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非妊娠相关性子宫内膜炎

Author
Katherine T Chen, MD, MPH
Section Editor
Robert L Barbieri, MD
Deputy Editor
Vanessa A Barss, MD, FACOG
Translators
郝琦蓉, 副主任医师

引言

子宫内膜炎是指子宫内膜(即子宫内衬的一层)的炎症。病理学家传统上将子宫内膜炎分为急性或慢性。急性子宫内膜炎以子宫内膜腺体内出现微脓肿或中性粒细胞为特征；而慢性子宫内膜炎则以子宫内膜间质中出现不同数量的浆细胞为特征[1,2]。

组织样本缺乏时，其他因素可有助于区分急性和慢性子宫内膜炎。两者临床表现(异常阴道出血和盆腔痛)相似，因此仅根据症状无法有效区分。不过发热是例外：急性子宫内膜炎患者常伴发热，而慢性子宫内膜炎患者发热的情况较少见。临床情况回顾也有助于判断子宫内膜炎为急性还是慢性(表 1)：

  • 非产科人群发生急性子宫内膜炎之前一般会发生盆腔炎性疾病(pelvic inflammatory disease, PID)，PID则继发于性传播感染或侵入性妇科操作。
  • 非产科人群的慢性子宫内膜炎可由多种原因引起，包括：感染(如衣原体、结核、与宫颈炎和PID有关的其他微生物)、宫内异物或生长物(如宫内节育器、子宫黏膜下肌瘤、息肉)和放疗。约有1/3的患者未能确定病因[3]。

与妊娠无关的子宫内膜炎将在此讨论。产后妇女的子宫内膜炎见其他专题。 (参见“产后子宫内膜炎”)

急性子宫内膜炎

盆腔炎性疾病 — PID可影响上生殖道。衣原体感染往往主要累及衬贴于输卵管内侧的输卵管内膜细胞，而淋球菌则倾向于经腔道感染其他部位。多数PID都是因下生殖道病理性菌群向上生殖道迁移所致。感染可能限于输卵管(输卵管炎)，或可能累及卵巢(输卵管卵巢炎)和/或宫腔(子宫内膜炎)。一般情况下，相对于输卵管，子宫内膜和卵巢不易受到感染。但是，子宫内膜(子宫内膜炎)或卵巢(卵巢炎)有时也可能是唯一的感染病灶。

                    

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Literature review current through: 2017-06 . | This topic last updated: 2015-11-09.
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