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Common sense: pelvic inflammatory disease female pelvic know more • Women should be wary of back pain cause of gynecological disease awareness: Female pelvic inflammatory disease most likely to get an understanding of pelvic inflammatory disease and sexual awareness: awareness of chronic pelvic inflammatory disease: problems women's disease - pelvic inflammatory disease awareness: What is chronic pelvic inflammatory disease?The differential diagnosis of chronic pelvic inflammatory disease pelvic inflammatory disease More * Diagnosis: Diagnosis of the differential diagnosis of chronic pelvic inflammatory disease: diagnosis and treatment of pelvic inflammatory disease diagnosis: The diagnosis of chronic pelvic inflammatory disease diagnosis: the diagnosis of pelvic congestion syndrome reference to diagnosis: acute Diagnosis and differential diagnosis of pelvic inflammatory disease: diagnosis and treatment of female pelvic inflammatory disease
Pelvic inflammatory disease female pelvic genital inflammation, referred to, including endometritis, salpingitis, oophoritis, pelvic connective tissue inflammation and pelvic peritonitis. Disease can be limited to one or more parts, or the entire pelvic several organs, acute and chronic pelvic inflammatory disease of the points. Acute onset of acute symptoms of severe sepsis may be due to the crisis of life, good and bad of chronic symptoms, recurrent, the formation of chronic pelvic inflammatory mass, can lead to pelvic adh


esions organizations, and even the formation of frozen pelvis, leading to ovarian dysfunction, adhesions blocked fallopian tube, resulting in abdominal pain, backache, vaginal discharge and more and even infertility. Affect people's health and work, and serious consequences. So should actively treat the disease. Chinese medicine treatment can be recommended that you use the "pelvic inflammatory disease pill" treatment. It has the blood circulation, Tongluosanjie, liver qi, dampness, heat, swelling the role of diuretic for acute and chronic pelvic inflammatory disease, annex inflammation, inflammatory mass and other common gynecological diseases. It can promote the pelvic blood circulation, relieve pelvic congestion, exudation, ease adhesion, to promote the disappearance of inflammation, which play anti-inflammatory, regulates menstruation, bleeding, pain, restore the treatment of ovarian function to achieve the purpose of treatment of pelvic inflammatory disease. In the course of treatment to lift the ideological concerns, and enhance the confidence of the treatment, usually should be increased nutrition, exercise, attention to work and rest, increase body resistance.
Penqiangyanzheng
Female genitalia and the surrounding connective tissue within the pelvic peritoneum inflammation, said pelvic inflammatory disease. Most sexually active pelvic inflammatory disease occurred in the period of menstruation of women. Inflammation may be confined to one area, can also involve several parts, the most common is salpingitis and tubal ovarian inflammation, endometritis, or simply rare ovarian inflammation. There are two types of acute and chronic pelvic inflammatory disease. The development of acute pelvic inflammatory disease can cause diffuse peritonitis, sepsis, septic shock, severe cases can be life threatening. If in the acute phase has not been completely cured, then to chronic pelvic inflammatory disease, often prolonged unhealed, and repeated attacks, not only seriously affects women's health, life and work, can also cause the burden of family and society. Because of medical conditions and standards, the popularity of women's health knowledge, the application of broad-spectrum antibiotics, severe life-threatening acute pelvic inflammatory disease and long treatment of chronic pelvic inflammatory disease, clinical has been rare.
Female reproductive tract in the anatomy, physiology is characterized by a relatively perfect natural defense capabilities and enhance the defense capabilities of the infection, except for shade, vagina, cervix's natural defenses, the gestational age cyclical endometrium of women stripping also the elimination of bureaucratic favorable conditions for infection. In addition, the oviduct epithelial cells and fiber Mao Xiangzi tubal uterine peristalsis direction of swing, are conducive to prevent the invasion of pathogens. But when the decline in immune function, endocrine changes, or invasion of exogenous pathogens, can cause inflammation.
Pathogens causing pelvic inflammatory disease from two s, from the original dwelling on the vaginal flora, including aerobic and anaerobic, and from outside Chennai coli pathogens such as gonorrhea, Chlamydia trachomatis, Mycobacterium tuberculosis, the Green pus bacillus.(A) of the pathogens and their pathogenic characteristics
Pathogen can cause pelvic inflammatory disease simply as aerobic, anaerobic bacteria alone or mixed infection of aerobic and anaerobic bacteria; may be associated or not associated with sexually transmitted disease pathogens. Aerobic and facultative anaerobic bacteria including Escherichia coli, Corynebacterium, Streptococcus, Enterococcus, Staphylococcus aureus; anaerobic bacteria, including Peptococcus, Peptostreptococcus, Bacteroides fragilis and so on. Pelvic inflammatory disease is often mixed aerobic and anaerobic infection, about 2 / 3 of cases associated with anaerobic infections. The main pathogens of sexually transmitted diseases gonorrhea Chennai coli, Chlamydia trachomatis, the text of the original body. In China, Nyquist gonorrhea bacteria, pelvic inflammatory disease caused by Chlamydia trachomatis are increasing, has attracted attention.
Different pathogens have different transmission and virulence characteristics of pathogens to understand these features can be judged to select antibiotics for the treatment to help.
1. Gram-positive streptococcus Streptococcus many different types of pathogenic beta-hemolytic streptococcus and strong, able to produce hemolysin and a variety of enzymes, so the infection can quickly spand cause sepsis, pus relatively thin, light red , the amount of more, but generally not concurrent metastatic abscess. The bacteria sensitive to penicillin.
2. Staphylococcal Gram-positive cocci, is the post-natal, post-operative inflammation and wound infection common genital pathogens, often along the vagina, uterus, oviduct ascending infection. Sub-epidermis, saprophytic and 3 Staphylococcus aureus, Staphylococcus epidermidis even pathogenic, saprophytic staphylococci usually do not cause disease, pathogenic Staphylococcus aureus strongest, the pus yellow, thick, does not stink , often accompanied by metastatic abscesses, the general resistance to commonly used antibiotics easy to produce, according to the ideal drug susceptibility testing. Effective drugs used to oxacillin sodium, cloxacillin sodium.
3. Escherichia coli Gram-negative bacteria, the normal intestinal and vaginal parasite, generally do not cause disease, but extremely weak when the body can cause serious infections, and even within the toxin, often mixed infection with other pathogens. E. coli infection pus does not stink, when mixed infection, resulting in thick pus and fecal odor. Ampicillin, amoxicillin and effective, but easy to produce drug-resistant strains, it is best for the sensitivity test, select the sensitive drugs.
4. Anaerobic gram-negative anaerobic bacteria are Bacteroides fragilis and Gram-positive Peptostreptococcus, Peptococcus and so on. These bacteria mainly from the colon, rectum, vagina and oral mucosa. Infection is characterized by its easy to form the pelvic abscess, septic thrombophlebitis, a fecal odor and pus bubbles in anaerobic infections, the virulence of Bacteroides fragilis strongest, often accompanied by severe infection abscess formation. Pus in a fecal odor in the light microscope to see polymorphism, uneven coloring Gram-negative bacteria, many of the white blood cells, suggesting the possibility of Bacteroides fragilis infections. Peptostreptococcus and Peptococcus common in puerperal infection, septic abortion, salpingitis, corporations are common, but not with severe pelvic infection. Fecal odor in the pelvic infection pus smear under light microscopy found that Gram-positive cocci, the diagnosis of help.
5. Nessler gonorrhea gram-negative bacteria as meningitis, gonorrhea bacteria is characterized by Chennai's invasion of the reproductive, urinary systems and transitional mucosal epithelium of columnar epithelium. Gonorrhea bacteria mainly Nyquist lower genital tract infection, 10 to 17% of patients can occur on the reproductive tract infections, gonorrhea caused by strains of Nyquist pelvic inflammatory disease, more than the menstrual period or within 7 days after onset, acute onset, may have high fever, body temperature over 38 exchange, often resulting in tubal empyema, sensitive to treatment. Nyquist gonorrhea bacteria to penicillin, second generation or third generation cephalosporins, aminoglycosides sensitive.
6. Chlamydia trachomatis common to their characteristics and Nyquist gonorrhea bacteria, as only infected columnar epithelium and transitional epithelium, not to deep infringement. Obvious symptoms of Chlamydia trachomatis infection, may have slight abdominal pain, but often cause serious damage to oviduct structure and function, and can lead to extensive pelvic adhesions.
7. Mycoplasma Mycoplasma is a class of prokaryotic cell walls of microorganisms, morphology was pleomorphic, is a normal vaginal flora. Reproductive tract isolated from one Mycoplasma hominis Mycoplasma, Ureaplasma urealyticum and genital mycoplasma. Under certain conditions, mycoplasma can cause genital tract inflammation.1. The bacteria spthrough the lymphatic system, vulva, vagina, cervix and trauma at the Palace of lymphatic invasion of the pelvic connective tissue and other parts of the genitalia, is puerperal infection, IUD insertion after abortion infection after infection and the main transmission, more common in streptococci, E. coli, anaerobic infections (Figure 30-1).
2. Pathogen spupward along the genital mucosa invasion of the vulva, vagina, along the mucosal surface through the cervix, endometrium, oviduct to the ovary and abdomen. Nyquist gonorrhea bacteria, Chlamydia trachomatis and Staphylococcus aureus spalong this pathway (Figure 30-2).
3. Blood circulating pathogens invading the human body before the other system, and then infected with genital blood circulation,
The main way for the TB infection (Figure 30-3).
4. Direct spof abdominal infection in other organs, the direct spto the genitals, such as appendicitis can cause the right side of salpingitis.An acute pelvic inflammatory disease
Causes which gave rise to a major cause of pelvic inflammatory disease are the following.
1. Postpartum or post abortion infection of maternal physical weakness after childbirth, the cervix is not fully closed, such as birth injury or birth canal caused by placenta, fetal membranes and other residues, pathogen invasion of the uterine cavity, prone to infection; abortion, vaginal bleeding during the time off long, or organized left in the uterine cavity, or surgical operation is not strictly sterile, acute pelvic inflammation may occur.
2. Intrauterine infection after surgical procedures such as curettage, tubal surgery, Hysterosalpingography Hysteroscopy, etc., due to surgical sterilization is not strictly caused by infection or poor choice of preoperative indications, such as chronic inflammation of the original genitalia, the interference caused by acute surgical and sp.
3. Menstrual health poor use of unclean menstrual pads, menstrual sex, etc., can be caused by invasion of pathogens inflammation.
The reproductive tract infection pathogens in the following endogenous flora of the main pathogens such as staphylococcus, streptococcus, E. coli, anaerobes, and so on.
4. Infection dirty sexual history of sexually transmitted diseases, early sexual intercourse, multiple sexual partners, frequency of sexual intercourse can be caused by sexually transmitted pathogens invasion, causing pelvic inflammatory disease. Nessler common pathogens as gonorrhea bacteria, Chlamydia trachomatis or in combination with aerobic and anaerobic bacteria infection.
5. Inflammation of direct spof adjacent organs such as appendicitis, peritonitis, mainly Escherichia coli.
6. Acute exacerbation of chronic pelvic inflammatory disease.
7. IUD first IUD in place within 10 days, can cause acute pelvic inflammatory disease, when infection with staphylococcus, streptococcus, E. coli, anaerobes based; The second is long-term placement of intrauterine IUD after the formation of secondary infection of chronic inflammation, sometimes acute.
Pathology
1. Endometritis and acute myositis common in uterine abortion, childbirth (see puerperal infection section).
2. Acute salpingitis, tubal empyema, acute salpingitis tubal ovarian abscess caused primarily by pyogenic bacteria, according to the different routes of transmission have different pathological features. If the bacteria spto the lymph through the cervical parametrial connective tissue, the first invasion, and serosal layer, the occurrence of inflammation around the fallopian tube, and then involving the muscle, and involvement in tubal mucosa may or involved small. Fallopian tube light were only mild redness, swelling, slightly thickened; severe tubal obvious thickening, bending, fibrino purulent exudate and more, resulting in the surrounding adhesions.
If the inflammation spupward through the endometrium, first tubal mucosa caused by inflammation, tubal mucosal swelling, interstitial edema, congestion and massive neutrophil infiltration, severe degenerative changes occur, or oviduct epithelial sheets off, causing oviduct adhesion lead to tubal lumen and closed the umbrella side, if the accumulation of pus in the fallopian tube lumen is the formation of empyema.
Few individual ovarian inflammation, albuginea is a good defensive barrier, often associated with inflammation of the fallopian tube ovary umbrella around the end of adhesions and ovarian inflammation, known as tubal ovarian inflammation, the study said adnexitis. Inflammation can be broken by ovulation real hole formed invasive ovarian ovarian abscess, empyema abscess wall and tubal adhesions and penetrating, the formation of tubal ovarian abscess. Tubal ovarian abscess can occur in the initial onset of acute inflammation after attachment, but it is often repeated in the acute exacerbation of chronic inflammation Annex on the basis of formation. Abscesses were located behind the uterus or the uterus, broad ligament between the posterior lobe and the intestinal adhesion area, which could break rectum or vagina, abdominal cavity if the break is caused by diffuse peritonitis.
3. Acute pelvic connective tissue inflammation in acute inflammation within the genital or vagina, cervix with trauma, pathogens via lymphatic vessels into the connective tissue caused by pelvic connective tissue hyperemia, edema and neutrophil infiltration. Parametrial connective tissue inflammation in the most common start local thickening, soft texture, ill-defined, was fan after the invasion to both sides of the pelvic wall, if the organization is the formation of suppurative pelvic extraperitoneal abscess may spontaneously break into the rectum or vagina.
4. Acute pelvic peritonitis pelvic organs of serious infection, usually spto the pelvic peritoneum, the peritoneal inflammation edema, and a small amount of exudate containing cellulose, the formation of pelvic organ adhesion. When a large number of purulent exudate accumulate in the adhesion of the gap can be formed scattered small abscess; accumulate in the rectum, the uterus is shaped pouch at the
As pelvic abscess, were more common. Uterine abscess in front of the rear for the rectum, at the top of the adhesion of bowel and omentum, rectal abscess can be broken leaving suddenly reduce the symptoms can also be broken into the abdominal cavity caused by diffuse peritonitis.
5. Sepsis and sepsis when the pathogen potency and quantity, reduced resistance in patients, often occurring sepsis. More common in severe puerperal infection, abortion, have also been reported in recent years, IUD insertion, tubal ligation sepsis caused organ damage, if not controlled in time, often soon septic shock and even death. After infection, if the rest of the body found in inflammatory lesions or multiple abscesses, should consider the existence of sepsis, but to be confirmed by blood culture.
Clinical severity and extent of inflammation may be due to the size of the different clinical manifestations. Incidence of abdominal pain with fever nowadays, if a serious condition may have chills, fever, headache, loss of appetite. Menstrual onset, there may be increased by the amount, extend the period of non-menstrual vaginal discharge onset may have increased. If peritonitis, the emergence of digestive symptoms such as nausea, vomiting, abdominal distension and diarrhea. If abscess formation, may have lower abdominal mass and symptoms of local compression to stimulate mass in front of the bladder irritation can occur, such as dysuria, urinary frequency, if the cause bladder can have dysuria and other myositis; mass located before irritation of the rectum, if the peritoneum can cause diarrhea, tenesmus and defecation difficulties sense. According to pathogen infection in different clinical manifestations are different. Nyquist gonorrhea infection acute onset, more high fever within 48 hours, peritoneal irritation, and purulent vaginal discharge. Strains of non-gonococcal pelvic inflammatory disease Nyquist slow onset, high fever and peritoneal irritation is not obvious, often accompanied by abscess formation. For anaerobic infections, is likely to have multiple recurrent abscess formation, older patients, often more than 30 years of age. Longer duration of chlamydial infection, fever is not obvious, long-lasting fever, mainly as mild lower abdominal pain, long treatment, irregular vaginal bleeding.
Patients showed acute tolerance, body temperature, heart rate, abdominal distension, lower abdominal tenderness, rebound tenderness and muscle tension, bowel sounds diminished or disappeared. Pelvic examination: the vagina may be congestion, and a large purulent discharge, surface discharge neck generals Shi Jing, see if the outflow of purulent discharge from the cervix, or uterine cervical mucosa shows acute inflammation. Wo Long obvious tenderness, should be noted that if full; cervical hyperemia, edema, pain was held; Palace slightly larger, there is tenderness, limited mobility; uterine tenderness evident on both sides, the case of pure salpingitis, palpable thickening fallopian tubes, there was tenderness; if the fallopian tubes or tubal ovarian abscess empyema, you can reach significant mass and tenderness; parametrial connective tissue inflammation, they can lay hands on to one or both sides of sheet parametrial thickening, or both a high degree of lateral ligament Palace San edema, swelling and tenderness was; if abscess formation and the location is low, palpable Long after the dome or lateral bending fluctuations and there is a sense of a lump, triple diagnosis can often assist in the further understanding of the situation pelvic .
Diagnosis, according to medical history, symptoms and signs can be made a preliminary diagnosis. In addition, the need to make the necessary tests, such as blood, urine, cervical secretions, and physical examination after the dome puncture. The clinical diagnostic criteria for acute pelvic inflammatory disease, need to meet the following three: lower abdominal tenderness with or without rebound tenderness; Palace cervical or give pain or pain in swing; annex area tenderness. Increase the specificity of diagnosis the following criteria: cervical secretion culture or Gram stain smear positive or gonorrhea Nyquist Chlamydia trachomatis-positive bacteria; temperature over 38 ; blood total lOxl09 / L; out of purulent posterior fornix puncture liquid; bimanual or B-mode ultrasound examination revealed pelvic abscess or inflammatory mass. Because the clinical diagnosis of acute salpingitis have a certain rate of misdiagnosis, laparoscopy can improve the diagnosis. Laparoscopic visual diagnostic criteria are: the surface of apparent congestive heart tube; tubal wall edema; tubal or serosal side umbrella purulent exudate. In making the diagnosis of acute pelvic inflammatory disease after the infection to clear the pathogen, by laparotomy or laparoscopy secretions directly to the site of infection for bacterial culture and susceptibility results of the most accurate. Cervical secretions and fluids after the dome puncture smears, culture and immunofluorescence assay, though not of direct discharge to the site of infection and sensitivity training to do precisely, but help clear pathogens, Gram stain of smears can be used, If found gonorrhea bacteria can be diagnosed Nyquist, Nyquist gonorrhea bacteria than look outside, according to morphology and Gram staining of bacteria, provide clues for the use of antibiotics in a timely manner; culture positive rate, can be clearly pathogens; mainly used for chlamydia immunofluorescence Check. In addition to the inspection of pathogens, but also based on history, clinical symptoms and signs characteristic of pathogens to make preliminary judgments.
Differential diagnosis of acute pelvic inflammatory disease should be acute appendicitis, abortion or ruptured tubal pregnancy, ovarian cyst torsion or rupture of acute phase identification.
Prevention
1. Well menstruation, pregnancy and postpartum health promotion.
2. Strictly obstetrics, gynecology surgical indications, preoperative preparation well; the attention aseptic technique, including abortion, IUD insertion, and other commonly used diagnostic curettage surgery; after well care, prevention of infection .
3. The treatment of acute pelvic inflammatory disease should be done timely treatment, completely cured, to prevent to chronic pelvic inflammatory disease.
4. Note that sexual health and reduce sexually transmitted diseases, prohibition of sexual intercourse during menstruation.1. Supportive therapy, bed rest, semi-recumbent position is conducive to the accumulation of pus in the rectum, leaving lacunae of uterine inflammation of limitations. Given high-calorie, high protein, high vitamin liquid food or semi-liquid food, fluids and attention to correct the electrolyte imbalance and acid-base imbalance, if necessary, a small amount of blood transfusion. High fever with physical cooling. Try to avoid unnecessary proliferation of gynecological examination in order to avoid inflammation, gastrointestinal decompression should be performed if abdominal distension.
2. The choice of antibiotic therapy is reasonable based on susceptibility testing, but the test results obtained before, to be based on history, clinical features which suggested the pathogen, and with reference to what kind of antibiotics used after the onset of selected drugs. Pathogens due to acute pelvic inflammatory disease, mostly aerobic and anaerobic bacteria, and chlamydia infection, aerobic and anaerobic gram-negative and there are gram-positive distinction, therefore, the choice of antibiotics, more use of combination therapy. Antimicrobial spectrum of antibiotics as follows: penicillins: Gram-positive cocci such as Streptococcus pneumoniae, Staphylococcus aureus sensitive to strong antibacterial effect on gram-negative bacteria and gram-negative bacteria have an antibacterial effect, but prone to drug resistance; cephalosporins: the first generation cephalosporins against Gram-positive cocci strong antibacterial effect, although Gram-negative bacteria have an antibacterial effect, but because of Gram-negative bacteria on the -lactamase resistance weak, Gram-negative bacteria more easily to the generation of antibiotic resistance; second-generation cephalosporins strong performance of anti-enzyme, antibacterial spectrum plant, on the role of gram-negative bacteria increased, but Gram-positive bacteria on the antibacterial performance and The first generation of similar or slightly lower; third-generation cephalosporin antimicrobial spectrum and anti-enzyme performance is better than the second generation cephalosporins, on the role of gram-negative bacteria more than the second-generation, second generation of drug resistance can be used to Gram-negative strains. In addition, some third-generation drugs on the anaerobic bacteria effective, but the third generation cephalosporins against Gram-positive bacteria the role and first-generation cephalosporins or less similar; aminoglycosides: antibacterial spectrum of gram-negative bacilli ; Macrolide; sensitive bacteria are mainly gram-positive cocci and mycoplasma, chlamydia; tetracyclines: mainly used for chlamydia, mycoplasma and rickettsial infections; imidazole nitrate: mainly used in anaerobic infections; clindamycin and other antibiotics such as lincomycin. Shall be reasonably compatible combination therapy, the drug is less toxic to small. The application of antibiotics required to achieve adequate and should be noted that toxicity. In the course of treatment, based on susceptibility test results with clinical response to treatment at any time to be adjusted. Route of administration by intravenous infusion of fast convergence.
Compatibility of commonly used antibiotics in acute pelvic inflammatory disease program are as follows:
(1) penicillin or erythromycin and metronidazole and aminoglycoside drugs: penicillin daily 3.2 million ~ g60 million U intravenous infusion, 3-4 times a small amount of liquid added intermittently rapid infusion; red ADM daily 1 ~ 2g, 3-4 intravenous drip; gentamicin 1 80mg, 2-3 times daily, intravenous infusion or intramuscular injection; amikacin daily 200 ~ 400mg, 2 times, intramuscular injection, treatment is generally not more than 10 days; metronidazole and glucose injection 250ml (containing metronidazole 5OOmg), intravenous infusion, every 8 hours 1, get better change oral 400mg, every 8 hours 1. Excretion of the drug through breast milk, lactating women with caution.
(2) The first-generation cephalosporins and metronidazole: Although the first generation cephalosporins against Gram-positive bacteria is stronger, but some drugs on the optimum Gram-negative bacteria, such as cephradine intravenously 2 ~ 4g, 4 times to give; cefazolin sodium per 0.5 ~ 1g, 2-4 times per day, intravenous drip.
(3) clindamycin or lincomycin and aminoglycosides (gentamicin or amikacin) combined: clindamycin 600mg, every 8 to 12 hours a time, intravenous infusion, body temperature After the change to the normal oral, each 250 ~ 5OOmg, 1 3-4 times; lincomycin per 300-60Omg, 3 times a day, intramuscular injection or intravenous drip. Clindamycin or lincomycin for most gram-positive bacteria and anaerobic bacteria effective in combination with aminoglycosides, either from the laboratory or clinical effects were good. These drugs have antagonistic effects with erythromycin, can not be combined with; long-term use can cause pseudomembranous colitis, the pioneer of the symptoms of diarrhea, the case of the symptoms should be immediately discontinued.
(4) The second generation cephalosporins or the equivalent of second-generation cephalosporin drugs: cefuroxime sodium, per 0.75 ~ 1.5g, 3 times a day, intramuscular or intravenous injection. Multiple intravenous or intravenous cephalosporins Meng, each 0.5 ~ 1g, 4 times a day, a heavier infection per 1g, 6 times a day. Cephalosporins for the safe daily 1 ~ 2g, divided 2-4 times given, serious infection can be used to the daily 4g. Cefoxitin sodium per 1 ~ 2g, 3-4 times daily, the drug in addition to a strong gram-negative bacteria, the Gram-positive bacteria and anaerobes (Peptococcus, Peptostreptococcus, Bacteroides fragilis ) are valid. If you consider a chlamydia infection, should also be given doxycycline 100mg orally every 12 hours
(5) The third generation cephalosporins, or equivalent third-generation cephalosporin drugs: cefotaxime sodium intramuscular or intravenous injection, 1 0.5 ~ 1g, 1 2-4 times; ceftriaxone sodium 1mg, IV day 1 injection for common infections, if a serious infection, daily 2g, 2 times to give; ceftizoxime daily 0.5 ~ 2g, seriously, 4g, divided 2-4 times given; cefotetan disodium daily 2g, intravenous injection or intravenous infusion of 1-2 points. Ceftriaxone, ceftizoxime and cefotetan disodium in addition to a strong gram-negative bacteria, the Gram-positive and anaerobic bacteria have antibacterial activity. Considering there are chlamydia or mycoplasma infection should be added with doxycycline 100mg orally every 12 hours 1, the condition improved, treatment should be continued 10-14. That can not tolerate doxycycline who can azithromycin alternative, each 5OOmg, 1 day, qd for 3 days. Nyquist gonorrhea infection caused by pelvic inflammatory disease of choice for this program.
(6) School La Xilin sodium is a new semi-synthetic penicillin, for most aerobic and anaerobic are valid. Daily 4 ~ 12g, 3-4 intravenous injection or intravenous infusion, severe infection, available daily 10 ~ 24g.
(7), quinolones and metronidazole combined: Fluoroquinolones are a relatively new class of synthetic antibacterial drugs, this class of drugs and many antibiotics no cross resistance. The third generation fluoroquinolones against gram-negative bacteria and gram-positive bacteria have antibacterial activity. Commonly used are ciprofloxacin per 100-2OOmg, 2 times a day, intravenous drip; ofloxacin per 400mg, 1 time every 12 hours, intravenous drip.3. Surgical treatment of the following conditions for the surgical indications.
(1) medical therapy: drug treatment of pelvic abscess formation by 48 to 72 hours of continuing down the body temperature, weight, or mass in patients with increased symptoms of poisoning, should timely surgery to avoid abscess rupture.
(2), empyema, or tubal tubal ovarian abscess: treatment by medication condition has improved, continue to control inflammation for several days, the mass has not disappeared but has been localized, surgical resection should be to prevent recurrence of acute attack still surgery.
(3) abscess rupture: sudden abdominal pain increased, chills, fever, nausea, vomiting, abdominal distension, abdominal examination or a refusal by the performance of toxic shock, should be suspected abscess rupture, requiring immediate exploratory laparotomy.
Surgery options under the circumstances, abdominal surgery or laparoscopic surgery. Extent of surgery should be based on extent of disease, patient age, general condition and other conditions fully into account. The main principles for removal of lesions. Young women ovarian function should be kept to the main use of conservative surgery; older, with bilateral involvement or attachment accessories made of the repeatedly abscess, hysterectomy and bi-oophorectomy; on the extreme weakness in critically ill surgical patients with the scope of the specific subject circumstances. For pelvic abscess or pelvic connective tissue abscess (extraperitoneal abscess), according to the location of transvaginal abscess or drainage of lower abdominal incision, the location if the abscess is low, after the conflict to the vaginal fornix, the vaginal incision may be, while injection of antibiotics; if abscess location of the higher and less superficial, such as pelvic extraperitoneal pelvic abscess extended upward beyond those available in the iliac cavity, and their mass, the top of the line in the extraperitoneal inguinal ligament incision and drainage row pus.4. Traditional Chinese medicine: the main blood circulation, detoxification drugs, such as: Yinqiaojiedu soup, Angongniuhuang and Zixue Dan and so on.Second, chronic pelvic inflammatory disease
Chronic pelvic inflammatory disease often fails to complete the treatment of acute pelvic inflammatory disease, or patients with prolonged course due to poor physical fitness, but also no history of acute pelvic inflammatory disease, such as salpingitis caused by Chlamydia trachomatis. More intractable chronic pelvic inflammatory disease, when body resistance is poor, can have acute attack.
Pathology
1. Chronic salpingitis and hydrosalpinx mostly bilateral chronic salpingitis, tubal had mild or moderate swelling, the umbrella can be partially or completely closed end, and with the surrounding tissue adhesion. Sometimes isthmus epithelial adhesion and proliferation of fibrous tissue, it was multiple fallopian tubes, nodular thickening, nodular salpingitis said isthmus. Tubal inflammation is light, umbrellas closed end and adhesion isthmus, the accumulation of serous exudate formation hydrosalpinx; sometimes becomes chronic empyema tube, gradually being absorbed pus, serous fluid oozing continued from the wall cavity filled with also the formation of hydrosalpinx. Water tube surface is smooth, very thin wall, the tube with water mesangial tubal wall can not expand the corresponding extension of the growth, so the water side of the oviduct to the Department of membrane bending, the shape of sausage or curved neck distillation flask was like, curled back, can be free or with a membrane-like adhesion of surrounding tissue.
2. Oviduct oophoritis and ovarian cysts tubal tubal inflammation spto the ovaries, fallopian tubes and ovarian inflammatory mass formation of adhesions, or tubal adhesions and the ovarian end of the umbrella through the liquid leaking tubal ovarian cyst formation, but also by tubal ovarian abscess pus fluid is absorbed by the formation of alternative exudate (Figure 304).
Hydrosalpinx Figure 304 (left), tubal ovarian cyst (right)
3. Chronic pelvic inflammation of connective tissue inflammation spto the Palace of San ligament, the fibrous tissue hyperplasia, harden. If the spof a wide range, make the uterus fixed cervical tissue is also thickened.(1) systemic inflammatory symptoms and more obvious, and sometimes only a low heat, susceptible to fatigue. The course of a long time, some patients may present symptoms of neurasthenia, such as lack of energy, the whole body discomfort, and insomnia. When the patient poor resistance, is easy to have acute or subacute onset.
(2) chronic inflammation and the formation of scar adhesion pelvic congestion, often resulting in lower abdominal bulge, pain, and lumbosacral pain. Often tired, aggravated sexual intercourse before and after menstruation.
(3) chronic inflammation leads to pelvic crazy blood, patients are often increased by the amount; ovarian function damage can cause menstrual disorders; tubal infertility adhesions can cause obstruction.
2. Symptoms after hysterectomy often has bent backward, limited mobility or adhesion fixed. For salpingitis, then touch one or both sides in the uterus was enlarged fallopian tube cable strip, and mild tenderness. For hydrosalpinx or tubal ovarian cysts, one or both sides in the pelvic cystic mass reach, activities and more limited. If the pelvic connective tissue inflammation, the uterus thickening of one or both sides of a sheet, tenderness, palace often scattered ligament thickening, hardening, tenderness.
Diagnosis and differential diagnosis of acute pelvic inflammatory disease history, and with obvious signs and symptoms, diagnosis, and more in time. But sometimes the symptoms are more patients, without obvious signs of pelvic inflammatory disease history and positive, then the diagnosis of chronic pelvic inflammatory disease should be cautious to avoid hasty diagnosis of the burden caused by patients thinking. Sometimes pelvic congestion or the broad ligament in varicose veins can also produce similar symptoms of chronic pelvic inflammatory disease.
Chronic pelvic inflammatory disease and endometriosis are sometimes difficult to identify, dysmenorrhea, endometriosis was secondary, progressive increase, if we can reach a typical tender nodules, the diagnosis. Difficult to distinguish when laparoscopy. Hydrosalpinx or tubal ovarian cysts and ovarian cysts be differentiated from ovarian cysts tubal addition to a history of pelvic inflammatory disease, the tumor showed a sausage-shaped, thin wall; surrounded by adhesions; and ovarian cysts generally more round or oval around no adhesion, easily. Annex inflammatory mass with surrounding adhesions, no, sometimes easy to be confused with ovarian cancer, inflammatory mass is cystic and solid ovarian carcinoma, B-mode ultrasound examination can help identify.
Prevention attention to personal hygiene, exercise, enhance physical fitness, timely and thorough treatment of acute pelvic inflammatory disease.
Treatment chronic pelvic inflammatory disease monotherapy less effective, integrated treatment is appropriate.
1. General treatment of patients discharged ideological concerns, and enhance the confidence of the treatment, increase nutrition, exercise, attention to work and rest, increase body resistance.
2. TCM treatment of chronic pelvic inflammatory disease in order to damp-heat in the majority, rule Zeyi heat and dampness, promoting blood circulation of the crazy main herbs used: RSM 18g, red peony root 15g, woody 12g, peach kernel 9g, honeysuckle 30g, dandelion 30g, Poria 12g, paeonol 9g, habitat 9g. Weight when the pain increases Corydalis 9g. Some patients Hanning Qi stagnation, government was warm through the cold, qi and blood circulation, often Guizhifuling Decoction. Qi by adding Codonopsis 15g, Bai Zhu 9g, Astragalus 15g. Chinese medicine can be taken orally or enema.
3. Physical therapy can promote pelvis warm local blood circulation, improve the nutritional status of organizations, improve metabolism to facilitate absorption and inflammation subsided. Commonly used short-wave, FM, microwave, laser, ion penetration (can be added a variety of drugs such as penicillin, streptomycin, etc.).
4. Other drugs, application of anti-inflammatory drug treatment, but also can be -chymotrypsin 5mg or hyaluronidase 1500U, intramuscular injection, every other day for 1, 7-10 times as one course, in order to facilitate decomposition and inflammatory adhesion absorption. Individual patients should be local or systemic allergic reactions drug withdrawal. In some cases, application of antibiotics and dexamethasone at the same time, oral dexamethasone 0.75mg, 3 times a day, stopping before the pay attention to the gradual reduction of dexamethasone.
5. Surgical treatment of tumors, such as hydrosalpinx or tubal surgery for ovarian cysts should be performed; the presence of small foci, repeated acute inflammation caused by surgical treatment should also be made of. The principle of operation to completely heal and avoid recurrence lesions left the opportunity to unilateral oophorectomy or hysterectomy and bilateral oophorectomy. Young women should be kept on ovarian function.



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