盆腔炎

盆腔炎 (Pelvic inflammatory disease) 是指女性生殖器官，包括子宮、卵巢和輸卵管，受到感染時的疾病，通常是由性接觸傳播感染引起，例如衣原體、淋病等。1-3 若缺乏適當治療，盆腔炎可導致患者的下腹疼痛，並影響其生育能力。

在美國，每年約有77萬名婦女被診斷患有盆腔炎。2 香港醫院管理局的資料顯示，在2014年共有2,617名患者因盆腔炎而需要住院。3

參考資料:

  1. Clevelandclinic. Pelvic inflammatory disease. Available at:https://my.clevelandclinic.org/health/diseases/9129-pelvic-inflammatory-disease-pid. Accessed April 10, 2022.
  2.  WebMD. What is pelvic inflammatory disease.Available at: https://www.webmd.com/women/guide/what-is-pelvic-inflammatory-disease. Accessed April 10, 2022.
  3. Medicinenet. Pelvic inflammatory disease. Available at: https://www.medicinenet.com/pelvic_inflammatory_disease/article.htm. Accessed April 11, 2022.
  4. Hospital Authority. Hospital Authority Statistical Report 2014-2015. Available at: https://www.ha.org.hk/haho/ho/stat/HASR1415_2.pdf. Accessed April 11, 2022.

盆腔炎

病理關注症狀診斷治療復康

病理

​盆腔炎大多是由於細菌感染並從陰道或子宮頸（子宮的入口）擴散到子宮、輸卵管和卵巢而引起的。1 很多不同類型的細菌都可以引起盆腔炎，當中以淋病或衣原體感染最常見。2,3 這些細菌通常是透過性接觸傳染。如果身體感染了衣原體，又沒有得到適當治療，一年內便有機會發展成盆腔炎。1

 

其他有可能引致感染的情況，包括

  • 月經期間
  • 分娩後
  • 流產或人工流產後
  • 用於避孕的儀器，例如植入式子宮環或需要把儀器放入子宮的檢查

也有機會令細菌進入生殖器官而導致感染。4

 

就細菌類型而言，衣原體佔透過性接觸導致的盆腔炎約50%，淋病則佔25%。由淋病引起的盆腔炎而引發輸卵管堵塞的風險一般會比較高。4

 

某些罕見的情況下，未必能夠找到感染盆腔炎的源頭，例如子宮頸可能有一些人體本身已存在的細菌，可以穿過子宮頸進入生殖器官。1 儘管這些細菌在陰道內並沒有害，但在身體其他部位例如子宮，則有可能引起感染。如果患者以前曾感染過盆腔炎、分娩時或進行流產後子宮頸受到損傷，或做過涉及打開子宮頸的手術，例如檢查子宮或植入宮內避孕器，便會更容易受這類型的細菌所感染。1

​

參考資料:

  1. National Health Service. Pelvic inflammatory disease. Available at:https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/causes/.Accessed April 13, 2022.
  2. Mayoclinic. Pelvic inflammatory disease-symptoms and causes. Available at:https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594. Accessed April 13, 2022.
  3. Medicine Plus. Pelvic inflammatory disease. Available at: https://medlineplus.gov/pelvicinflammatorydisease.html. Accessed April 14,2022.
  4. Betterhealth. Pelvic inflammatory disease. Available at:https://www.betterhealth.vic.gov.au/health/healthyliving/pelvic-inflammatory-disease-pid#causes-of-pid. Accessed April 13, 2022.

關注

​除了透過性接觸而感染，其他因素亦會增加患上盆腔炎的風險，包括：

​

參考資料:

  1. Mayoclinic. Pelvic inflammatory disease-symptoms and causes. Available at:https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594. Accessed April 13, 2022.
  2. Clevelandclinic. Pelvic inflammatory disease. Available at:https://my.clevelandclinic.org/health/diseases/9129-pelvic-inflammatory-disease-pid. Accessed April 10, 2022.
  3. Healthline. Pelvic inflammatory disease. Available at:https://www.healthline.com/health/pelvic-inflammatory-disease-pid#risks. Accessed April 16, 2022.
  4. Centers for Disease Control and Prevention. Pelvic Inflammatory Disease (PID) – CDC Fact Sheet. Available at:https://www.cdc.gov/std/pid/stdfact-pid.htm. Accessed April 16, 2022.
  5. 5. Medical News Today. What is pelvic inflammatory disease? Available at:https://www.medicalnewstoday.com/articles/177923. Accessed May 13, 2022.

症狀

​很多盆腔炎患者都沒有症狀或症狀輕微，而某些患者則可能出現超過1種症狀。1 如患者有嚴重的疼痛和症狀，應到急症室求診。2
​

參考資料:

  1. NHS. Overview-Pelvic inflammatory disease. Available at: https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/. Accessed May 11, 2022.
  2. Healthline. Pelvic inflammatory disease. Available at: https://www.healthline.com/health/pelvic-inflammatory-disease-pid#risks. Accessed April 16, 2022.
  3. Mayoclinic. Pelvic inflammatory disease-symptoms and causes. Available at:https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594. Accessed April 13, 2022.
  4. Centers for Disease Control and Prevention. Pelvic Inflammatory Disease (PID) – CDC Fact Sheet. Available at:https://www.cdc.gov/std/pid/stdfact-pid.htm.Accessed April 16, 2022.
  5. Patient Info. Pelvic Inflammatory Disease. Available at: https://patient.info/womens-health/pelvic-pain-in-women/pelvic-inflammatory-disease#nav-0. Accessed April 16, 2022.
  6. WebMD. What is pelvic inflammatory disease. Available at: https://www.webmd.com/women/guide/what-is-pelvic-inflammatory-disease. Accessed April 10, 2022.

診斷

盆腔炎並沒有單一的診斷方式，一般是根據患者的症狀和婦科檢查結果來診斷。

 

  1. 醫生會首先詢問患者的病歷和性接觸的經驗
  2. 然後進行盆腔檢查以查看陰道分泌物是否有異常1,2
  3. 醫生或會從陰道和子宮頸內提取一些樣本去化驗細菌，例如衣原體和淋病1,3,4

 

由於盆腔炎難以診斷，患者可能還需要進行其他檢查，以尋找感染的跡象或排除其他可能導致感染的原因。這些檢查項目包括：

 

  • 尿液或血液檢查1,3,4
  • 妊娠檢查（排除宮外孕的相似症狀）1,4
  • 陰道超聲波掃描可檢查發炎的輸卵管1,4
  • 腹腔鏡檢查，在腹部開兩個小切口，插入細小的內視鏡管子，以察看內部器官或抽取細胞樣本作化驗1,4,5

 

如果醫生診斷為盆腔炎，可能會為患者作進一步檢查，例如檢查盆腔器官有否損傷，因為盆腔炎可以在輸卵管上留下疤痕，並對生殖器官造成永久性損害。6 其他檢查包括盆腔超聲波檢查和子宮內膜樣本檢查。6

參考資料:

  1. National Health Service. Pelvic inflammatory disease. Available at:https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/causes/. Accessed April 13, 2022.
  2. WebMD. What is pelvic inflammatory disease.Available at: https://www.webmd.com/women/guide/what-is-pelvic-inflammatory-disease. Accessed April 10, 2022.
  3. Betterhealth. Pelvic inflammatory disease. Available at:https://www.betterhealth.vic.gov.au/health/healthyliving/pelvic-inflammatory-disease-pid#causes-of-pid. Accessed April 13, 2022.
  4. Patient Info. Pelvic Inflammatory Disease. Available at: https://patient.info/womens-health/pelvic-pain-in-women/pelvic-inflammatory-disease#nav-0. Accessed April 16, 2022.
  5. NHS. Diagnosis. Available at: https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/diagnosis/. Accessed May 11, 2022.
  6. Healthline. Pelvic inflammatory disease. Available at:https://www.healthline.com/health/pelvic-inflammatory-disease-pid#risks. Accessed April 16, 2022.

治療

如醫生最初診斷為盆腔炎，會建議患者盡快接受治療，以減低出現併發症的機會。

藥物治療／手術

 

服用抗生素是治療盆腔炎的最常見方法。

醫生會根據患者種菌的結果來調整處方抗生素的類別。1-4 通常醫生會處方2種不同的抗生素以涵蓋可能導致盆腔炎的各種病菌，療程一般為2星期，藥物例子包括 ： 3,5 

  • 甲硝唑（metronidazole)
  • 多西環素（Doxycycline)
  • 頭孢曲松（Ceftriaxone)

即使患者在服用抗生素後幾天感到情況好轉，亦應完成整個抗生素療程。2

 

如果患者正在或可能正在懷孕

  • 應告知醫生，以便處方合適的抗生素

 

若患者對口服藥物沒有反應或懷疑輸卵管有膿腫等情況

  • 便有可能需要住院治療，並接受靜脈注射抗生素，甚至進行切除輸卵管手術 3

 

由於患者的伴侶可能沒有任何明顯的症狀，為了防止再次感染性病，患者的伴侶也應該接受檢查和治療。3 患者和伴侶應避免性交，直到治療結束，症狀得到緩解為至。3

併發症

若盆腔炎患者沒有得到適當治療，可能導致生殖道內出現疤痕和膿腫，對生殖器官造成永久性損害。6 盆腔炎可引發的併發症包括：

 

  • 宮外孕：在沒有治療的情況下，盆腔炎可導致輸卵管內出現疤痕，引致宮外孕。疤痕會損害和阻止受精卵通過輸卵管到達子宮內；相反，卵子會植入輸卵管中。宮外孕可導致患者大量出血，甚至危及性命。5,6 患有盆腔炎而沒有接受治療的孕婦，其引發妊娠併發症（例如流產、早產和死胎）的風險會增加3,6
  • 不育：患上盆腔炎的次數越多，不孕的風險便越大3,6
  • 慢性盆腔疼痛：盆腔炎可引起盆腔疼痛，可持續數月或數年6
  • 輸卵管和卵巢膿腫：如果濃液持續積聚，感染有機會擴散到全身
  • 反應性關節炎：這是一種不常見的關節炎和眼部炎症3

參考資料:

  1. Healthline. Pelvic inflammatory disease. Available at: https://www.healthline.com/health/pelvic-inflammatory-disease-pid#risks. Accessed April 16, 2022.
  2. Mayoclinic. Pelvic inflammatory disease-symptoms and causes. Available at:https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594. Accessed April 13, 2022.
  3. Patient Info. Pelvic Inflammatory Disease. Available at: https://patient.info/womens-health/pelvic-pain-in-women/pelvic-inflammatory-disease#nav-0. Accessed April 16, 2022.
  4. Betterhealth. Pelvic inflammatory disease. Available at:https://www.betterhealth.vic.gov.au/health/healthyliving/pelvic-inflammatory-disease-pid#causes-of-pid. Accessed April 13, 2022.
  5. Medical News Today. Treatment of Pelvic Inflammatory Disease. Available at: https://www.medicalnewstoday.com/articles/177923#treatment. Accessed on May 13, 2022.
  6. Mayoclinic. Pelvic inflammatory disease-symptoms and causes. Available at:https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594. Accessed April 13, 2022.

復康

盆腔炎是難以預防的疾病，但仍可透過以下不同方法來減低罹患的風險：

 

1. 安全性行為: 即使已有使用其他避孕方法，在每次進行性行為時，亦應使用安全套以預防性傳播感染

2. 及早求醫: 如發現有初期性病，應及早治療以避免患上盆腔炎

3. 自我監察: 如發現不正常的陰道分泌物、盆腔疼痛或經期間出血，應及早求醫

4. 定期檢查: 應定期進行婦科檢查和篩查；同時，也應鼓勵伴侣定期接受檢查，有助避免盆腔炎復發

5. 限制性伴侶的數量: 如果患者或伴侶曾有其他性伴侶，其感染性病的風險會增加

6. 不要沖洗陰道: 沖洗陰道會清除陰道內一些保護人體免受感染的正常細菌。沖洗也有機會令細菌進入其他區域，例如子宮、卵巢和輸卵管，增加患上盆腔炎的風險4

7. 不要濫用酒精或藥物: 過量飲酒或吸毒有可能令人進行不安全的性行為，增加患上性病的風險4

8. 如廁後的清潔: 如廁後應用紙巾從前往後擦拭，以杜絕細菌進入陰道5

參考資料:

  1. Mayoclinic. Pelvic inflammatory disease-symptoms and causes. Available at:https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594. Accessed April 13, 2022.
  2. Clevelandclinic. Pelvic inflammatory disease. Available at:https://my.clevelandclinic.org/health/diseases/9129-pelvic-inflammatory-disease-pid. Accessed April 10, 2022.
  3. American College of Obstetricians and Gynecologists. Pelvic Inflammatory Disease. Available at: https://www.acog.org/womens-health/faqs/pelvic-inflammatory-disease. Accessed April 17, 2022.
  4. US Department of Health & Human Services. Office on Women’s Health. Pelvic Inflammatory Disease. Available at: https://www.womenshealth.gov/a-z-topics/pelvic-inflammatory-disease. Accessed May 11, 2022.
  5. Healthline. wiping from front to back after using the bathroom to stop bacteria from entering your vagina. Available at: https://www.healthline.com/health/pelvic-inflammatory-disease-pid. Accessed May 11, 2022.
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