Pelvic connective tissue inflammation

Introduction to pelvic connective tissue inflammation Pelvic connective tissue inflammation pelvic inflammatory disease, can be divided into acute and chronic: 1. Acute pelvic connective tissue inflammation pelvic connective tissue is extraperitoneal tissue, located behind the pelvic peritoneum, both sides of the uterus and the anterior bladder gap, these parts There is no obvious boundary between connective tissues. Acute pelvic connective tissue inflammation (acuteparametritis) refers to the initial inflammation of the pelvic connective tissue, not the inflammation of the ovarian and ovary, the connective tissue that originates in the uterus, and then Expand to other parts. 2. Chronic pelvic connective tissue inflammation Chronic pelvic connective tissue inflammation due to acute pelvic connective tissue inflammation treatment is not complete, or the patient's poor constitution, inflammation prolonged into chronic. Because the lymphatic vessels of the cervix are directly connected to the pelvic connective tissue, it can also develop into pelvic connective tissue inflammation due to chronic cervicitis. The pathological changes of this disease are mostly pelvic connective tissue from hyperemia, edema, to fibrous tissue, thickened and hardened scar tissue, connected with the pelvic wall, the uterus is fixed and can not move, or the activity is limited, the uterus is often biased The pelvic connective tissue on the affected side. basic knowledge The proportion of illness: 0.02% Susceptible people: women Mode of infection: non-infectious Complications: salpingitis pelvic peritonitis

Causes of pelvic connective tissue inflammation

(1) Causes of the disease

The disease is mostly due to tearing of the cervix or vaginal end during delivery or cesarean section, cervical rupture during difficult cervical dilatation, hematoma around the vaginal rupture during transvaginal hysterectomy, and accidental injury to the uterus during abortion. In the case of cervical wall and other conditions, bacteria enter the infection.

The pathogens of pelvic connective tissue inflammation are mostly streptococcus, staphylococcus, Escherichia coli, anaerobic bacteria, gonococcus, chlamydia, mycoplasma and the like.

1. Streptococcus: Gram-positive Streptococcus, which has the strongest pathogenicity of Streptococcus B, can produce hemolysin and a variety of enzymes, so that the infection spreads, the pus is thin, pale red, and more. The bacteria are sensitive to penicillin, and group B hemolytic streptococcus is common in postpartum uterine infections.

2. Staphylococcus: postpartum, after cesarean section, infection after gynecological surgery, wounds with staphylococcus, golden yellow, white, lemon color 3, strong pathogenicity, pus yellow, thick, odorless, It is easy to produce resistance to commonly used antibiotics. It is ideal according to the drug sensitivity test. Penicillin-resistant Staphylococcus aureus is sensitive to cephalosporin V, clindamycin, vancomycin and chloramphenicol.

3. Escherichia coli: Gram-negative bacteria, the bacteria generally do not cause disease, but if the body is weak, there is trauma, or after surgery, it can also cause more serious infections, often mixed infection with other bacteria, pus Thick, thick and with fecal odor, effective against ampicillin (ampicillin), amoxicillin (amoxicillin), cephalosporin and aminoglycoside antibiotics, but susceptible to drug-resistant strains, preferably based on drug sensitivity test Medication.

4. Anaerobic bacteria: In acute pelvic connective tissue inflammation, Peptostreptococcus can be seen, Bacteroides fragilis, which are mostly derived from colon, rectum, vagina and oral mucosa, and easily form pelvic abscess. Infectious thrombophlebitis, pus with bubbles, with fecal odor, it has been reported that 70% to 80% of abscess pus can cultivate anaerobic bacteria, the use of anaerobic bacteria and aerobic bacteria antibiotics such as penicillin should be used , clindamycin, cephalothin V, cephalosporin, second-generation and third-generation cephalosporins, metronidazole, etc.

(1) Bacteroides fragilis: Gram-negative bacilli, often accompanied by severe infections and easy to form abscesses, pus often with fecal odor, microscopically, plaque-negative bacilli can be seen, uneven coloration, Gram-negative bacilli It is not sensitive to penicillin, the first generation of cephalosporin and aminoglycoside drugs, and sensitive to metronidazole and clindamycin.

(2) Digestive Streptococcus and Digestive Cocci: It is an anaerobic Gram-positive cocci, which is more pathogenic, more common in postpartum, salpingitis after cesarean section and after abortion, pelvic connective tissue inflammation, pus with fecal odor Gram-positive cocci are visible, and the bacteria are sensitive to metronidazole, clindamycin and cephalosporin.

5. Tuberculosis: Tuberculosis, which is more common in other organs, is rare in pelvic connective tissue inflammation.

6. Pathogens of sexually transmitted diseases: gonococcus, chlamydia and mycoplasma are pathogens of concern to obstetricians and gynecologists in the 1980s. Chlamydia is a microorganism that is different from viruses and develops in host cells; Mycoplasma It is a microorganism between bacteria and virus. It has no cell wall and is highly pleomorphic. It is a kind of normal flora and is sensitive to tetracycline. This pathogen can sometimes be found in acute pelvic connective tissue inflammation.

(two) pathogenesis

After acute pelvic connective tissue inflammation, local tissue appears edema, hyperemia, and a large amount of white blood cells and plasma cells infiltrate, the inflammation occurs at the beginning of the genital damage, such as damage from the uterine neck into the cervix One side of the pelvic connective tissue can gradually spread to the connective tissue on the opposite side of the pelvic cavity and the first half of the pelvic cavity. The inflamed part is easy to purulent, forming an abscess of varying sizes. If not controlled in time, inflammation can pass through the lymphatic to the fallopian tube, ovary or Diffusion in the armpit, because the pelvic connective tissue is close to the pelvic blood vessels, can cause pelvic thrombophlebitis, and now there are more broad-spectrum antibiotics, the masses have a wider understanding of the disease, can be treated early, and thrombophlebitis has occurred. Not much.

If the abscess is formed in the broad ligament, the drainage of the pus can not be cut in time. The abscess can be ruptured to the vagina, bladder, and rectum. The high abscess can also cause diffuse peritonitis to the abdominal cavity. The sepsis causes the disease to deteriorate rapidly, but the drainage After patency, the inflammation can gradually disappear, such as poor drainage, can also cause long-term unhealed sinus.

Pelvic connective tissue inflammation prevention

Prevention of pelvic inflammatory disease: PID can come from postpartum, cesarean section, abortion, and gynecological surgery. Therefore, it is necessary to do a good job in publicity and education, pay attention to the constitution during pregnancy, reduce local damage during childbirth, and operate lightly on the injured part. Pay attention to local disinfection, weak resistance of genital organs during menstrual period, open cervix, easy to cause ascending infection, so surgery should be avoided. Before the operation, the patient's physique should be examined in detail, whether there is anemia or other organ infections, etc. It should be treated later.

In addition, there are some PIDs that occur after pelvic surgery. In the past 20 years, there has been a large amount of data in China and abroad. After the prevention of antibiotics by transabdominal or transvaginal hysterectomy, the prevalence and postoperative infections are obvious. Decline, gynecological perioperative period should use broad-spectrum antibiotics, commonly used ampicillin (ampicillin), cephalexin, cefazolin, cefoxitin, ceftime, cefotetan, ceftriaxone (cefatriazine) Etc., most scholars advocate that antibiotics should be administered intravenously at an induction period of anesthesia, 30 minutes before surgery. After 20 minutes, the concentration of antibiotics in the tissue can reach a peak. If necessary, add anti-anaerobic antibiotics such as metronidazole, tinidazole, gram. Linmycin, etc., if the operation is more than 60 ~ 90min, the second drug is given within 4h, cesarean section can be administered after clamping the umbilical cord, and anti-anaerobic drugs such as metronidazole and tinidazole can be used. The dosage and frequency of clindamycin, etc., must be determined according to the type of lesion, the complexity of the operation, and the age of the patient.

Other operations that can cause PID common include all kinds of instruments that need to be inserted into the uterine cavity operation, such as artificial abortion, release, looping, hysterosalpingography, etc. In the United States, 1 million cases of early pregnancy induced abortion, upper reproductive The proportion of infections is close to 1:200. Therefore, it is recently proposed to apply prophylactic antibiotics before high-risk abortion to reduce the occurrence of iatrogenic PID. Recent studies by PEACH (PID assessment and clinical health) confirmed that IUD The use of (IUD) was significantly associated with histologically confirmed endometritis in patients with acute PID, but some scholars reviewed the literature and suggested that the incidence of PID after placement of IUD is very low, even if it occurs. In the first few months, most of the symptoms are mild, and there is no need to prescribe prophylactic antibiotics before surgery. Antibiotics also do not reduce the incidence of PID. Before the family planning operation involving the uterine cavity, we need to routinely check the vaginal cleanliness. Insects, fungi, etc., have been found to have vaginal inflammation before treatment, may help prevent postoperative PID.

The history of sexual disorder is an important factor leading to PID. The awareness and education of sexually transmitted diseases among young women and their sexual partners should be strengthened, including delaying the time of first sexual intercourse, the number of restrictive partners, and avoiding sexually transmitted diseases. Sexual contact, adherence to the use of barrier-type contraceptives, active diagnosis and treatment of uncomplicated lower genital tract infections, etc. Some scholars have suggested that the screening of Chlamydia pneumoniae infection can reduce the risk of PID occurrence to 0.44.

Pelvic connective tissue inflammation complications Complications Fallopian tube pelvic peritonitis

Peripheral tissue adhesions and often associated with inflammation of the ovaries, pelvic peritoneum, acute fallopian tubes.

Symptoms of pelvic connective tissue symptoms Common symptoms: lower back pain, lower back pain, dysuria, abdominal pain, high fever, nausea

1. Acute pelvic connective tissue inflammation: In the early stage of inflammation, patients may have high fever, lower abdominal pain, body temperature up to 39 ~ 40 ° C, lower abdominal pain and acute tubal oophoritis, such as a history of disease before the onset of a total hysterectomy, There was a single wall or double wall injury during cesarean section. The diagnosis was more easily obtained. If abscess was formed, except for fever and lower abdominal pain, rectal, bladder compression symptoms such as frequent frequency, bowel movement, nausea and vomiting were common. Painful urination, frequent urination and other symptoms.

Gynecological examination: In the early stage of the disease, there is obvious tenderness on the side or both sides of the uterus and the thickening of the border is not obvious. The thickening can reach the pelvic wall, the uterus is slightly larger, the activity is poor, tenderness, one side of the vagina or bilateral vaginal fornix May touch the mass, the upper boundary of the mass is often parallel with the bottom of the uterus, and the tenderness is obvious. If the abscess is formed, the abscess flows down into the uterus, and the posterior vaginal fornix often touches the soft mass, and the tenderness is obvious.

2. Chronic pelvic connective tissue inflammation: mild chronic pelvic connective tissue inflammation, generally more asymptomatic; occasionally when the body is tired, there is low back pain, lower abdomen pain, severe cases may have more serious lower abdominal pain, back pain and sexual pain, Gynecological examination, the uterus is mostly posteriorly inclined, and the trigeminal ligament is thickened and stripped in the three-compartment diagnosis. It is tender, and the bilateral para-uterine tissue is hypertrophy and tender. If it is a side, it can be Touching the uterus dislocation, flexing to the affected side, if the frozen pelvis has been formed, the activity of the uterus can be completely restricted.

Examination of pelvic connective tissue inflammation

Blood routine examination, urine routine examination.

When laparoscopic exploration, the most serious part of the lesion should be determined to determine the condition, and the pelvic exudate or pus should be sent to the bacterial culture plus drug sensitivity test, which is helpful for antibiotics after surgery.

Diagnosis and diagnosis of pelvic connective tissue inflammation

Diagnostic criteria

1. Acute pelvic connective tissue inflammation: According to the medical history, clinical symptoms and gynecological examinations are not difficult to diagnose.

2. Chronic pelvic connective tissue inflammation: According to the history of acute pelvic connective tissue inflammation, clinical symptoms and gynecological examination, diagnosis is not difficult.

Differential diagnosis

1. Acute pelvic connective tissue inflammation should be differentiated from the following diseases:

(1) Tubal pregnancy rupture: There is a history of menopause, sudden abdominal pain, pale, acute illness, abdominal peritoneal irritation, a small amount of vaginal bleeding, urinary HCG (+), posterior iliac puncture for blood.

(2) ovarian cyst pedicle torsion: there is a sudden side abdominal pain, with or without a history of tumor, unilateral peritoneal irritation, tenderness, gynecological examination of the uterus touched the mass and tenderness, no history of menopause .

(3) Acute appendicitis: pain occurs slowly, confined to the right lower abdomen, there is tenderness at the McPherson point, and no gynecological examination is seen.

2. Chronic pelvic connective tissue inflammation must be differentiated from endometriosis, tuberculous pelvic inflammatory disease, ovarian cancer and old ectopic pregnancy:

(1) endometriosis: more dysmenorrhea history, and increased month by month, gynecological examination may touch the uterine tibia ligament with tender nodules or lumps on both sides of the uterus, this point and chronic pelvic connective tissue inflammation Different, B-mode ultrasound and laparoscopy can help diagnose.

(2) tuberculous pelvic inflammatory disease: also a chronic disease, many other organs of tuberculosis history, abdominal pain is often persistent, abdominal distension, occasional abdominal mass, sometimes amenorrhea history, can be accompanied by endometrial tuberculosis, X-ray Examination of the lower abdomen showed calcification, the location of the mass was higher than the chronic pelvic connective tissue inflammation.

(3) ovarian cancer: the mass is mostly substantial, hard, irregular surface, often with ascites, patients generally have weak health, advanced cancer also has lower abdominal pain, diagnosis is sometimes difficult, B-ultrasound, laparoscopy, serum tumor Markers and pathological biopsy can help with diagnosis.

(4) Old ectopic pregnancy: more history of amenorrhea and vaginal bleeding, partial pain in the lower side of the affected side, gynecological examination of the uterus with a sticky mass of unclear boundaries, tenderness, B-ultrasound and laparoscopy can help diagnose.

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