盆腔脓肿腹腔镜手术治疗进展

盆腔脓肿是育龄妇女最常见的急腹症之一,传统的抗生素保守治疗往往使病情迁延难愈,部分患者保守治疗失败仍需手术治疗。盆腔脓肿不仅引起慢性盆腔疼痛,还影响女性生殖和内分泌功能,病情严重者甚至危及生命。腹腔镜是诊断盆腔脓肿的金标准。与开腹手术相比,腹腔镜手术安全有效,早期手术患者从手术时间、术中出血量、术后体温恢复、肠道功能恢复等均提示病程明显缩短、症状缓解,且远期输卵管复通率高,更有机会保留子宫、附件,改善女性的生殖内分泌功能,减少盆腔炎复发,提高生活质量。临床上应筛选预期单纯抗感染治疗无效的患者以及年轻有生育要求的女性及早施行腹腔镜手术,个体化制定手术术式。由于盆腔脓肿手术相对复杂,建议由熟练掌握腹腔镜技术的妇科医师来完成手术。

Progress in Laparoscopic Treatment of Pelvic Abscess

Pelvic abscess is one of the most common acute abdominal diseases in women of childbearing age. Traditional antibiotic conservative treatment is usually delayed and difficult to completely cure. Some patients can fail conservative treatment and switch to surgery. Pelvic abscess not only causes chronic pelvic pain, but also affects female reproductive and endocrine functions. Severe cases can endanger the patient′s life. Laparoscopy is the gold standard for the diagnosis of pelvic abscess. Compared with open surgery, laparoscopic surgery is safe and effective. In patients undergoing early operation, the course of disease was significantly shortened and symptoms were alleviated in the aspects of operation time, intraoperative blood loss, postoperative body temperature recovery and intestinal function recovery. Patients have a high rate of tubal recanalization, and have more chances to retain the uterus and appendix, improve reproductive endocrine function, reduce pelvic recurrence, and improve quality of life. Laparoscopic surgery should be performed as early as possible in patients who are expected to fail in simple antibiotic conservative therapy and in young women with fertility requirements. In addition, individual surgical procedures should be formulated. Because the operation of pelvic abscess is relatively complicated, it is recommended to be performed by a gynecologist who is proficient in laparoscopic techniques.