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目的探讨绝经后女性宫腔积脓的发病原因及诊治策略。方法回顾性分析2010年1月至2016年1月安徽医科大学第一附属医院收治的31例绝经后宫腔积脓患者的临床资料,包括临床表现、辅助检查结果、病理结果及治疗方法。结果 (1)主要临床表现有下腹痛15例(48.39%)、阴道异常分泌物24例(77.42%)、阴道流血5例(16.13%)。2例并发自发性子宫穿孔(6.45%),分别误诊为卵巢囊肿蒂扭转及胃肠穿孔。27例B超报告宫腔积液或积脓(87.10%)。(2)病原学检查阳性者7例(22.58%),大肠杆菌5例(16.13%),草绿色链球菌2例(6.45%)。病理诊断均为炎性改变(100.00%)。(3)29例抗感染同时行宫颈扩张术或宫腔置管引流术达到临床治愈,自发性子宫穿孔2例行全子宫双附件切除术,治愈率100.00%。结论宫腔积脓可能为子宫内膜炎和宫颈炎引起,根据症状、体征及辅助检查结果可明确诊断。宫腔积脓自发性子宫穿孔应作为老年女性急性腹膜炎的鉴别诊断之一。宫腔积脓首选治疗为抗感染同时行宫颈扩张引流术,并发自发性子宫穿孔时首选手术治疗。
Objective To investigate the etiology and diagnosis and treatment of empyema in postmenopausal women. Methods The clinical data of 31 cases of post-menopausal uterine empyema patients admitted to the First Affiliated Hospital of Anhui Medical University from January 2010 to January 2016 were retrospectively analyzed. The clinical manifestations, the results of auxiliary examinations, the pathological findings and the treatment methods were included. Results (1) The main clinical manifestations were abdominal pain in 15 cases (48.39%), vaginal abnormal secretion in 24 cases (77.42%), vaginal bleeding in 5 cases (16.13%). Two cases of spontaneous uterine perforation (6.45%) were misdiagnosed as ovarian cyst torsion and gastrointestinal perforation. 27 cases of B-report of uterine effusion or empyema (87.10%). (2) Seven cases (22.58%) were positive for etiological examination, five cases (16.13%) were Escherichia coli and two cases (6.45%) were Streptococcus viridans. Pathological diagnosis of inflammatory changes (100.00%). (3) 29 cases of anti-infective cervical dilation or uterine catheter drainage to achieve clinical cure, spontaneous uterine perforation 2 cases of hysterectomy double attachment resection, the cure rate was 100.00%. Conclusions Uterine empyema may be caused by endometritis and cervicitis, according to the symptoms, signs and auxiliary examination results can be a clear diagnosis. Uterine empyema spontaneous uterine perforation should be used as one of the differential diagnosis of acute peritonitis in elderly women. Uterine empyema treatment of choice for anti-infection cervical dilatation and drainage at the same time, the preferred surgical treatment of spontaneous uterine perforation.