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目的探讨宫腔积脓并子宫穿孔的原因、诊断及治疗方法。方法对孝感中心医院收治的5例宫腔积脓并发子宫穿孔的患者的临床表现及治疗进行回顾性分析。结果 5例宫腔积脓并发子宫穿孔均发生于绝经后妇女,首发症状为阴道流液和(或)下腹疼痛,症状不典型,易与消化道穿孔及其他外科急腹症相混淆。引起宫腔积脓并子宫穿孔的原因与卫生条件差、子宫内膜炎、宫颈癌和子宫内膜癌有关。5例患者均采取手术治疗,手术方式为子宫修补术为主,除1例术后放弃治疗外,其余4例术后预后良好。术后病原学检查均为阳性,病理诊断以感染和恶性肿瘤为主。结论绝经妇女宫腔积脓并发子宫穿孔病情进展缓慢,临床症状不典型,容易误诊,应针对原因进行预防,及时采取保守性手术,术后根据病原学和病理学诊断进行后续治疗至关重要。
Objective To investigate the causes, diagnosis and treatment of uterine empyema and uterine perforation. Methods A retrospective analysis was performed on the clinical manifestations and treatment of 5 cases of uterine empyema complicated with uterine perforation admitted to Xiaogan Central Hospital. Results 5 cases of uterine empyema complicated by uterine perforation occurred in postmenopausal women, the first symptom of vaginal fluid and (or) abdominal pain, the symptoms are not typical, easily confused with gastrointestinal perforation and other surgical acute abdomen. The causes of uterine empyema and uterine perforation are related to poor hygiene, endometritis, cervical cancer and endometrial cancer. All the 5 patients were treated by surgery. The surgical method was uterine repair. Except for one case, the other 4 cases had good prognosis after operation. Postoperative etiological examination were positive, pathological diagnosis of infection and malignant tumors. Conclusions The progress of uterine empyema complicated with uterine perforation in postmenopausal women is slow, the clinical symptoms are not typical, it is easy to be misdiagnosed, prevention should be done according to reasons, and conservative surgery should be taken in time. Postoperative follow-up treatment based on etiological and pathological diagnosis is very important.