子宫积脓自发性穿孔：7 例报告并文献复习。
Spontaneous perforation of pyometra: a report of seven cases and review of the literature.
机构信息
Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata 990-9585, Japan.
出版信息
Gynecol Obstet Invest. 2013;75(4):243-9. doi: 10.1159/000349981. Epub 2013 Mar 29.
BACKGROUND/AIMS: The spontaneous perforation of pyometra is very rare and is associated with a poor prognosis. The present study aimed to evaluate the clinical characteristics and prognostic factors for patient survival.
PATIENTS AND METHODS
We reported on 7 patients with spontaneous rupture of pyometra. We also reviewed 47 additional published cases. Thus, all 54 patients were analyzed for mortality.
RESULTS
We investigated the prognosis in 44 of 54 patients, excluding 8 patients with undocumented outcome and 2 who died of other diseases. The mortality rate was 25% (11 of 44). In univariate analysis, variables such as age, correct preoperative diagnosis, comorbidities, the presence of malignancy, and hysterectomy were not significant between surviving and deceased patients. In bacterial cultures from the peritoneal cavity, the most common etiological organisms were Escherichia coli and anaerobes such as Bacteroides and Peptococcus species. The rate of isolation of anaerobic bacteria was significantly increased in patients who died (odds ratio, 6.33; 95% confidence interval, 1.28-31.02; p = 0.04).
CONCLUSION
Antibiotic therapy for E. coli and anaerobes should be considered in patients with spontaneous perforation of pyometra.
背景/目的：子宫积脓自发穿孔非常罕见，且预后不良。本研究旨在评估患者生存的临床特征和预后因素。
患者和方法
我们报告了 7 例子宫积脓自发性破裂的患者。此外，我们还回顾了 47 例额外的已发表病例。因此，对所有 54 例患者进行了死亡率分析。
结果
我们排除了 8 例无记录结局的患者和 2 例死于其他疾病的患者，共对 54 例患者中的 44 例进行了预后调查。死亡率为 25%（11/44）。在单因素分析中，存活和死亡患者之间的变量如年龄、正确的术前诊断、合并症、恶性肿瘤的存在和子宫切除术无显著差异。在腹腔细菌培养中，最常见的病原体是大肠杆菌和厌氧菌，如拟杆菌和消化球菌属。死亡患者中分离出厌氧菌的比例显著增加（比值比，6.33；95%置信区间，1.28-31.02；p=0.04）。
结论
对于子宫积脓自发性穿孔的患者，应考虑使用针对大肠杆菌和厌氧菌的抗生素治疗。
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