Crossman Steven H
Fairfax Family Practice Residency Program, Virginia 22033, USA.
Am Fam Physician. 2006 Mar 1;73(5):859-64.
Pelvic inflammatory disease (PID) is an infection of the upper genital tract in women that can include endometritis, parametritis, salpingitis, oophoritis, tubo-ovarian abscess, and peritonitis. The spectrum of disease ranges from subclinical, asymptomatic infection to severe, life-threatening illness; sequelae include chronic pelvic pain, ectopic pregnancy, and infertility. PID is diagnosed clinically, with laboratory and imaging studies reserved for patients who have an uncertain diagnosis, are severely ill, or do not respond to initial therapy. The Centers for Disease Control and Prevention diagnostic criteria include uterine, adnexal, or cervical motion tenderness with no other obvious cause in women at risk of PID. Empiric treatment should be initiated promptly and must cover Chlamydia trachomatis and Neisseria gonorrhoeae; the possibility of fluoroquinolone-resistant N. gonorrhoeae also should be considered. Hospitalization for initial parenteral therapy is necessary for patients with tubo-ovarian abscess and for those who are pregnant, severely ill, unable to follow a prescribed treatment plan, or unable to tolerate oral antibiotics. Patients also should be hospitalized if a surgical emergency cannot be excluded or if no clinical improvement occurs after three days. Routine screening for asymptomatic chlamydial infection can help prevent PID and its sequelae.
盆腔炎（PID）是女性上生殖道的一种感染，可包括子宫内膜炎、宫旁组织炎、输卵管炎、卵巢炎、输卵管卵巢脓肿和腹膜炎。疾病范围从亚临床、无症状感染到严重的、危及生命的疾病；后遗症包括慢性盆腔疼痛、异位妊娠和不孕。PID通过临床诊断，对于诊断不确定、病情严重或对初始治疗无反应的患者，可进行实验室和影像学检查。美国疾病控制与预防中心的诊断标准包括有PID风险的女性出现子宫、附件或宫颈举痛，且无其他明显病因。应立即开始经验性治疗，且必须覆盖沙眼衣原体和淋病奈瑟菌；还应考虑耐氟喹诺酮淋病奈瑟菌的可能性。对于患有输卵管卵巢脓肿的患者以及孕妇、病情严重者、无法遵循规定治疗方案者或无法耐受口服抗生素者，初始需进行胃肠外治疗，因此需要住院。如果不能排除外科急症或三天后无临床改善，患者也应住院。对无症状衣原体感染进行常规筛查有助于预防PID及其后遗症。
