medicine
1, Antibiotics: It is advisable to use drugs in combination, and it is best to choose drugs according to bacterial culture and drug sensitivity test.
(1) penicillin g: 2.4 million100000 units per day, intravenous drip; After the condition improved, it was reduced to 80 1 day, 6.5438+0.6 million units, and intramuscular injection was carried out in stages.
(2) Erythromycin: 1- 1.5g once a day, intravenous drip, plus 0.5g kanamycin twice a day, intramuscular injection.
(3) Gentamicin: 654.38+0.6 million units per day, divided into 2-3 intravenous drip or intramuscular injection.
(4) Lincomycin: 0.3-0.6g each time, intramuscular injection three times a day.
(5) Clindamycin: 0.6g each time, intravenous drip, every 6 hours 1 time. After the body temperature drops to normal, take orally, 0.3g each time, every 6 hours 1 time.
Psychotherapy is generally to relieve patients' worries, strengthen treatment confidence, increase nutrition, exercise, pay attention to the combination of work and rest, and improve the body's resistance.
Surgical therapy
(1) drug treatment is ineffective: after 48-72 hours of drug treatment, the body temperature does not drop continuously, and the patient's poisoning symptoms are aggravated or the tumor is enlarged to avoid abscess rupture.
(2) Persistence of abscess: After drug treatment, the condition improved and the inflammation was controlled for several days (2-3 weeks). The mass has not disappeared but is limited, so it should be surgically removed to avoid another acute attack or chronic pelvic inflammatory disease.
(3) Abscess rupture: sudden abdominal pain aggravation, chills, high fever, nausea, vomiting and abdominal distension. If the abdomen refuses to be pressed or toxic shock occurs, it should be suspected that the abscess is ruptured. If abscess rupture is not diagnosed and treated in time, the mortality rate is high. Therefore, once abscess rupture is suspected, laparotomy should be performed at the same time as antibiotic treatment.
Abdominal surgery or laparoscopic surgery can be selected according to the situation. The scope of operation should be considered comprehensively according to the scope of the lesion, the age of the patient and the general state. The principle is to remove the focus. Young women should try to preserve ovarian function and give priority to conservative surgery; Elderly patients with bilateral adnexal involvement or recurrent adnexal abscess underwent total hysterectomy and double adnexal resection; For critically ill patients with extreme weakness, the scope of operation should be determined according to the specific situation. If the pelvic abscess is low and protrudes to the posterior fornix of vagina, the abscess can be discharged through vaginal incision and antibiotics can be injected at the same time.