绝经后子宫积脓穿孔致脓毒症休克1例并文献复习

Spontaneous Perforation of Pyometra Leading to Septic Shock in a Postmenopausal Patient: A Case Report and Literature Review

摘要: 目的：报告1例绝经后子宫积脓穿孔致脓毒症休克患者，并结合文献讨论其临床特点、辅助检查、诊断及治疗。方法：通过病例报告方式，结合国内外文献复习，进行综合分析。结果：本例患者入院后病情进展迅速，出现脓毒症休克，但腹膜炎症状不明显，给予腹腔镜探查发现子宫积脓穿孔，术后转入重症医学监护支持治疗，整个救治过程中及时、敏感的抗生素治疗至关重要，患者好转后出院。子宫积脓合并子宫穿孔罕见，表现为急腹症，缺少特异性，病情进展迅速，有较高死亡率，需要紧急处理。结论：临床中应当加强对该病的认识，早诊断、早治疗，避免漏诊、误诊，一旦发生子宫穿孔，需要紧急外科手术干预以控制弥漫性腹膜炎甚至脓毒症休克的发生，根据患者病情选择合适的手术方式，同时应当及时应用抗生素治疗以及重症监护支持。

Abstract: Objective: A case of postmenopausal woman with spontaneous rupture of pyometra was reported, and we also review the related literatures to summarize the clinical characteristics, auxiliary ex-amination, diagnosis and treatment of this disease. Methods: The clinical data of a patient with spontaneous rupture of pyometra were retrospectively analyzed, and the related literatures were reviewed. Results: The patient’s condition progressed rapidly with septic shock after admission, but the symptoms of peritonitis were not obvious. An emergency operation was performed, thus uterine perforation was found during the operation. The patient was transferred to intensive medical care for supportive treatment after surgery. Timely and sensitive antibiotic treatment was crucial throughout the rescue process, and the patient is discharged after improvement. Spontaneous per-foration of pyometra presenting as acute abdomen is an extremely rare complication of pyometra, which is always lacking specificity, with rapid progression and a high mortality rate, requiring ur-gent management. Conclusion: Awareness of the disease should be enhanced, with early diagnosis and treatment to avoid missed diagnosis and misdiagnosis. Once uterine perforation occurs, urgent surgical intervention is needed to control diffuse peritonitis or even septic shock, and appropriate surgical procedures should be selected. Administration of broad-spectrum antibiotics and postop-erative intensive care support are essential to reduce the high mortality.