宫腔积脓并子宫穿孔的临床分析_效小莉

·全科临床论著·

宫腔积脓并子宫穿孔的临床分析

效小莉，钱桂兰，李静文

【摘要】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。

【关键词】宫腔积脓;子宫穿孔;临床分析;绝经

【中图分类号】Ｒ711．74【文献标识码】A【文章编号】1674-4152（2013）07-1023-02

Clinical Analysis of Uterine Perforation Caused by Pyometra XIAO Xiao-li，QIAN Gui-lan，LI Jing-wen．Department of Gy-naecology and Obstetrics，Xiaogan Central Hospital，Xiaogan432000，Hubei，China

【Abstract】Objective To investigate the etiological factors，diagnosis and therapy of uterine perforation caused by pyometra．Methods The5cases of uterine perforation caused by pyometra who hospitalized at Xiaogan central hospital were retrospectively analyzed．Ｒesults The5cases of uterine perforation caused by pyometra occurred in postmenopausal women and the initial symptoms were vaginal fluid and（or）abdominal pain，which were not typical and easy confused with gastrointestinal perforation

and other surgical abdomen．Uterine perforation was related with poor sanitary conditions，endometritis，cervical cancer and endo-metrial cancer．Five patients were taken to surgery for uterine repair mostly．One patient gave up continuing the treatment；other4 patients had a good postoperative prognosis．All the postoperative pathogenic examinations were positive and the pathological diag-nosis were infection or malignancy．Conclusion The courses of postmenopausal uterine perforation caused by pyometra makes a slow progress，with no evident clinical symptoms，which is easy to be misdiagnosed．We should prevent the disease aim at early di-agnosis．It’s very important to take conservation surgery timely and following-up treatment according to the etiology and pathology diagnosis．

【Key words】Pyometra；Uterine perforation；Clinical analysis；Menopause

宫腔积脓是指宫腔内有脓液积滞，当患有急性或

作者单位：432000湖北省孝感市中心医院妇产科（效小莉，李静文）；

100037北京市，海军总医院妇产科（钱桂兰）

通讯作者：李静文，电子信箱：zhranhui@sina．com 慢性子宫内膜炎时，宫颈口堵塞，引流不畅，分泌物滞留在子宫内，即可发生宫腔积脓。若宫颈口堵塞，脓液无法流出，宫腔内压力增大到一定程度可引起自发性子宫穿孔。如不及时治疗，可并发感染性休克，危及生

46．20个月，高于EＲp29表达阴性行化疗患者的27．00个月。表明EＲp29表达与胃癌的预后相关，可作为预测胃癌预后的一个潜在指标。因此，检测胃癌织组EＲp29的表达情况，对预后具有一定指导意义。

综上所述，胃癌组织中EＲp29表达下降，并且与肿瘤分期、淋巴结转移呈负相关，但与患者年龄、性别、肿瘤部位、癌组织学类型及局部浸润深度等无明显相关性，提示EＲp29是一个潜在抑癌基因。胃癌组织EＲp29的表达与患者预后相关，可作为预测胃癌预后的一个潜在指标。然而，EＲp29抑制肿瘤发展的机制尚不清楚，尚有待进一步研究。

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（收稿日期：2012-09-12）