Tanir H M, Hassa H, Ozalp S, Kaya M, Oge T
Department of Obstetrics and Gynecology, Osmangazi University School of Medicine, Eskisehir, Turkey.
Eur J Contracept Reprod Health Care. 2005 Mar;10(1):15-8. doi: 10.1080/13625180400020820.
To assess the causality between pelvic abscess formation and intrauterine device (IUD) use through a clinical study in a hospital.
Sixty-two pelvic abscesses were retrospectively evaluated over a 7-year period. Patient records retrieved for the women enrolled in this study consisted of demographic characteristics, duration of IUD use and clinical management details.
All the women were monogamous Muslim women without any suspicious sexual contacts, immunosupressive states, or drug use at the time of IUD insertion. In 10 cases (16.1%), a history of pelvic surgery was present. The mean age of the women was 36.1 +/- 2.3 years (range 19-50 years). Of the 62 women, 14 (22.6%) were current IUD users. The mean time interval for women using IUD prior to the diagnosis of pelvic abscess was 5.7 +/- 1.2 years (range 1-14 years). In all cases, a pelvic mass and abdominal pain constituted the referral signs and symptoms. All women received an initial antibiotic regimen comprising penicillin (24 mU/day), clindamycin (900 mg/day) and gentamycin (240 mg/day) in divided doses. In 38 cases (61.3%), medical treatment yielded a satisfactory clinical outcome, defined as a decreas in mass volume together with pain relief and a decrease in leukocytosis. Twenty-four cases (38.7%) underwent a subsequent surgical procedure, either laparotomy (n = 19) or laparoscopy (n = 5). The type of surgery ranged from abscess drainage to more radical approaches such as total abdominal hysterectomy and/or unilateral or bilateral salpingo-oophorectomy. There were no differences between those women responding to medical therapy and those who did not respond in terms of mean age, percentage of past pelvic surgery, gravidity, parity and the size of pelvic abscess.
A substantial number of women with an IUD were diagnosed as having a pelvic abscess within a 7-year period at the university clinic. Despite current knowledge that pelvic inflammatory disease and pelvic abscess are rarely encountered in long-term IUD users, the presence of an IUD should be investigated in cases with an initial diagnosis of pelvic abscess based on clinical and ultrasonographic evaluation, demonstrating mostly acquisition via sexually transmitted disease.
通过在一家医院进行的临床研究评估盆腔脓肿形成与宫内节育器（IUD）使用之间的因果关系。
对62例盆腔脓肿患者进行了为期7年的回顾性评估。为参与本研究的女性检索的患者记录包括人口统计学特征、IUD使用时长及临床治疗细节。
所有女性均为一夫一妻制的穆斯林女性，在放置IUD时无任何可疑的性接触、免疫抑制状态或药物使用情况。10例（16.1%）有盆腔手术史。女性的平均年龄为36.1±2.3岁（范围19 - 50岁）。62例女性中，14例（22.6%）为当前IUD使用者。在诊断盆腔脓肿之前使用IUD的女性的平均时间间隔为5.7±1.2年（范围1 - 14年）。所有病例中，盆腔肿块和腹痛构成转诊的体征和症状。所有女性均接受了初始抗生素治疗方案，包括青霉素（2400万单位/天）、克林霉素（900毫克/天）和庆大霉素（240毫克/天），分剂量给药。38例（61.3%）患者经药物治疗取得了满意的临床结果，定义为肿块体积减小、疼痛缓解且白细胞增多症减轻。24例（38.7%）患者随后接受了手术治疗，其中剖腹手术（n = 19）或腹腔镜手术（n = 5）。手术类型从脓肿引流到更激进的手术方式，如全腹子宫切除术和/或单侧或双侧输卵管卵巢切除术。在平均年龄、既往盆腔手术百分比、妊娠次数、产次及盆腔脓肿大小方面，对药物治疗有反应的女性与无反应的女性之间无差异。
在大学诊所的7年期间，大量使用IUD的女性被诊断为患有盆腔脓肿。尽管目前已知盆腔炎性疾病和盆腔脓肿在长期IUD使用者中很少见，但对于初步诊断为盆腔脓肿的病例，应根据临床和超声检查评估调查IUD的存在情况，多数感染是通过性传播疾病获得的。
