中医药综合外治法治疗盆腔炎性疾病后遗症临床效果

正盆腔炎性疾病后遗症(SPID)又称慢性盆腔炎,具有病程长、病情缠绵难愈、易复发等特点,18%的盆腔炎急性发作后会出现慢性盆腔痛,多发生在急性发作后的4~8周,临床主要表现为慢性盆腔痛及盆腔炎性疾病反复发作、不孕症、异位妊娠等~([1])。西医抗菌消炎药物对慢性盆腔疼痛治疗作用有限,肝肾功能损害大,痊愈率低;对盆腔炎性疾病反复发作、药物治疗无效、肿块持续存在或增大甚至脓肿破裂者,需配合手术切除病灶,但术后盆腔囊肿很快复     

抗生素联合中药栓剂治疗盆腔炎性疾病的疗效观察

盆腔炎(PID)是育龄妇女的常见多发病,是指上生殖道的一组感染性疾病,主要包括子宫内膜炎、输卵管炎、输卵管卵巢脓肿、盆腔腹膜炎。若未能及时彻底治疗,可导致不孕输卵管妊娠、慢性盆腔痛以及炎症反复发作,从而影响妇女生[1]     

盆腔炎性疾病发病机制的现代研究

<正>盆腔炎性疾病(pelvic inflammatory disease,PID)是妇科常见病,是指女性上生殖道感染引起的一组疾病〔2006美国疾病预防控制中心(CDC)定义〕,主要包括子宫内膜炎(endometritis)、输卵管炎(salpingitis)、输卵管卵巢脓肿(tubo-ovarian abscess,TOA)和盆腔腹膜炎(peritonitis)。此病缠绵难愈,易反复发作导致盆腔炎的后遗症,包括盆腔     

盆腔炎性疾病的诊治——盆腔炎性疾病的概述

盆腔炎性疾病是常见的妇科疾病，涉及临床范围很广，包括任何合并有子宫内膜炎，输卵管炎，输卵管、卵巢脓肿或盆腔腹膜炎的疾患，大多发生在性活跃期有月经的妇女。本病过去被称为“盆腔炎症”，但为了与英文病名相统一，也为了体现本病为非单一部位的单一疾病，而是一组上生殖道感染性疾病的总称，故将其命名规范为“盆腔炎性疾病”。由于性传播疾病发病率逐年增高，盆腔炎性疾病发病率也逐年上升。盆腔炎性疾病多数为各种病原体的混合感染，可反复发作，患者可发生不孕、异位妊娠、慢性盆腔痛等后遗症，对女性健康有较大危害。     

中药灌肠联合西医治疗盆腔炎性疾病的疗效分析

<正>盆腔炎性疾病(pelvic inflammatory disease,PID)是指女性上生殖道的一组感染性疾病,主要包括子宫内膜炎、输卵管炎、输卵管卵巢脓肿、盆腔腹膜炎,可分为急性和慢性两类。PID病因复杂,病情反复,治疗棘手,能导致育龄妇女不孕、异位妊娠和慢性盆腔痛,严重影响患者的身体健康和生存质量[1]。本文分析2005年1月至2012年12月在浙江省德清县中医医院就诊的300例PID患者采用中药辨证分     

浅析开封市农村盆腔炎性疾病住院治疗患者的发病特征

<正>盆腔炎性疾病(PID)主要包括子宫内膜炎、输卵管炎、输卵管卵巢脓肿(TOA)、盆腔腹膜炎。炎症可局限于一个部位,也可同时累及几个部位,以输卵管炎、输卵管卵巢脓肿最常见。PID若未能得到及时、彻底治疗,可导致不孕、输卵管妊娠以及炎症反复发作,从而影响妇女的生殖健康,增加家庭与社会经济负担[1]。为了解PID的年龄层次以及是否     

慢性盆腔炎的药物治疗

慢性盆腔炎多为急性盆腔炎未能彻底治疗,或患者体质较差,病程迁延所致。但沙眼衣原体长期反复感染时,症状多不明显,形成慢性盆腔炎。由于慢性盆腔炎往往经久不愈,并可反复发作,导致不孕、输卵管妊娠、慢性盆腔痛,严重影响了妇女健康。对慢性盆腔炎的治疗应采取全身与局部综合治     

输卵管性不孕的高危因素分析

目的:探讨输卵管性不孕(TFI)的病因,并为其预防和临床治疗提供参考依据。方法:采用病例-对照研究方法,病例组为在弋矶山医院确诊为输卵管性不孕妇女,对照组为在妇产科人流妇女。两者均填写统一调查表,并检测衣原体(CT)、支原体(UU)。资料采用非条件Logistic回归分析。结果;病例组衣原体、支原体感染(25.7%、18.8%)明显高于对照组(6.7%、2.5%)。危险因素为:初次性生活年龄20岁(OR:3.373)、性伴侣数1人(OR:3.056)、人流史(OR:1.057)、输卵管妊娠史(OR:6.579)、宫颈炎(OR:2.890)、盆腔炎史(OR:6.488)、结核史(OR:4.986)、阑尾炎史(OR:4.915)。结论:UU、CT感染,初次性生活年龄过小、性伴侣多、输卵管妊娠史、宫颈炎、盆腔炎史、结核史、阑尾炎史是输卵管性不孕的危险因素。人流史与TFI无显著相关。     

超短波合并中药治疗慢性盆腔痛疗效观察

慢性盆腔痛（PIP）是女性生殖道炎症引起的一组疾病,包括子宫内膜炎、输卵管炎、输卵管卵巢囊肿和盆腔腹膜炎,病原体包括淋病奈瑟菌、沙眼衣原体、一些需氧菌、厌氧菌、病毒和支原体、PID多是混合感染。延误对PID的诊断和有效治疗都能导致生殖道感染后遗症,包括输卵管因素的不孕症和异位妊娠,我科进行了药物加超短波对PID的疗效研究。报告如下。     

大黄芎香散辅以心理治疗女性盆腔炎性疾病后遗症的疗效观察

目的:探讨中药大黄芎香散辅以心理治疗女性盆腔炎性疾病后遗症的疗效。方法:选择我院2012年12月至2015年4月共收治的162例女性盆腔炎性疾病后遗症患者作为研究对象,回顾这162例患者的临床诊治资料,分析疾病的转归。结果:对于轻、中度慢性盆腔痛的治疗效果,观察组明显优于对照组,差异有统计学意义(P0.05);治疗后6个月炎症复发情况,观察组的复发率4.2%,对照组的复发率27.4%,有显著统计学意义,P0.05;治疗后半年观察组的宫内妊娠率高于对照组,有统计学意义,P0.05。结论:大黄芎香散辅以心理治疗女性盆腔炎性疾病后遗症可以显著缩短病程,减少疾病复发,并提高宫内妊娠率。     

腹腔镜治疗急性盆腔炎的临床评价

目的:探讨腹腔镜手术治疗盆腔炎的安全性及疗效。方法:回顾性分析该院2005年9月～2007年11月住院治疗的急性盆腔炎或慢性盆腔炎急性发作病例45例的临床资料,腹腔镜手术+抗生素治疗组20例,保守治疗组(单纯药物组)25例,分别分析两组疗效。结果:腹腔镜组病人症状缓解时间明显短于药物组,有极显著差异(P<0.01);手术组中,急性盆腔炎病人和慢性盆腔炎急性发作的病人在盆腔粘连程度上,以及需行输卵管或附件切除的例数上均有显著差异(P<0.05)。随访期间手术组术后腹痛比例少于保守治疗组,腹腔镜手术组均未发生严重并发症。结论:具备熟练的腹腔镜操作技术对急性盆腔炎或慢性盆腔炎急性发作行腹腔镜手术是安全的。腹腔镜用于诊断盆腔炎可减少治疗的盲目性,缩短病程及治疗时间,且复发率低,安全有效。     

Opportunistic screening for genital infections with Chlamydia trachomatis in sexually active population of Amsterdam. II. Cost-effectiveness analysis of screening women]

OBJECTIVE: To estimate the cost effectiveness of Chlamydia trachomatis (CT) screening of young women visiting general practitioners. DESIGN: Economic model analysis. METHODS: Data on the health care needs for CT complications were derived from various sources; costing was done using estimated cost prices, charges and the friction cost method; epidemiological data were derived from a pilot study among 22 general practices in Amsterdam, the Netherlands. The analyses were carried out assuming screening with ligase chain reaction test of a urine sample and treatment of identified cases of infection with single-dose azitromycin. The model intervention consisted of screening all heterosexually active women aged 15-19, 15-24, 15-29, or 15-34 years (strategies 1, 2, 3 and 4, respectively). Cost effectiveness was presented in net direct and indirect costs per woman cured and per major outcome averted (pelvic inflammatory disease (PID), chronic pelvic pain, ectopic pregnancy, infertility and pneumonia of newborns). RESULTS: The first two strategies were cost saving. For the third strategy net costs per woman cured and per major outcome averted were almost 110.- Dutch guilders (DFL) and over DFL 300, respectively. The last strategy costs over DFL 320 per woman cured and over DFL 910 per major outcome averted. The cost effectiveness was sensitive to the assumed probability of progression of CT infection to PID. CONCLUSION: Universal implementation of the screening programme investigated in Amsterdam for women aged 15-24 years would result in approximately equal savings and costs. Screening of all 15-29-year-old women would require a net investment of DFL 350,000.     

未育输卵管妊娠发生的相关因素及预防

目的探讨未育输卵管妊娠发生的相关因素及预防措施。方法采用回顾性病例对照的研究方法,对在贵港市港北区人民医院诊治的25例未育输卵管妊娠患者的临床资料进行分析。结果未育输卵管妊娠发生率相比占同期住院输卵管妊娠人数的43.9％。未育输卵管妊娠相关因素有慢性盆腔炎史、盆腔手术史、流产史、不孕史等,未育与已育输卵管妊娠者的差异无统计学意义。结论未育输卵管妊娠发生率比较高,发生与多种因素有关;培养健康的生活方式、避免或减少盆腔手术（包括流产）、治疗盆腔炎、健康性生活等可减少未育输卵管妊娠的发生。     

腹腔镜手术治疗急性盆腔炎的临床价值

目的:探讨腹腔镜手术治疗急性盆腔炎的安全性及疗效。方法:回顾性分析63例急性盆腔炎或慢性盆腔炎急性发作患者的临床资料、治疗效果及复发情况,其中腹腔镜手术组(以下称腔镜组)28例,传统开腹手术组(以下称开腹组)35例。结果:腔镜组与开腹组比较,临床症状缓解、术后72 h体温降至正常、白细胞数降至正常的时间及住院时间均明显缩短,无伤口感染和肠梗阻发生,但有2例发生手术期的严重并发症。开腹组出现7例伤口感染和5例肠梗阻。追踪治疗1年后的39例病人,腹痛或腹部不适减少。结论:腹腔镜手术治疗急性盆腔炎能缩短病程,降低盆腔炎症反应,减少盆腔粘连及慢性盆腔痛,疗效显著,具有较好的临床应用价值,慎重把握好手术时机可降低手术风险。     

Evidence-based guidelines for the management of genital chlamydial infection in general practice. (Leicestershire Chlamydia Guidelines Group).

BACKGROUND: Valid clinical guidelines can be effective in improving patient care. Genital Chlamydia trachomatis infection is the commonest curable sexually transmitted disease (STD) in England and Wales and is an important cause of pelvic inflammatory disease (PID), tubal infertility and ectopic pregnancy. No published guidelines exist on managing genital chlamydial infection in British general practice. OBJECTIVE: We aimed to develop valid guidelines for the management of genital chlamydial infection for use in British general practice. METHODS: A district-wide postal questionnaire survey was used to document current clinical practice. A critical review of the evidence concerning the management of genital chlamydial infection as it relates to British general practice was performed. The information gained from the critical review and survey was used to develop evidence-based guidelines within a multidisciplinary guideline recommendation group. RESULTS: The guidelines covered the diagnosis, investigation, drug treatment and referral of adult male and female patients with genital chlamydial infection in general practice. CONCLUSION: Valid guidelines for the management of genital chlamydial infection have been developed for use in British general practice. Appropriate dissemination and implementation of the guidelines should lead to earlier detection and treatment of men and women with chlamydial infection and thereby reduce the incidence of PID, tubal infertility and ectopic pregnancy in women.     

Pelvic inflammatory disease

This article discusses the etiology, epidemiology, diagnosis, and treatment of pelvic inflammatory disease (PID). PID, which affects at least 1 million women in the US each year, has serious consequences: about 15% of cases become sterile after 1 infection, 15% develop chronic pain requiring surgery, and the ectopic pregnancy rate among women who do become pregnant is 10 times that among women without infection. The goal is to prevent PID by identifying cervicitis and endometritis before salpingitis develops and by advocating contraceptive methods that will reduce attack rates. Also important are prompt, accurate diagnosis and effective therapy. Sexually transmitted organisms are responsible for 50-75% of acute primary spontaneous salpingitis. Epidemiologic factors influence the rate of cervicitis and the development of salpingitis from cervicitis. These factors include age, number of sexual partners, frequency of sexual intercourse, and OC use. OC users have 1/2-1/4 the expected rate of both gonococcal and chlamydial salpingitis. The tremendous range of clinical signs and symptoms makes the diagnosis of salpingitis difficult, implying a need for physical and laboratory determinations. It is suggested that laparoscopy be more widely used to diagnose acute pain. Adequate treatment includes both antibiotic administration and close follow up to assess the clinical response and antibiotic compliance.     

盐酸左氧氟沙星在盆腔炎治疗中的临床疗效及安全性评估

目的:探讨盐酸左氧氟沙星在盆腔炎治疗中的临床疗效及安全性评估。方法:选择以盆腔炎来院治疗的患者156例,其中急性盆腔炎患者80例,慢性盆腔炎76例。按照治疗方法不同可以分为治疗组78例(给予盐酸左氧氟沙星治疗)和观察组78例(给予氧氟沙星治疗)。密切观察两组患者间白细胞计数、体温变化、下腹疼痛程度变化、附件增厚程度及阴道出血情况;密切观察两组患者治疗过程中恶心呕吐、腹痛腹胀、头痛头晕、肝功能异常等不良反应的发生率。结果:治疗组总有效率为87.2%明显高于观察组(64.1%),差异具有统计学意义(P<0.05);治疗组总不良反应发生率为7.8%明显低于观察组(25.6%),差异具有统计学意义(P<0.05)。结论:盐酸左氧氟沙星注射液治疗妇科盆腔炎具有很好的疗效,且不良反应较小,值得临床推广使用。     

Overestimation of complication rates in evaluations of Chlamydia trachomatis screening programmes--implications for cost-effectiveness analyses

BACKGROUND: Cost-effectiveness analyses of screening programmes for asymptomatic Chlamydia trachomatis infection suggest that screening at low prevalences in the population is cost-effective. However, the decision models in these studies are based on assumptions about the risk of complications, which are derived from the literature. Incorrect assumptions may lead to under- or overestimation of the effectiveness of screening. The first objective of this paper is to evaluate the assumptions about the probability of complications after an asymptomatic C. trachomatis infection. The second objective is to calculate alternative rates by using available data on the incidence of complications. METHODS: We identified cost-effectiveness studies via Medline, and evaluated these for the evidence for the quoted probabilities. In addition, the probability of complications was calculated for Amsterdam from available registration data. RESULTS: In the three studies that were identified, the assumptions for the rates of pelvic inflammatory disease (PID) (clinical and subclinical) after C. trachomatis infection varied from 15% to 80%, and for ectopic pregnancy, tubal factor infertility, and chronic pelvic pain after PID from 5-25%, 10-20%, and 18-30%, respectively. The assumptions were based on data from high-risk populations, case-control data, and data not accounting for misdiagnoses. Using data obtained from local registrations, we estimated the probability of a clinical PID (0.43%), ectopic pregnancy (0.07%), and tubal factor infertility (0.02%) for women with a current infection. These estimates were consistently lower than the estimates based on the literature. CONCLUSIONS: We argue that an overestimation of the current complication rates is likely. The effect of overestimation is potentially the greatest in populations with a low prevalence, since the currently assumed cost savings associated with screening may disappear when using more realistic estimates for complications.     

中西医结合治疗慢性盆腔炎性继发不孕症的疗效分析

目的:研究中西医结合方法治疗慢性盆腔炎所致继发不孕症的临床疗效。方法:研究慢性盆腔炎所致不孕症患者共206例,随机分为两组,中西医结合治疗组及单纯西医治疗组,各103例。中西医结合治疗组采用经期抗炎及经间期中药治疗;单纯西医治疗组采用经期抗炎,比较两组继发不孕症患者经治疗后其临床疗效、输卵管造影结果显示正常(双侧输卵管通畅)者以及妊娠率有无差别。结果:轻度、中度慢性盆腔炎患者其中西医结合治疗组(治疗组)的临床疗效、输卵管造影结果显示正常(双侧输卵管通畅)者以及妊娠率明显高于西医治疗组(对照组),有显著性差异(P<0.05),但重度慢性盆腔炎患者两组无显著性差异(P>0.05)。结论:中西医结合治疗轻度、中度慢性盆腔炎所致继发不孕症的疗效明显高于单纯西医治疗组。     

Outpatient management of pelvic inflammatory disease

Pelvic inflammatory disease (PID) is a spectrum of inflammatory disorders of the female genital tract involving at least the endrometrium and may include the fallopian tubes, ovaries, and pelvic cavity. Over 1 million women each year are treated for PID in the United States, and it is one of the most serious infections diagnosed in women due to its sequelae. Women with PID acutely experience pain and are at risk for sepsis; however, the significant increases in ectopic pregnancy and infertility are the most disturbing long-term complications. It most often is initiated with an infection by a sexually transmitted disease, but can also involve a variety of pathogenic aerobes and anaerobes secondarily.