Beijing Union Medical College Hospital Obstetrics and Gynecology
Salpingitispelvic infectionThe main place of onset of symptomatic diseases, most of which occur in sexually active women with menstruation, before menarchemenopauseLater or unmarried people seldom happen.If it happens, it is often the spread of inflammation in adjacent organs.If timely and correct treatment is not available, pelvic adhesionObstruction of fallopian tubeLeading to infertilityTubal pregnancy, chronic pelvic pain, recurrent inflammation and other sequelae.,Oviductitis is mostly caused by pathogen infection, mainly including Staphylococcus, Streptococcus, Escherichia coli, Neisseria gonorrhoeae, ProteuspneumoniaCaused by cocci, chlamydia, etc., divided intoAcute salpingitisandChronic salpingitisThe latter is more common in infertile women.
This disease is easy to occur when there are many bacteria, strong virulence or the body resistance is reduced.According to the different types of pathogenic bacteriaAcute salpingitisIt is divided into two categories: one is specificitygonorrheaDiplococcal infection,gonorrheaDiplococcus diffused to oviduct mucosa along cervical mucosa and endometrium;The other is nonspecific suppurative bacterial infection. Bacteria enter the parauterine connective tissue from the endometrium through lymphatic vessels and blood vessels, and finally lead to peritubal inflammation and salpingitis.Acute salpingitisIf the disease develops further, it may lead to acute pelvic cavityperitonitisAnd acuteperitonitis。
clinical manifestation
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Salpingitispelvic infectionThe most common part of symptomatic disease is also associated with inflammation in other parts, and its clinical manifestations may vary depending on the severity and scope of inflammation.Mild person has no symptoms or mild symptoms.The common causes are lower abdominal pain, fever, and increased vaginal secretions.Abdominal pain is persistent, active or aggravated after sexual intercourse.If the condition is serious, there may be chills, high feverheadache, lack of appetite and other systemic symptoms.If accompaniedperitonitisThere may be digestive tract symptoms.If anyabscessThe formation may have lower abdominal mass and local compression irritation symptoms;If the mass is located in front of the uterus, there may be bladder irritation symptoms, such as dysuria, frequent urination, bladder myositis and pain in urination;Rectal irritation may occur when the mass is located behind the uterus.If there are symptoms and signs of salpingitis and pain in the right upper abdomen, perihepatitis should be suspected.
The physical signs of patients vary greatly, and there is no obvious abnormality found in the mild cases orGynecological examinationIf tenderness is found in the accessory area, it is often accompanied by inflammation in other parts, and the body examination will also show positive signs in the corresponding parts.Serious cases are acuteSTDVolume, body temperature increases, heart rate increases, tenderness, rebound pain and muscle tension in the lower abdomen, even abdominal distension, bowel sounds weaken or disappear.Gynecological examinationIf it is simple salpingitis, the thickened fallopian tube can be touched, with obvious tenderness;In case of tubal empyema or tubal ovaryabscess, the mass can be touched, the tenderness is not obvious, and there is no activity.
inspect
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1. Blood examination
The total number of white blood cells increased, and neutrophils accounted for more than 80%.
2. Blood culture
People with chills and high fever should have a blood culture test to understand the condition, determine the type of pathogenic bacteria and the sensitivity of pathogenic bacteria to drugs, so as to be targeted when applying antibiotics.
3. Urethral or cervical secretions smear or culture
To understand the pathogenic bacteria.
4. Puncture of posterior fornix
The exudate or pus can be punctured.
diagnosis
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A preliminary diagnosis can be made according to the medical history, symptoms, signs and laboratory tests.The accuracy of clinical diagnosis is not high due to large differences in clinical manifestations.The ideal diagnostic criteria should be both sensitive and specific.However, there is no single medical history, physical signs or laboratory testing means.The definite diagnosis requires laparotomy or laparoscopic surgery. It is not feasible to directly take the secretion from the infected site for culture and drug sensitivity test. It can also be used to take the smear, culture and nucleic acid amplification of the secretion or posterior fornix puncture fluid from the cervical canal involved at the same time to detect pathogens to assist in diagnosis.
Outpatient treatment: if the patient is generally in good condition with mild symptoms, can tolerate oral antibiotics, and has follow-up conditions, oral or intramuscular antibiotic treatment can be given in the outpatient department.Common scheme: ① Take ofloxacin 400mg orally twice a day, or levofloxacin 500mg orally once a day, and take metronidazole 400mg additionally, 2-3 times a day, for 14 consecutive days. ②Ceftriaxone sodium 250mg, single intramuscular injection, or cefoxitin sodium, single intramuscular injection, while taking Probenecid, and then changed to Doxycycline 100mg, twice a day, for 14 days, and metronidazole 400mg, twice a day, for 14 days;Or use other third-generation cephalosporins in combination with doxycycline and metronidazole.
Inpatient treatment: if the patient's general condition is poor and serious, accompanied by fever, nausea and vomiting;Or with pelvic cavityperitonitis；Or oviduct ovaryabscess；Or the outpatient treatment is invalid;Or can not tolerate oral antibiotics;If the diagnosis is unclear, they should be hospitalized and given comprehensive treatment based on antibiotics.
(1) General support and symptomatic treatmentAbsolutely lying in bed and semi lying position to facilitate drainage and drainage, and to help limit inflammation.Drink more water and eat high calorie, digestible semi liquid diet.High fever patients should be rehydrated to prevent dehydration and electrolyte disorders.correctconstipation, take traditional Chinese medicine, such as senna, or use normal saline or 1, 2, 3 doses of enema.Those who are in pain can be given sedatives and analgesics.In case of severe symptoms of peritoneal irritation in the acute phase, ice bags or hot water bags can be used to apply to the painful parts.After 6-7 daysGynecological examinationAnd the total number of white blood cells, ESR tests confirmed that the condition has been hidden, can be changed to infrared or short wave diathermy.
(2) Antibiotic drug treatment to control infectionThe intravenous drip is the effective way of administration, and the commonly used compatibility is as follows: ① The second-generation or third-generation cephalosporins or equivalent drugs can be used in combination with tetracyclines.For example, cefoxitin sodium, cefuroxime sodium, ceftriaxone sodium, etc., add doxycycline intravenous drip. ②Clindamycin combined with aminoglycosides. ③Combination scheme of quinolones and metronidazole. ④A joint programme of penicillin and tetracycline drugs.
After 24 to 48 hours of improvement in clinical symptoms, the patient was switched to oral medication.For those who cannot tolerate doxycycline, azithromycin can be used instead.For fallopian tube and ovaryabscessClindamycin or metronidazole can be added to more effectively fight against anaerobic bacteria.The treatment must be thorough, and the dosage and application time of antibiotics must be appropriate. Insufficient dosage can only lead to the generation of drug-resistant strains and the continued existence of lesions, which will evolve into chronic diseases.The sign of effective treatment is the gradual improvement of symptoms and signs, which can be seen within 48~72 hours generally, so do not change antibiotics easily.
(3) Surgical treatmentMainly used when antibiotic control is unsatisfactory.The indications for surgery are ineffective drug treatmentabscessPersistent, abscess rupture, etc.Abdominal or laparoscopic surgery can be selected for the operation, mainly to remove the focus.
After abscess formation, systemic application of antibiotics is not ideal.If the abscesses of fallopian tubes and ovaries are close to the posterior vault, and the vault is full and wavy after vaginal examination, the puncture of the posterior vault should be performed. The pus can be discharged through the incision of the posterior vault, and a rubber tube can be placed for drainage.If the pus is thick and hard to draw out, it can be diluted with normal saline containing antibiotics to make it become blood serum sample and easy to be sucked out.Generally, the abscess will disappear after 2-3 times of treatment.
asPelvic abscessIf the perforation breaks into the abdominal cavity, there is often a change in the general situation at the same time, and immediate infusionblood transfusion, correct electrolyte disorder, correctshockIncluding intravenous drip of antibiotics and dexamethasone.While correcting the general condition of the body, laparotomy should be carried out as soon as possible to remove pus and abscess.After the operation, silicone tubes were placed on both sides of the lower abdomen for drainage.After operation, gastrointestinal decompression and intravenous drip of broad-spectrum antibiotics were used to continue to correct dehydration and electrolyte disorders,blood transfusionTo improve the body's resistance.
Chronic salpingitisThe onset may be chronic, or it may be the result of the untreated acute inflammation.It can be divided into chronic interstitial salpingitis, isthmus nodular salpingitis, pysalpinxHydrosalpinx, oviduct hematocele, etc.It is often delayed and difficult to cure, and its symptoms are mainly caused by pelvic adhesion caused by inflammation. Most of the infected pathogens have disappeared, so symptomatic treatment is often used, such as rest, nutrition enhancement, and physical therapy.
