What is Uterus Didelphys?
Uterine inflammation is a common disease of infectious diseases of the reproductive system, the most important of which is endometritis, which can be divided into two types, chronic and acute, and can also develop uterine empyema. Pathogens that cause uterine inflammation include Escherichia coli, Staphylococcus aureus, anaerobic bacteria, and hemolytic streptococci. Sexually transmitted pathogens include mycoplasma, chlamydia, and gonorrhea.
- Chinese name
- Foreign name
- Uterine inflammation is a common disease of infectious diseases of the reproductive system, the most important of which is endometritis, which can be divided into two types, chronic and acute, and can also develop uterine empyema. Pathogens that cause uterine inflammation include Escherichia coli, Staphylococcus aureus, anaerobic bacteria, and hemolytic streptococci. Sexually transmitted pathogens include mycoplasma, chlamydia, and gonorrhea.
Uteritis 1. Causes and related diseases
- The pathogenesis of acute endometritis is closely related to pregnancy, including abortion, childbirth, post-cesarean section, and premature rupture of membranes, excessive prenatal and postpartum hemorrhage, obstetric surgery, weak constitution, and amniotic infection And late pregnancy sexual life can induce acute endometritis. In addition, after endometrial curettage, intrauterine device placement, long-term vaginal bleeding, chronic diseases, endometrial tumors, submucosal uterine fibroids, and necrotizing endometrial polyps, it can also induce acute endometritis.
- When acute endometritis is infected into the lining of the endometrium, it will become a condition for the recurrence of chronic endometritis. Women place a contraceptive device in the uterus for a long time, the placenta is not completely restored, and some of the placental tissue remains after abortion or childbirth, which can cause chronic endometritis. After menopause, some women have low estrogen levels and a thin endometrium, which makes them vulnerable to bacterial infections that cause chronic endometritis.
- Cervical obstruction caused by acute or chronic endometritis, such as inflammatory secretions in the uterine cavity that are poorly drained or unable to drain, can develop into uterine empyema. The causes of cervical stenosis and obstruction include cervical laser, tapering, and electrocautery, or scarring caused by severe vaginitis, cervical injury, and chronic cervicitis. Elderly women have a higher chance of purulent uterine cavity. This is because their anti-infective ability declines with age, causing the endometrium to not fall off periodically. In addition, the cervix is narrow or occluded, making secretions in the uterine cavity impossible. Excluded, resulting in pyogenic pus after infection.
Uteritis 2. Differential diagnosis
1 Pathological examination of Uteritis 1, Endometritis
- There are many plasma cells and lymphocytes in the intimal stroma. It is worth noting that the presence of more plasma cells is extremely important for diagnosis. Fibroblasts and capillary proliferation can be seen in those with longer inflammation. Senile endometritis presents with thick, hardened blood vessels and sometimes calcification. When the lesion is severe, local ulcers form. When the endometrial glands atrophy, the surface epithelium may have squamous metaplasia. When the squamous metaplasia is extensive, there are large scale squamous epithelium covering the entire inner wall of the uterine cavity, which is called uterine ichthyosis. Endometritis after abortion should pay attention to the presence of villi and decidua, especially if the abortion lasts a long time, the villi can be highly degraded, and even no villi can be found, but scattered pieces of decidual tissue can often be found around the blood vessels .
2 Uteritis 2, diagnostic curettage
- Can identify the cause and exclude malignant lesions. Inflammation should be controlled for three days before surgery, and antibiotics should be given to reduce inflammation after surgery. Intraoperative operation should be gentle, because the infected uterine wall is fragile, and it is easy to cause uterine perforation. Senile endometritis has a thin endometrium, which should be paid more attention when scraping. Endometritis may have residual embryonic tissue after abortion, and it should be carefully and thoroughly scraped for examination, which can often play a therapeutic role at the same time.
Uteritis III. Principles of treatment
- In the treatment of patients with acute endometritis, the following methods can be taken: Support the treatment, adjust the nutritional status of the patient, and correct its water and electrolyte. If the patient is accompanied by anemia or is too ill, appropriate plasma or blood can be given. Clean the palace in time. If the B-ultrasound shows that there is tissue residue in the uterine cavity, antibiotics should be applied and then immediately cleared . If there is a foreign body such as an IUD in the patient's uterine cavity, remove it immediately. It should be noted that the patient is in a semi-recumbent position to facilitate drainage. For the application of antibiotics, it is necessary to take a broad-spectrum and high-efficiency antibiotic according to the results of drug sensitivity tests. Before that, 8 million U of penicillin or 240,000 U of gentamicin can be used, and 200 mg of metronidazole can be combined. For patients with severe illness, three generations of cephalosporin antibiotics can be taken directly; for patients with severe symptoms of poisoning, adrenocortical hormone therapy can be combined in a short period of time, which will help improve the body's stress ability.
- In the treatment of patients with chronic endometritis, antibiotics are first used, and the etiology is clear. If chronic endometritis is caused by abortion or childbirth and IUD removal, strict hysterectomy can be performed to remove mechanized and residual placental tissue; if the patient is accompanied by submucosal fibroids or endometrium For signs of polyps, use hysteroscopy and then perform cautery under the microscope; if it is an elderly patient, a curettage should be taken to remove the outer endometrium of the malignant lesion, and a small amount of estrogen can be used. Bu Jiale was used continuously for 21 days. On the 11th day, 8 mg of medroxyprogesterone was added daily for 10 days.
- In the treatment of patients with uterine empyema, the uterine probe can be inserted into the uterine cavity to allow the pus to flow out. In special cases, the cervix can be dilated or the uterine cavity can be used to attract the pus. In some patients, due to scarring or bending of the cervical canal, it is difficult to insert the probe, and 600 g of misoprostol should be placed in the posterior fornix of the vagina to facilitate dilation. Drainage in the uterine cavity, while preventing the short-term uterine cavity from being blocked again, affecting the discharge of pus. It should be noted that in the course of treatment, patients need to be treated with antibiotics.