女性盆腔血栓性静脉炎的诊疗特点

女性盆腔静脉炎为妇产科感染的严重并发症,其病情复杂多变,常见两种类型,即血栓性静脉炎和静脉血栓形成,是一种疾病的不同阶段.血栓与管壁黏着较松,易于脱落形成肺动脉栓塞等严重并发症;也可引起远期疾病,皮肤褪色、关节和病变附近增粗或溃疡不愈合、潜在的穿透性出血、疼痛、感染或炎症、深静脉功能不全等.由于女性围生期的生理改变,以及部分患者合并遗传性血栓形成倾向,使产后成为女性患者深静脉血栓形成的高危期….产后盆腔静脉炎多发生在产褥感染的同时或之后,累及的静脉包括卵巢静脉、子宫静脉、髂内静脉、髂总静脉及阴道静脉,以卵巢静脉炎和髂静脉炎多见.妇科手术尤其是恶性肿瘤术后的患者也是血栓性静脉炎的高危人群.     

盆腔和下肢血栓性静脉炎的诊断和治疗

盆腔和下肢血栓性静脉炎（ｐｅｌｖｉｃａｎｄｌｏｗｅｒｅｘｔｒｅｍｉｔｉｅｓｔｈｒｏｍｂｏｐｈｌｅｂｉｔｉｓ）是一种极为严重的盆腔感染合并症。临床经过险恶，病情危笃，如不及时诊断和治疗，一旦发生脓毒败血症，病人常因体质过度消耗，全身衰竭而死亡。本病最...     

妊娠及产褥期血栓性静脉炎12例分析

妊娠及产褥期血栓性静脉炎是产科严重并发症之一 ,因其病情复杂多变、且感染血栓易脱落随血液循环运行可致肝、肾、脑脓肿或肺血栓栓塞 (ＰＴＥ) [1] ,从而引起脓毒血症致猝死 ,严重危及孕产妇生命 ,故需引起高度重视。现将我院诊治血栓性静脉炎 12例 ,分析报告如下。1　临床资料1 1　一般资料　 1989年 1月至 1996年 12月 ,我院产妇分娩总数 10 5 38例 ,其中血栓性静脉炎 12例 ,发病率占0 11%。本报道罹病者均为足月妊娠之初产妇 ,年龄 2 3～2 6岁 ,平均年龄 2 4 5 8岁。发病诱因 :妊高征 5例(41 7% ) ,其中 1例为妊娠期糖尿病并发妊高征 …     

妊娠合并静脉血栓和血栓性静脉炎

妊娠合并静脉血栓和血栓性静脉炎是一类可能危及母亲生命的严重疾病。孕期特殊凝血状态致其在妊娠期易发。其临床表现差异性大,有一定的隐匿性。常用的检测方法有静脉超声和静脉造影。应加强对高危妊娠妇女的筛查和预防,对于已形成血栓的患者加强抗凝治疗以及围产期、产褥期监管。     

脓毒性盆腔血栓性静脉炎

脓毒性盆腔血栓性静脉炎(Septic pelvicthrombophlebitis,SPT)是一严重但幸而少见的盆腔感染合并症。SPT 是指由于感染引起的盆腔静脉血栓,故与深静脉栓塞有明显区别。此病最常见于产褥感染或流产感染,也可见于手术后感染,少数发生于输卵管卵巢脓肿病例。一、病理SPT 主要由厌氧类杆菌和厌氧球菌感染引起。最初,感染起于子宫或附件,扩展至子宫肌层静脉和阔韧带血管,受累的静脉内膜被细菌侵犯而受损害引起血栓,此后细菌侵入血栓,盆腔多个部位发生感染性血栓,卵巢静脉和髂内静脉累及的机会相等。卵巢静     

韩志河老师治疗曲张性静脉炎经验总结

韩志河,男,1936年生。现为研究生导师、主任中医师、教授。历任河北省中医药专家学术经验继承工作第一批指导老师、河北省优秀中医药临床人才培养项目指导老师及第四批全国老中医药专家学术经验继承工作指导老师。韩老师临床经验丰富,擅长治疗周围血管病、心脑血管病、风湿病、糖尿病及并发症、不孕症等各科疑难杂症。曲张性浅静脉炎是静脉曲张的三大并发症之一。     

剖宫产术后并发血栓性静脉炎致肺梗死1例

患者24岁,G3P0。末次月经2005-06-20,预产期2006-04-14。孕期产检无异常。孕40周 3入院待产。既往体健,无血栓病史、慢性心肺疾病史及静脉曲张病史,父亲有脑血栓病史。入院查体:一般情况可,心肺未见异常。宫高34cm,腹围94cm,胎方位ROA,胎心136/min。实验室检查:入院时血小板323×109/L,红细胞压积0.273。血凝常规正常范围。心电图正常。诊断:G3P0,孕40周 3,ROA。因“胎儿窘迫”急诊于联合麻醉下行子宫下段剖宫产术终止妊娠。术后预防感染。术后体温波动在38~39℃之间持续不退。术后第2天始下床,第3天下午出现双下肢略水肿乏力,行走困难…     

低分子右旋糖酐联合丹参治疗产后血栓性静脉炎20例体会

我站自1990～1998年收治产后血栓性静脉炎20例，采用低分子右旋糖酐、复方丹参注射液、山莨菪碱联合治疗，效果满意，现报告如下。     

妇科盆腔手术后下肢深静脉血栓形成的回顾分析和前瞻性研究

目的:探讨妇科盆腔手术后并发下肢深静脉血栓(LEDVT)形成的潜在危险因素及预防措施。方法:回顾分析2009年1月至2011年12月于同济大学附属同济医院住院并行盆腔手术的4319例妇科患者的临床资料,其中术后发生LEDVT者358例,分析可能的危险因素并总结治疗经验。对2012年1至12月于我院拟行盆腔手术的1561例患者按潜在的危险因素预防治疗,分析其预防及治疗效果。结果:回顾性研究中,盆腔手术后LEDVT的发病率为8.3%;高龄、高脂血症、手术时程5h以及术后卧床时间7d可能是盆腔手术后发生LEDVT的危险因素。对拟行盆腔手术并伴有高危因素的117例患者进行预防治疗,7例术后发生LEDVT,发生率为0.45%。7例术后发生LEDVT者采取一般治疗与药物治疗,其中6例无效,需行手术治疗。发生LEDVT患者的术后卧床时间显著长于无发生LEDVT者。回顾分析中确诊PE 32例,前瞻性研究中均无PE发生。结论:血液呈高凝状态、血流缓慢及血管壁的损伤是血栓形成的主要因素,对有LEDVT形成的高危因素的患者采取预防性治疗可有效减少其发生并取得理想的治疗效果。     

IUDs and pelvic infection

The risk of pelvic infection in wearers of IUDs is discussed from the viewpoint of criteria used in epidemiology to indicated cause and effect. There are 3 types of statistical associations in epidemiology: spurious, or false associations; indire ct associations acting through another factor; and causal, by which exposure leads to the outcome. The evidence for IUDs leading to pelvic infection is reviewed using the criteria listed by Hill. First, a large relative risk: reported risks range from 1.5-12, usually 3-5, are not considered due to bias. Second, consistent association across all types of studies: this has been true until recently. Third, specificity of effect, meaning one exposure leads to a single outcome: this is not true for pelvic infection, which is influenced by many factors. Fourth, temporal sequence, meaning the exposure must precede the outcome; although temporal association does not prove causal association. Fifth, biologic gradient or dose-response: in this case, more infections are associated with briefer rather than longer duration of IUD use. Sixth, plausibility: that IUDs could cause infection seem plausible. Seventh, experimental or analogous argument: there are no relevant laboratory models for IUDs in women, nor can IUDs be considered like a foreign body in other tissues. Since PID is sexually transmitted, the literature on IUDs and infection is confounded by use of comparison groups with artificially low infection rates. Diagnosis of PID, and even hospitalization rates in IUD users are inflated because of subjective bias against IUDs with respect to PID, leading to selection bias in epidemiologic studies. Three recent well-designed studies with sexually active controls not using contraceptive methods that protect against STDs show no increase in incidence of PID in IUD users.     

Sonography of pelvic infection

Ultrasound is the most valuable imaging modality in evaluating the female presenting with pelvic infection The appropriate interpretation of the ultrasound study requires correlation with the patient's clinical history and laboratory values. Pelvic sonography is commonly performed in patients with a clinical diagnosis of pelvic inflammatory disease. Sonography can also help to distinguish acute from chronic abnormalities in the fallopian tubes. Though the study may be normal or sometimes non-specific, there are a variety of findings that are characteristic of this process. Understanding of the sonographic features of pelvic inflammation, salpingitis, pyosalpinx, tubo-ovarian complex and tubo-ovarian abscess will allow the interpreter to make more specific, clinically useful diagnoses.     

Pregnancy outcome following pelvic infection

To determine whether a previous pelvic infection has an effect on the outcome of a subsequent pregnancy, we identified women with a diagnosis of pelvic inflammatory disease (PID), amnionitis, and postpartum or postabortal endometritis-salpingitis by a retrospective chart review of all patients admitted to the Department of Obstetrics and Gynecology at The New York Hospital-Cornell Medical Center between 1975 and 1977 and between 1985 and 1988. Antimicrobial regimens effective against Chlamydia trachomatis were initiated in 1985. Controls were randomly selected patients presenting during the same time period for routine examinations who had normal Pap smears and no infections. Both groups were comparable for age, race, gravity, and parity. Differences were evaluated by chi square analysis, using the Yates correction factor. We identified 183 women with a history of the above infections who subsequently conceived, and 82 controls. There were no differences in outcome between the two index groups. Term vaginal deliveries occurred in 14.2% of the women with a prior pelvic infection and in 56% of the controls (P < 0.001). Among the 97 women who had had PID, 21 (21.6%) had a spontaneous abortion in the subsequent pregnancy, as opposed to 6 (7.3%) of the controls (P = 0.013). In addition, eight of the women with PID (but no controls) went into preterm labor (P = 0.021). An increased incidence of preterm labor (P = 0.001) was also observed in women with a history of amnionitis. A history of endometritis was not associated with an increased prevalence of abnormal outcome in subsequent pregnancies. PID and amnionitis may adversely affect the outcome of subsequent pregnancies.     

Contraception and pelvic infection in women

Although sexually transmitted diseases are a major public health problem at the international level, the relationship between contraception and pelvic infection is seldom examined. Numerous STDs are more difficult to diagnose, more frequent, and more serious in women than in men. Differential diagnosis between pelvic infection and other intraabdominal syndromes has been a concern for practitioners for years, and many pelvic infections are probably never diagnosed. Lower abdominal pain and sensitivity as well as fever, leucocytosis, accelerated sedimentation rate, inflammatory annexial mass evident on sonography, and microorganisms in the pouch of Douglass and presence of leucocytes in the peritoneal fluid are diagnostic criteria. Apart from errors in treatment resulting from errors in diagnosis, pelvic infections are often inadequately treated, especially in the initial phase before symptoms are confirmed. The exact incidence of pelvic infections in the US is unknown, but pelvic inflammatory disease (PID) accounted for over 200,000 hospitalizations per year between 1970-75. PID carries grave risks of subsequent ectopic pregnancy, chronic pelvic pain, and infertility which is more likely as the number of acute episodes increases. The female genital tract has diverse microenvironments propitious for growth of microorganisms of different types, aerobic and anaerobic. Each anatomic site has specific features conditioning bacterial growth. Histological modifications during the menstrual cycle and pregnancy affect the microbial flora. Except in the case of gonorrhea, it is not known how many female lower genital tract infections spread to the upper tract. Since 1970, several studies have domonstrated a growing diversity of cervical and vaginal flora in asymptomatic subjects. The principal risk factors for PID have been well described in the literature. All contraceptive methods except the IUD provide some degree of protection against PID. Even among IUD users the risk of PID is probably not greater than among women with a comparable risk of exposure to STDs. The protective effect of condoms has been recognized since the era of Casanova, but it is difficult to quantify. Studies describing the protective effects of spermicides used one against pelvic infection are very rare, and protective effects have usually been demonstrated only in vitro. Surfactants such as nonoxynol probably have viricidal properties against herpes simplex. Condoms and diaphragms have been seen to exercise a protective effect independent of spermicide, with relative risks of .6 and .4 compared to nonouse of contraception. There is as yet no consensus on changes in risk of PID during oral contraceptive (OC) use, but several studies have shown OCs to have a protective effect. Risks of PID in IUD users apparently stem from contamination during insertion or of the thread during prolonged use, but both possibilities remain controversial. The use of women not using contraception as controls in studies of relative risks of PId may not be appropriate because their sexual behavior and risks of exposure to STDs may differ. At the moment of ovulation, when the mucus is most receptive, IUDs do not place any barrier in the way of ascension of sperm and bacteria to the upper genital tract.     

应用网片盆底重建手术术后感染的防治

与传统治疗女性盆底功能障碍性疾病的术式相比,经阴道网片置入术可以明显降低复发率。但网片相关的并发症也日益凸显。文章针对与网片相关的感染的发病率、临床表现、高危因素、预防与诊治进行了详细的阐述。