Boyd M E
Can J Surg. 1985 Jan;28(1):11-3.
New causal agents of pelvic inflammatory disease that have recently been determined are Chlamydia trachomatis, anaerobic bacteria and penicillinase-producing gonococci. It is also recognized that the pelvic infection is normally polybacterial. The symptoms produced by these organisms are so indefinite that diagnosis based on clinical findings alone is often difficult. The diagnosis of pelvic inflammatory disease should therefore be established by laparoscopy in these cases. Antibiotics capable of eradicating most pelvic infections are now available. As a result of their use, the primary therapy has become medical. The indication for surgery is, in essence, failed medical therapy. Ablative surgery should generally be delayed until adequate antibiotic therapy has been tried and found inadequate. Furthermore, the surgery should be conservative because the disease is often unilateral. Total abdominal hysterectomy and bilateral salpingo-oophorectomy as a treatment for pelvic inflammatory disease should be the exception rather than the rule.
近期已确定的盆腔炎新致病原包括沙眼衣原体、厌氧菌和产青霉素酶的淋球菌。人们还认识到盆腔感染通常是多菌性的。这些病原体产生的症状非常不明确，以至于仅根据临床症状进行诊断往往很困难。因此，在这些病例中，盆腔炎的诊断应通过腹腔镜检查来确立。现在有能够根除大多数盆腔感染的抗生素。由于这些抗生素的使用，主要治疗方法已变为药物治疗。手术指征本质上是药物治疗失败。一般应推迟进行切除性手术，直到尝试了充分的抗生素治疗且发现其效果不佳。此外，手术应保守，因为该病通常是单侧性的。全腹子宫切除术和双侧输卵管卵巢切除术作为盆腔炎的一种治疗方法应为例外而非常规。
