摘要
目的 分析探讨卵巢子宫内膜异位囊肿(OE)破裂合并感染的临床特点及诊疗策略.方法 对 2020 年 1 月—2023 年 1 月收治于宁夏医科大学总医院妇科的 57 例OE破裂合并感染患者的临床特点、诊疗经过及预后进行分析和总结,并结合相关文献对OE破裂合并感染进行探讨.结果(1)临床表现及实验室检查:57 例患者中,48 例表现为腹痛、发热及盆腔包块,51 例患者白细胞(WBC)、C反应蛋白(CRP)、糖类抗原CA 125 均升高.(2)手术方式比较:腹腔镜组共有 39 例,开腹组共有 18 例,两组手术时间、术中出血、术后首次排气时间、术后住院天数、术后切口感染相比,差异有统计学意义(P<0.05).(3)不同术式术后妊娠及复发结局:术后随访率 91.2%(52/57),中位随访时间 14 个月(6～36 个月).腹腔镜组自然受孕者17 例,2 例异位妊娠保守治疗成功,2 例体外受精-胚胎移植(IVF-ET)受孕,自然流产 3 例;7 例患者术后6～24 个月复查彩超发现盆腔囊性占位,2 例再次行囊肿剥除术;12 例无生育要求随访中;3 例失访.开腹组3 例自然受孕,13 例无生育要求随访中,2 例失访.结论 卵巢子宫内膜异位囊肿破裂合并感染患者临床表现缺乏特异性;腹腔镜手术优于开腹手术.
Abstract
Objective To analyze the clinical characteristics and diagnosis and treatment methods of ovarian endometriotic cysts(OE)rupture combined with infection.Methods The clinical characteristics,diagnosis and treatment process,and prognosis of 57 patients with OE rupture complicated by infection admitted to the Gynecology Department of Ningxia Medical University General Hospital from January 2020 to January 2023 were analyzed and summarized,and were discussed with OE rupture complicated by infection in relevant literature.Results(1)Clinical manifestations and laboratory tests:Among the 57 patients,48 showed abdominal pain,fever,and pelvic masses,while 51 patients had elevated levels of white blood cells(WBC),C-reactive protein(CRP),and carbohydrate antigen CA125.(2)Comparison of surgical methods:There were a total of 39 cases in the laparoscopic group and 18 cases in the open group.There were statistically significant differences in intraoperative blood loss,postoperative exhaust time,postoperative hospital stay,and postoperative incision infection between the two groups(P<0.05).(3)Pregnancy and recurrence outcomes after different surgical procedures:The postoperative follow-up rate was 91.2%(52/57),and median follow-up time was 14 months(6～36 months).There were 17 cases of natural conception in the laparoscopic group,2 cases of successful conservative treatment for ectopic pregnancy,2 cases of in vitro fertilization embryo transfer(IVF-ET)conception,and 3 cases of natural miscarriage.Seven patients were found to have cystic masses in the adnexal region during follow-up of 6 to 24 months after surgery,and two patients underwent cystectomy again.12 cases without fertility requirements were under followed up.Three cases were lost to follow-up.In the open abdominal group,3 cases became naturally pregnant,13 cases had no fertility requirements during follow-up,and 2 cases were lost to follow-up.Conclusion The clinical manifestations of patients with ruptured ovarian endometriotic cysts combined with infection lack specificity.Laparoscopic surgery is superior to open surgery.
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