if broken enters the abdominal cavity to cause the proliferating peritonitis.
? Third, when the acute pelvic cavity knot contracts in the organization inflammation the reproductive organ acute inflammation, when or the vagina, the cervix of the uterus have the wound, the pathogen may pass through the lymph vessel to enter the pelvic cavity knot to contract the organization to cause the knot to contract the organization hyperemia, dropsy, neutral white blood cell infiltration. The knot contracts the organization inflammation by the womb nearby to be most common, starts the partial organization accumulation, the quality of material is soft, the boundary is unclear, later will become the fan-shaped infiltration to the both sides trough wall, if the organization suppuration will form the retroperitoneal abscess, but spontaneous will broken enter the rectum or the vagina.
? Fourth, when in acute pelvic cavity peritonitis pelvic cavity organogenesis serious infection, often spreads to the pelvic cavity peritoneum, inflammation’s peritoneum hyperemia, dropsy and has few size thready to seep out, forms between the pelvic cavity internal organs’ adhesion. When has the massive purulent percolate agglomeration in the adhesion gap, may form disperses at the small abscess, agglomerates falls the depression in the womb rectum to form the pelvic abscess, sees. Abscess’s front is the womb, behind is the rectum, the crown for the intestines and the big net interface, abscess may broken enter the rectum to cause the symptom to reduce suddenly; May also broken enter the abdominal cavity to cause the proliferating peritonitis.
Fifth, the septicaemia pyemia pathogen toxicity is extremely strong, quantity are many, when the patient resistivity is low, often has the septicaemia. Sees in the serious puerperal infection, infectiousness miscarries, recent years also had the report to lay aside in the official the birth control, the oviduct ligation surgery damaged the septicaemia which the organ caused, if were not prompt controls, often very quickly had the infection shock even to die. After having the infection, if bodily other spots discovered that many place inflammation infections or abscess, should consider has pyemia to exist, but must pass through it raise confirmation.
[clinical manifestation] May has the difference because of the inflammation weight and the scope size. Gets up gets sick the present abdomen ache, the partner gives off heat, like the condition serious may have the high fever, the shiver, the headache, the appetite not sickness. If has the peritonitis to present the digesting system sickness like disgusting, the vomit, the distension of the abdomen, diarrhea and so on. If has abscess to form, may have abdomen Bao Kuai and the partial oppression stimulation symptom; Wraps the block to be possible to have the urinary bladder located at the front to stimulate the symptom, like the urination difficulty, frequent micturition, like cause the urinary bladder myositis also to be possible to have the urine pain and so on; Wraps the block after only then has the rectum to stimulate the symptom, if may send the diarrhea and the tenesmus feeling and the bowel movement outside the peritoneum is difficult.
The patient assumes the acute sickly appearance, the body temperature is high, the heart rate is quick, the distension of the abdomen, the underbelly has the muscle to be tight, the tenderness and the bounce pain, the abdominal rumbling sound weakens or vanishing. Pelvic cavity inspection: The anti- road possible hyperemia, and has the massive purulent secretion, the dome has touches a sore spot obviously. The cervix hyperemia, dropsy, lift the pain to be obvious. The uterus is slightly big, has the tenderness, the activity is limited. The womb two slot the tenderness to be obvious, sometimes may hold and the tumour. Nearby when the womb the knot contracts the organization inflammation, may hold under abdomen one side or the both sides has the laminated accumulation. Or both sides palace shinbone ligament dropsy increases highly thickly, has abscess to form, and the position is low time, may hold and the latter dome or the side dome has the tumour, and has the wave person or household who refuses to move and bargains for unreasonably high compensation when the land is requisitioned for a construction project. :
?[diagnosis] According to the medical history, the symptom and the symptom may a diagnosis. In addition. Still needs to make some essential chemical examinations, if the blood, the routine urine test, the blood and the canalis cervicalis secretion raise (including anaerobe raise) and the medicine experiments sensitively, although the non-sanies raises directly, to clinical also has certain reference value. When necessity after doing, ? the hole or the side ? hole have the tumour, and has the wave person or household who refuses to move and bargains for unreasonably high compensation when the land is requisitioned for a construction project.
?[differential diagnosis] The acute pelvic inflammatory disease should with the acute appendicitis, the extrauterine pregnancy, the ovary ? swell acute abdominal pains and so on reverse or breakage distinguishes.
[prevention]
First, completes the menstrual period, the gestation period and the puerperal period hygienic propaganda
Second, grasps obstetrics strictly, before the gynecology department surgery refers to drafts finishes the technique to prepare, when technique pays attention to the aseptic technique, including the induced abortion, lays aside in the palace the birth control, surgeries and so on diagnosis dilation and curettage. After the technique, finishes nursing, the prevention infection.
Third, the thorough cure acute pelvic inflammatory disease, prevents to transfer chronic.
[treatment]
? First, the general support therapy has bedrest, the L half decubitus favors the sanies to accumulate falls in the womb rectum sinks causes the inflammation limitation. Gives the full nutrition and the liquid takes, correction turtle solution nature disorder and acid-base equilibrium, when necessity small amount blood transfusion, when high fever uses the physical temperature decrease, avoids the nonessential gynecological examination as far as possible, in order to avoid causes the inflammation proliferation. If has the distension of the abdomen to give the stomach and intestines reduced pressure,
Second, the antibiotic treatment selects the antibiotic according to the medicine sensitive experiment to be more reasonable, before the lab results have not come out, if the condition not too serious may select the blue mildew hydrogen chain mildew element; If the condition is serious, then must select the broad spectrum antibiotic, the union medication curative effect is good, blends must be reasonable, the medicine type must be few, the toxicity is small, after the bacilliculture result comes out, may replace the antibiotic according to the situation. Is quick for the medicine way by the vein drop note result. The antibiotic application requests to achieve the sufficiency, and must pay attention to the toxic response. After symptom vanishing continues to give the medicine two weeks by the consolidated curative effect, makes every effort to cure thoroughly, avoids forming the chronic trough inflammation.
Blue mildew rope G is also effective to the anaerobe, when treatment uses the large dose, gives 2,400,000 ~1000, ten thousand IU vein drop note every day according to the condition order of severity, after to improve, may reduce to every day 1,200,000 ~ 2,401,000 U, divides 4 intramuscular injections. If to the penicillin allergy, may select the erythromycin every day 1.2g vein drop note, in addition uses card that mildew element each time 0.5g, daily 2 times, intramuscular injection.
Chronic pelvic inflammatory disease
The acute pelvic inflammatory disease procrastinates does not recover, generally will transfer the chronic pelvic inflammatory disease. Therefore in has the acute pelvic inflammatory disease should the active treatment.
