Inflammation of female internal genitalia and its surrounding connective tissue and pelvic peritoneum is called pelvic inflammatory disease. ※. Pelvic inflammatory disease is a common gynecological disease. Inflammation can be confined to one site, or it can occur in several sites at the same time. According to its pathogenesis and clinical manifestations, it can be divided into acute and chronic. Acute inflammation may lead to serious consequences, such as diffuse peritonitis, sepsis and septic shock. Chronic inflammation can't be cured for a long time, and it occurs repeatedly, which affects women's physical and mental health and brings pain to patients. Therefore, we must pay attention to the prevention and treatment of pelvic inflammatory disease.

Because of the anatomical and physiological characteristics of female reproductive tract, it has a relatively perfect natural defense function and enhanced the defense ability against infection, so there may be some pathogens in the vagina of healthy women, but it may not necessarily cause inflammation.

[Natural Defense Function of Female Genital Organ] ※

First, the labia majora on both sides naturally closes to cover the vaginal opening and urethral opening.

Second, due to the action of pelvic floor muscles, the mouth is closed and the front and rear walls of the vagina are tight, which can prevent external pollution. In multipara, this defense function is very poor because of vaginal relaxation.

Thirdly, under the influence of estrogen secreted by ovaries, vaginal epithelium proliferates and thickens, which increases the resistance to pathogen invasion. At the same time, epithelial cells are rich in glycogen, which is decomposed into lactic acid under the action of vaginal bacilli, maintaining the normal acidic environment of vagina (pH 4.2 ~ 5) and inhibiting pathogens suitable for reproduction in alkaline environment, which is called vaginal self purification.

Fourth, the mucus secreted by the cervix and endometrium forms a mucus plug, blocking the cervical canal, and the internal opening of the cervix is usually closed, which is conducive to preventing the invasion of pathogens. It is reported that bacteria can be detected in the lower 1/3 of cervical mucus plug, but not in the upper 2/3.

5. Regular endometrial denudation of women of childbearing age is also a favorable condition to eliminate bureaucratic infection.

Sixth, the cilia of epithelial cells of oviduct mucosa swing in the direction of uterine cavity, and the peristalsis of oviduct is beneficial to prevent the invasion of pathogens.

Main Pathogenic Vaccine and Its Sensitivity to Antibiotics The main pathogens causing pelvic genital inflammation are Staphylococcus, Streptococcus, Escherichia coli and anaerobic bacteria. ※.

First of all, streptococcus has many kinds of gram-positive streptococcus, including A, B and C. Class b hemolytic chain

Coccus is highly pathogenic and can produce hemolysin and various enzymes, which makes infection easy to spread and cause septicemia. The pus is thin, reddish and large, but it is generally not complicated with metastatic abscess. Before the emergence of antibiotics, about 75% of puerperal women who died of septicemia were infected by group A hemolytic streptococcus B, which was sensitive to penicillin, and the maternal death was basically controlled after the application of penicillin.

Second, staphylococcus is gram-positive, which is a common pathogen of genital inflammation and wound infection after delivery and operation, and often infects along the vagina, uterus and fallopian tube mucosa. Staphylococcus aureus, Staphylococcus albus and Staphylococcus citricola are all pathogenic, among which Staphylococcus aureus is the most pathogenic. The pus is yellow in color, thick and tasteless, often accompanied by metastatic abscess, which is easy to produce resistance to commonly used antibiotics. According to the drug sensitivity test, the drug use is ideal. Penicillin-resistant Staphylococcus aureus is sensitive to cephalosporin Ⅰ, vancomycin, clindamycin and chloramphenicol.

Third, Escherichia coli is gram-negative, a normal parasitic bacterium in the intestine, and generally does not cause disease. However, when the body is extremely weak or invades parenteral tissues or organs due to trauma, it can cause serious infection and even produce endotoxic shock, which is often mixed with other pathogenic bacteria. The pus of Escherichia coli is not smelly. When there is mixed infection, thick silk pus and fecal odor are produced. Kanamycin, gentamicin, cephalosporin I, carbenicillin, etc. Can be used, but easy to produce drug-resistant strains. It is best to do drug sensitivity test and choose sensitive drugs. Penicillin g, ampicillin, tetracycline, etc. It can also be used for patients with serious mixed infection of Gram-positive bacteria.

4. Anaerobic bacteria Due to the progress of anaerobic culture technology, the importance of anaerobic bacteria in pelvic inflammatory disease has been paid more and more attention since the 1970s, mainly including Streptococcus digestion, Streptococcus digestion and Bacteroides. These bacteria mainly come from colon, rectum, vagina and oral mucosa. General sampling and culture techniques are not easy to get positive results. In the past, there was no colony growth in pus culture of some pelvic abscess, which was probably anaerobic infection, but due to the limitation of anaerobic culture technology at that time, no positive results were obtained. According to literature reports, 70% ~ 80% of pelvic abscess can cultivate anaerobic bacteria. In pelvic inflammatory disease, anaerobic bacteria can be infected alone or mixed with aerobic bacteria. Therefore, attention should be paid to the necessity of controlling anaerobic bacteria when choosing antibiotics. Streptococcus digestive is sensitive to penicillin, cephalosporin (cepha 10thin), chloramphenicol and metronidazole.

Five, sexually transmitted pathogens such as gonorrhea, chlamydia trachomatis, others may have mycoplasma, herpes virus.

※ transmission path. ※

1. Bacteria spread through lymphatic system invade pelvic connective tissue and other parts of internal genitalia through lymphatic vessels of vulva, vagina, cervix and uterus, which is the main way of puerperal infection, post-abortion infection and some intrauterine device-related infections.

Second, through blood circulation, pathogens first invade other systems of the human body, and then infect genitals through blood circulation.

It is the main route of tuberculosis infection.

Third, pathogens spread along the genital mucosa and invade the vulva. After vagina, it passes through the cervix, endometrium and oviduct endometrium along the mucosal surface to the ovary and abdominal cavity. Staphylococcus and Neisseria gonorrhoeae spread along this route.

Fourth, direct spread to other organs in abdominal cavity and internal genitalia, such as appendicitis, can cause salpingitis.

※ acute pelvic inflammatory disease

The cause of disease

The main causes of acute pelvic inflammatory disease are as follows:

First, postpartum or postpartum infection after abortion, the maternal body is weak, and the official neck is not closed properly. For example, during childbirth, the birth canal is damaged or the placenta and fetal membrane remain, and pathogens invade the official cavity, which is easy to cause infection; Post-abortion infection can occur if the bleeding time is too long, or the tissue remains in the uterine cavity, or the aseptic operation is not strict.

Second, postoperative infections such as placing intrauterine devices, curettage, tubal ventilation, salpingography, hysteroscopy, etc. Due to poor surgical disinfection or improper selection of preoperative indications, the original chronic inflammation of reproductive tract is caused by acute attack and spread after surgical intervention. -

Third, menstrual hygiene is not good. There are dilated sinuses and blood clots on the exposed surface of endometrium during menstruation, which is a good breeding environment for bacteria. If you don't pay attention to hygiene, use unclean menstrual pads, menstrual intercourse, etc. It will lead to the invasion of pathogens and cause inflammation.

Fourth, the inflammation of nearby organs spreads directly, such as appendicitis and peritonitis.

Verb (abbreviation of verb) Acute aggravation of chronic pelvic inflammatory disease

pathology

First of all, acute endometritis and acute hysteromyositis are more common in abortion after delivery.

Second, acute salpingitis, fallopian tube empyema, fallopian tube ovarian abscess Acute salpingitis is mainly caused by purulent bacteria, which spread to the tissues around the uterus through the lymph of the cervix, first invading the serosa layer, causing inflammation around the fallopian tube, and then involving the muscular layer, while the endometrial layer of the fallopian tube is not very lightly affected. Its lumen can often be narrowed by thickening and compression of muscle wall, but it can still be kept unobstructed. The lesion is mainly interstitial inflammation of fallopian tube, and the fallopian tube is only slightly congested, swollen and slightly thickened. In severe cases, the fallopian tube is obviously thickened and thinned, and there are many cellulosic purulent exudation, which leads to peripheral adhesion.

If inflammation spreads upward through the endometrium, it will first cause salpingitis, salpingitis swelling and interstitial edema. A large number of neutrophils are congested and infiltrated, and in severe cases, the epithelium is variable or exfoliated, which causes adhesion of fallopian tube mucosa and occlusion of fallopian tube lumen and umbrella tip. If pus accumulates in the lumen, it will form tubal empyema.

Ovaries are rarely inflamed alone, and the white membrane is a good defense barrier. Most of the ovaries are attached to the umbrella-shaped end of tubal inflammation, resulting in periovarian inflammation, which is called tubal oophoritis, also known as adnexitis. Inflammation can invade ovarian parenchyma through ovarian ovulation hole, forming ovarian abscess. If the abscess wall is attached to the fallopian tube abscess, it will form a fallopian tube ovarian abscess. Tubo-ovarian abscess can appear after the first attack of acute tubal oophoritis, but it is often formed on the basis of repeated attacks of chronic adnexitis. Abscess is mostly located at the back of uterus or the adhesion of uterus, posterior lobe of broad ligament and intestine, which can break into rectum or vagina. If it breaks into abdominal cavity, it will cause diffuse peritonitis.

Third, acute pelvic connective tissue inflammation, acute genital inflammation, or vaginal and cervical trauma, pathogens can enter pelvic connective tissue through lymphatic vessels, causing connective tissue congestion, edema and neutrophil infiltration. Parauterine connective tissue inflammation is the most common, which begins with local tissue thickening, soft texture and unclear boundary, and then infiltrates into both pelvic walls in a fan shape. If the tissue is suppurated, it will form a retroperitoneal abscess, which can spontaneously break into the rectum or vagina.

Fourth, when acute pelvic peritonitis occurs in pelvic organs, it often affects pelvic peritoneum, inflammatory peritoneal congestion and edema with a small amount of serous fibrous exudation, and adhesion is formed between pelvic organs. When a large amount of purulent exudate accumulates in the adhesion gap, it can form scattered small abscesses, which are more common in the accumulation of hysterorectal recess to form pelvic abscess. In front of the abscess is the uterus, behind it is the rectum, and above it is the intestine and omentum. An abscess can break into the rectum and suddenly relieve symptoms. It can also break into abdominal cavity, causing diffuse peritonitis.

Verb (abbreviation of verb) Septicemia is a very septic pathogen, which is toxic and numerous, and the patient's resistance is low, so septicemia often occurs. It is more common in severe puerperal infection and infectious abortion. In recent years, it has also been reported that sepsis caused by organ injury caused by intrauterine device and tubal ligation, if not controlled in time, often leads to septic shock and even death. After infection, if there are many inflammatory lesions or abscesses in other parts of the body, sepsis should be considered, but it needs to be diagnosed through culture.

According to the severity and scope of inflammation, the clinical manifestations may be different. Abdominal pain accompanied by fever, such as high fever, chills, headache, anorexia, etc. If peritonitis occurs, digestive system diseases such as nausea, vomiting, abdominal distension, diarrhea, etc. If there is abscess formation, there may be lower abdominal mass and local compression and irritation symptoms; If the lump is located in the front, it may cause bladder irritation symptoms, such as dysuria and frequent urination, and if it causes bladder myositis, it may also cause dysuria. If the mass is located in the rear, it can cause rectal irritation, such as extraperitoneal diarrhea, feeling heavy after acute diarrhea, and having difficulty defecating.

The patient has acute symptoms, such as high body temperature, rapid heart rate, abdominal distension, muscle tension, tenderness and rebound pain in the lower abdomen, and the bowel sounds are weakened or disappeared. Pelvic examination: Obstruction can be congested, with a large number of purulent secretions and obvious tenderness in the vault. Cervical hyperemia, edema and pain are obvious. The uterine body is slightly larger, with tenderness and limited activity. Uterine tenderness is obvious, and sometimes a lump can be felt. When there is connective tissue inflammation around the uterus, there may be flaky thickening on one or both sides of the lower abdomen. Or when the bilateral uterosacral ligaments are highly swollen and thickened, forming an abscess and the position is low, the posterior or lateral fornix can be palpated with a lump and a sense of fluctuation. ：

Diagnosis can be made according to the medical history, symptoms and signs. In addition, some necessary tests must be done, such as blood routine, urine routine, blood and cervical canal secretion culture (including anaerobic bacteria culture), drug sensitivity test and so on. Although it is not directly cultured with pus, it has certain reference value for clinic. If necessary, there is a lump and a sense of fluctuation in the posterior hole or lateral hole.

Differential diagnosis of acute pelvic inflammatory disease should be differentiated from acute appendicitis, ectopic pregnancy, ovarian swelling, torsion or rupture and other acute abdominal diseases.

prevent

First, do a good job in health promotion during menstruation, pregnancy and puerperium.

Second, strictly grasp the indications of gynecological surgery, make good preparations before operation, and pay attention to aseptic operation during operation, including induced abortion, intrauterine device placement, diagnostic curettage and other operations. Pay attention to nursing after operation to prevent infection.

Third, completely cure acute pelvic inflammatory disease and prevent it from becoming chronic.

treat cordially

First, the general supportive therapy is bed rest, and the L semi-recumbent position is beneficial to uterine and rectal empyema and limits inflammation. Give adequate nutrition and liquid intake, correct the disorder of digestion and acid-base balance of soft-shelled turtle, give a small amount of blood transfusion when necessary, and use physical cooling when high fever occurs, try to avoid unnecessary gynecological examination and avoid the spread of inflammation. If you have abdominal distension, you can decompress the gastrointestinal tract.

Second, choose antibiotics reasonably according to drug sensitivity test. Before the test results come out, if the condition is not too serious, streptomycin can be used; If the condition is serious, broad-spectrum antibiotics should be used. The medicine combination has good curative effect and reasonable compatibility. There are few kinds of drugs and little toxicity. After the results of bacterial culture come out, antibiotics can be replaced according to the situation. Intravenous drip is an effective way of administration. The application of antibiotics needs to be sufficient, and attention should be paid to toxic reactions. After the symptoms disappear, continue to take the medicine for two weeks to consolidate the curative effect, strive for a complete cure and avoid the formation of chronic pelvic inflammatory disease.

Penicillium g is also effective against anaerobic bacteria. During the treatment, according to the severity of the disease, a large dose of 2.4 million ~ 1000, 10,000 IU was injected intravenously every day. After the condition improves, it can be reduced to120,000 ~ 2.4 million 1U, and it can be injected into muscles in four times. If you are allergic to penicillin, you can choose erythromycin 1.2g daily intravenous drip, plus 0.5 g kanamycin twice a day and intramuscular injection.

Prevention and treatment of chronic pelvic inflammatory disease ※

Chronic pelvic inflammatory disease is often caused by acute pelvic inflammatory disease can not be properly and thoroughly treated, or the patient's physical condition is poor and the course of disease is prolonged. Some chronic pelvic inflammatory diseases have no history of acute pelvic inflammatory diseases.

The systemic symptoms of chronic pelvic inflammatory disease are not obvious. Sometimes there may be low fever, fatigue, listlessness, general fatigue, insomnia and so on. When the patient's resistance drops, it can have an acute attack. Scar, adhesion and pelvic congestion caused by chronic inflammation can cause abdominal bulge, pain and backache. It is often aggravated after fatigue, sexual intercourse, defecation and menstrual period. Due to pelvic blood stasis, the patient's menstrual flow increases and leucorrhea increases; Menstrual disorders may occur when ovarian function is impaired; Tubal obstruction can lead to infertility. Check the uterus for backward position, limited mobility or adhesion and fixation. One or both sides of the uterus can feel the cord-like thickened fallopian tube with mild tenderness.

We should explain clearly the relevant knowledge of chronic pelvic inflammatory disease to patients, relieve their worries, enhance their confidence in treatment, increase nutrition, exercise, pay attention to the combination of work and rest and improve their resistance.

Traditional Chinese medicine has obvious curative effect on chronic pelvic inflammatory disease, and damp-heat type is common. It is advisable to clear away heat and promote diuresis, promote blood circulation and remove blood stasis. Radix Salviae Miltiorrhizae, Radix Paeoniae Rubra, Radix Aucklandiae, Semen Persicae, Flos Lonicerae, Herba Taraxaci, Poria, Cortex Moutan and Radix Rehmanniae can be selected. If it is cold coagulation and qi stagnation type, it should be mainly based on warming meridians to dispel cold, promoting qi and promoting blood circulation, and Guizhi Fuling decoction is often used to add and subtract. In addition, it can also be applied externally, with 500 grams of fried Radix Isatidis or 500 grams of vinegar mixed with Ganlisha, and applied to the lower abdomen with a cloth, or 100 ml of Caulis Sargentodoxae decoction can be used as retention enema. As well as body acupuncture, ear acupuncture and other traditional Chinese medicines have certain therapeutic effects.

Blocking therapy can also be used to block malignant stimulation and improve tissue nutrition. Generally, 40 ml of 0.25% novocaine is used before each sacral angle, once a week 1-2 times, 4-5 times as a course of treatment.

Physical therapy such as short wave, ultrashort wave, laser, audio frequency, iontophoresis and wax therapy can promote pelvic blood circulation, improve tissue nutrition and increase metabolism, so as to facilitate the absorption and regression of inflammation.

All kinds of antibacterial drugs should also be selected according to the drug sensitivity test of bacteria. At the same time, chymotrypsin 5 mg or hyaluronidase 1500 units were added, and intramuscular injection 1 time every other day, 5 5- 10/time was a course of treatment, which was beneficial to the absorption of adhesion and inflammation.

Surgical resection is feasible for those with obvious masses.

Pelvic inflammatory disease can be prevented. ※.

1 Don't forget to exercise when you are busy.

You can participate in various sports activities, especially endurance training such as running and mountaineering, to enhance your resistance.

At present, urban women, especially professional women, have more and more work pressure and time constraints. They are in a state of physical and mental exhaustion and have little free time. Even if I have a little time, I often sleep mainly. As a result, physical strength is getting worse and worse and resistance is getting lower and lower. Over time, it often gives bacteria an opportunity to form a high-risk group of pelvic inflammatory disease. Therefore, female friends should use all possible time to strengthen their exercise, such as riding a bike to work. Women who take a bus can get off two stops in advance and walk to work, stand up to exercise their muscles at work and do gymnastics while watching TV at home. ...

2 Losing weight does not reduce nutrition

Some female friends are worried about obesity, and simply rely on not eating to lose weight, leaving their bodies in a state of extreme weakness, even causing serious damage to liver and kidney function, or becoming anorexia. If adequate nutrition is not given in time, the body's resistance will drop sharply, which may lead to various types of infections and even pelvic inflammatory disease.

The correct way is that while dieting, women may wish to eat more high-protein foods, such as lean meat and bean products, and eat more fruits and vegetables, which not only meet the needs of the human body, but also will not gain weight.

3 pay attention to menstrual hygiene

At present, most female friends can avoid sleeping together during menstruation. However, due to the increasing work pressure of modern professional women, they can't get enough rest during menstruation, but they must work as hard as men, which will easily lead to pelvic congestion, decreased resistance and pelvic inflammatory disease over time.

Therefore, women should first avoid the same room during menstruation; Secondly, we should pay attention to rest, for example, let our husband or children do housework and be the commander in chief.

4 fixed sexual partners

With the progress of society, people's sexual concepts are gradually updated. Extramarital sexual relations, multiple sexual partners have become commonplace. However, the increase of sexual partners has also brought new sources of infection to female friends. Especially when both men and women have multiple sexual partners, the probability of women suffering from pelvic inflammatory disease is dozens of times higher than that of women with fixed sexual partners, and the incidence of sexually transmitted diseases has doubled. Therefore, a serious sexual attitude and a fixed sexual partner are the principles we should adhere to.

5 Use condoms

An effective and low-cost protection method to prevent pelvic inflammatory disease is to vigorously promote the application of condoms. According to the survey, the incidence of pelvic inflammatory disease of female friends who insist on using condoms is significantly lower than that of women of the same age who do not use condoms, especially for women with many sexual partners and complicated sexual relations.

Research shows that even between husband and wife, the use of condoms can significantly reduce the incidence of female pelvic inflammatory disease. Therefore, we should renew our concept that condoms are not only a good contraceptive method, but also can protect female friends from the pain of pelvic inflammatory disease.

By the way, condoms can not only avoid the spread and infection of many bacteria and pelvic inflammatory disease, but also avoid the spread of most HIV. However, it should be reminded that condoms are not omnipotent and cannot isolate all virus transmission, such as human papillomavirus. Therefore, leading an honest and clean life may be the best protection.

References:

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