Pelvic Inflammatory Disease

A dramatic increase in the incidence of pelvic inflammatory disease in recent years has led to a parallel increase in consequent infertility. The economic and psychologic costs of infection and infertility are severe and preventable. The author reviews and outlines current diagnostic and therapeutic recommendations that are now being used to prevent infectious morbidity. A brief review of the indications, techniques, and prospects for surgical correction of tubal disease and pelvic adhesions is also presented.     

Intrauterine Devices and Pelvic Inflammatory Disease

Summary: There is convincing clinical evidence that PID is more common in IUD users than in users of other contraceptive methods. There appears to be a smaller but significant increase when IUDs are compared with sexually active noncontraceptive users. However, the incidence of PID severe enough to warrant hospitalization is only of the order of 1 to 2 per 1,000 women per year. The question which remains is whether beyond this low figure of moderate and severe desease there is a much higher incidence of subclinical PID which may result in complications for IUD users. Development of a marker such as C-Reactive protein or the split complement component C3d to detect mild PID would prove invaluable in the elucidation of several crucial problems in the clinical management of women using IUDs.     

盆腔炎动物模型建立及应用进展

盆腔炎性疾病(PID)是困扰广大生育期女性的多发病.建立一个适宜的动物模型,对于了解PID的临床发病机制、药物的评价监测以及疫苗开发利用都起着极为重要的作用.目前盆腔炎动物模型建模方法较多,建立的模型在应用方面有一定局限性,尚需进一步研究完善.综述PID动物模型的建立及其应用情况.     

Pelvic Inflammatory Disease: Risk Factors and Microbial Etiologies

Objective: To review the risk factors and microbial etiologies of pelvic inflammatory disease (PID).
Data sources: Include 77 current and historical references on PID, PID risk factors, and sexually transmitted diseases.
Study selection: 34 studies that address specific research questions.
Data extraction: Data were used from studies whose methodologies are discussed.
Data synthesis: This review identifies research problems regarding the definition, diagnosis, and identification of microbial profiles and risk factors of PID.
Conclusions: More reliable diagnostic criteria for the varied clinical presentations of this polymicrobial infection are needed. PID is a disease with multiple, interrelated risks. Education is an important nursing intervention.     

Enterobius Vermicularis-Associated Pelvic Inflammatory Disease in a Child

BackgroundEnterobius vermicularis is the most highly prevalent intestinal worm in childhood and is generally considered of low pathogenicity. Little is known about the inflammatory complications of the female genital tract induced by E. vermicularis in childhood.CaseA case of E. vermicularis-associated pelvic inflammatory disease with right salpingitis mimicking acute abdomen due to appendicitis in an 11-year-old girl is presented.ConclusionE. vermicularis-related pelvic inflammatory disease should be included in the differential diagnosis of abdominal pain in children. Increased awareness is necessary to avoid an unnecessary surgery and to choose the correct antibiotic treatment.     

Ascites - an Unusual Association with Pelvic Inflammatory Disease

Summary: A case is reported of clinically subacute pelvic inflammatory disease associated with exudative ascites, which resolved after laparoscopic restoration of pelvic anatomy and antibiotic therapy.     

Mycoplasma genitalium as a Cause of Pelvic Inflammatory Disease

BackgroundMycoplasma genitalium is an increasingly recognized cause of pelvic inflammatory disease (PID).CaseA 17-year-old female adolescent presented with chronic pelvic pain and dysmenorrhea. Test results for Chlamydia trachomatis and Neisseria gonorrhea were negative, and multiple radiologic test results were normal. The patient failed several empiric courses of therapy over 1 year. Laparoscopy revealed findings consistent with PID. Nucleic acid amplification test results were positive for M genitalium.Summary and ConclusionM genitalium causing PID can be challenging to diagnose because of its often atypical presentation. Further epidemiological studies are needed to understand the burden of disease and to establish testing and treatment guidelines.     

康妇炎胶囊治疗盆腔炎性疾病的临床观察

目的:探讨康妇炎胶囊用于治疗女性盆腔炎性疾病(PID)的疗效.方法:选择北京7家医院门诊438例PID患者,依据症状、体征、实验室检查指标进行病情轻重评分,随机分为6组,分别为单纯口服抗生素(A组)、口服抗生素+妇乐颗粒(B组)、口服抗生素+康妇炎胶囊(C组)、单纯静脉使用抗生素(D组)、静脉使用抗生素+妇乐颗粒(E组)、静脉使用抗生素+康妇炎胶囊(F组),治疗后再次进行病情评分,比较6组患者的治疗效果.结果:A组治疗有效率最高为第7天的17.33％,从第7天开始,有效率逐渐下降,且差异有统计学意义(P =0.003).C组治疗有效率在第56天达76.12％,且第28天、第56天疗效基本稳定,C组有效率明显优于A组,差异有统计学意义(P =0.000).从第28天起,C组有效率明显优于B组,差异有统计学意义(P =0.000).F组在第28天及第56天有效率与D组、E组比较,差异均有统计学意义(P=0.000).治疗前后血常规、生化指标变化差异均无统计学意义.结论:抗生素联合康妇炎胶囊治疗PID效果明显,具有一定优势.     

兔盆腔炎性疾病后遗症模型的制备

目的:制备兔盆腔炎性疾病后遗症模型.方法:选用5～6个月龄未交配雌性兔5只,应用大肠埃希菌和金黄色葡萄球菌混合菌液采用逆行宫腔插管灌注细菌法建立兔盆腔炎性疾病后遗症模型.定期监测模型动物血常规、体温、体质量等指标,腹腔镜下观察兔盆腔炎症进展过程,取兔全子宫双输卵管行病理检查.结果:5只兔全部成功注入混合菌液,注射细菌3...     

Pelvic Inflammatory Disease in Virginal Adolescent Females without Tubo-Ovarian Abscess

Pelvic inflammatory disease (PID) is an infection of the upper genital tract that is often caused by an ascending sexually transmitted infection. The complications of PID include pyosalpinx and tubo-ovarian abscess, infertility or ectopic pregnancy, and chronic pelvic pain of varying degrees. These sequelae underscore the importance of prompt diagnosis. We present 2 cases of PID in young women who denied any history of sexual activity or sexual abuse. Both cases were brought to the operating room with suspected appendicitis; however, laparoscopic evaluation revealed purulent fluid surrounding the pelvic organs. The literature is scant with respect to PID in the virginal patient. It is important to keep pelvic infection in the differential diagnosis of virginal patients who present with clinical symptoms of an acute abdomen.     

腹腔镜在诊断和治疗盆腔炎症性疾病方面的应用

盆腔炎性疾病是一组多病原学引起的生殖道感染性疾病,主要包括子宫内膜炎、输卵管炎、输卵管卵巢脓肿和盆腔腹膜炎。盆腔炎性疾病临床表现轻重不一,临床诊断准确性不高。若未能得到及时正确的诊治,盆腔炎性疾病易引起一系列后遗症,包括不孕、异位妊娠、慢性盆腔痛及炎症反复发作等,严重影响女性身心健康。腹腔镜是目前评价盆腔炎性疾病的金标准,尤其对于急性盆腔炎性疾病,不仅可以明确诊断,术中可同时获得病原微生物检测的样本,并且在诊断同时可对盆腔病变进行相应手术治疗。     

Perioperative Complications of Laparoscopic versus Open Surgery for Pelvic Inflammatory Disease

Study ObjectiveTo compare complications in patients undergoing laparoscopic vs open surgery for acute pelvic inflammatory disease (PID).DesignWe performed a retrospective cohort study of patients who underwent surgery for PID, using the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2015. Propensity score matching was used to balance baseline characteristics and compare complications in patients who underwent laparoscopic vs open surgery.SettingSurgical management of acute PID.PatientsPatients with a preoperative diagnosis of PID were identified using International Classification of Diseases, Ninth Revision, codes. We excluded patients with chronic PID, gynecologic malignancy, and those for whom the surgical route was unknown.InterventionsSurgery for acute PID.Measurements and Main ResultsThe study included 367 patients. The mean age was 43.0 ± 11.1 years, body mass index was 30.9 ± 11.2 kg/m², and American Society of Anesthesiology class was 2 (interquartile range 2–3). Preoperative signs of sepsis were noted in 33.8% of the patients, and septic shock was present in 1.4%. Hysterectomy was performed in 67.6%, oophorectomy in 12.0%, and salpingectomy in 4.6%. Complications were experienced by 114 patients (31.1%), 11 (3.0%) of which were potentially life-threatening. Multivariate logistic regression identified the following to be independently associated with complications: laparoscopy (adjusted odds ratio [aOR] 0.48; 95% confidence interval [CI], 0.3–0.8; p <.01), operative time (aOR 1.01; 95% CI, 1.00–1.01; p <.01), appendectomy (aOR 2.36; 95% CI, 1.0–5.4; p = .04), elevated international normalized ratio (aOR 2.30; 95% CI, 1.3–4.2; p <.01), and low hematocrit level (aOR 2.53; 95% CI, 1.4–4.5; p <.01). Propensity scores were calculated and used to generate a matched cohort of patients who underwent laparoscopic vs open surgery; the groups were similar, with p <.05 for all covariates. After balancing confounding variables, a laparoscopic approach to surgery remained significantly associated with a lower risk of complications (coefficient –0.07; 95% CI, –0.11 to –0.02; p = .008).ConclusionLaparoscopy was associated with lower complication rates than open surgery in this well-matched cohort of patients who underwent surgery for acute PID.