摘要目的 探讨盆腔脓肿合并子宫内膜异位症(内异症)的临床特点及诊治策略.方法 回顾性分析2000年1月至2016年1月在中国医学科学院北京协和医院住院治疗的盆腔脓肿患者129例的临床病理资料,其中合并内异症34例(观察组)、单纯盆腔脓肿95例(对照组);比较两组患者的临床特点、诊治过程及预后.结果 (1)一般情况:两组患者的年龄、盆腔包块最大径、术前白细胞计数、术前血CA125水平、宫内节育器在用情况、既往盆腔炎症性疾病史等均无差异(P均>0.05);但观察组痛经(65%,22/34)、合并不孕症(21%,7/34)的比例明显高于对照组[均为7%(7/95)],分别比较,差异均有统计学意义(P<0.05).(2)临床表现:两组均以发热、腹痛、盆腔包块为主要临床表现,观察组和对照组发生感染性休克的比例分别为12%(4/34)和2%(2/95),两组比较,差异有统计学意义(P<0.05).(3)治疗:观察组介入穿刺治疗7例,但均失败转手术治疗(7/7);对照组介入穿刺治疗19例,18例好转出院,1例失败转手术治疗(1/19);两组穿刺治疗失败率比较,差异有统计学意义(P<0.05).观察组和对照组,腹腔镜手术时间[分别为(76±41)、(53±21)min]、术中出血量[分别为(216±296)、(43±36)ml],开腹手术时间[分别为(168±58)、(116±35)min]、术中出血量[分别为(448±431)、(145±24)ml],分别比较,差异均有统计学意义(P<0.05).结论 盆腔脓肿合并内异症病情危重,介入穿刺联合静脉抗生素治疗失败率高,应积极手术治疗;虽然手术困难,但预后比较满意.

abstractsObjective To investigate the clinical features, diagnosis and treatments of pelvic abscess with endometriosis. Methods A retrospective analysis was performed on 129 cases of pelvic abscess in Peking Union Medical College Hospital from January 2000 to January 2016. Among them, 34 women with endometriosis were divided into the study group and the others were in the control group. The clinical characteristics, therapeutic regimens and outcomes were compared. Results (1) General conditions:there were no statistic differences between the two groups in age, WBC, serum CA125, intrauterine device in use, pelvic inflammatory disease history;while incidence rates of dysmenorrhea (65%, 22/34) and infertility (21%, 7/34) in the study group were higher than those in the control group (all P<0.05). (2) Clinical manifestations:fever, abdominal pain and pelvic mass were the main symptoms in two groups. The incidence rates of septic shock were 12%(4/34) in the study group and 2%(2/95) in the control group (P<0.05). (3) Treatment:treatment with puncture all failed in the study group (7/7) and surgeries were required. In contrast, there was only 1/19 treatment failure with puncture in the control group. The puncture failure rates were statistically significant (P<0.05). Compared with the study group and the control group, there were significant differences (P<0.05) in the operation time of laparoscopic surgery [(76±41) versus (53±21) minutes] and of laparotomy [(168±58) versus (116±35) minutes], intra-operative blood loss of laparoscopic surgery [(216±296) versus (43±36) ml] and of laparotomy [(448 ± 431) versus (145 ± 24) ml]. Conclusions Pelvic abscess in women with endometriosis is more severe and refractory to antibiotics and puncture treatment. Active surgical intervention is required. Although surgical procedures are often difficult, prognosis is comparatively satisfied.