Hydrometra

　　1, Etiology

　　Cervical obstruction caused by acute or chronic endometritis, such as when inflammatory secretions in the uterine cavity cannot be drained outward or the drainage is not smooth, can lead to pelvic cavity empyema.

　　2, Pathogenesis

　　The cause of cervical canal stenosis and obstruction may be related to cervical malignant tumors, especially in patients after radiotherapy, cervical electrocautery, cryotherapy, or cone biopsy, severe chronic cervicitis, vaginitis, which can lead to scar formation, as well as the atrophy of the cervix in older women, etc., which makes the retained secretions and pathogens in the tumor tissue difficult to be discharged and accumulate.

　　1, Infection of the fallopian tubes, urinary system, and vagina

　　Due to the pelvic cavity being filled with pathogenic pus, it can cause secondary infection of adjacent organs, and the fallopian tubes, urinary system, and vagina are among the locations prone to infection.

　　2, Affecting pregnancy

　　Pelvic cavity empyema can destroy the endometrium, causing decreased menstrual flow. Although there is a certain possibility of pregnancy, due to the uterus being the warm bed for fetal development, without a good living environment, it may also lead to difficulty in pregnancy, and even if pregnant, it may be harmful to the fetus.

　　3, Uterine cavity adhesions

　　Any factor that causes damage to the endometrium can lead to uterine cavity adhesions, and if pelvic cavity empyema is not treated thoroughly, it is likely to cause uterine cavity adhesions. In cases of complete uterine cavity adhesions, amenorrhea may occur, with a long duration, and treatment with estrogen and progesterone is not effective.

　　Patients with endometrial cancer, women after pelvic cavity radiotherapy, and women after cervical and pelvic cavity surgery may experience lower abdominal pain, accompanied by fever, chills, and other systemic symptoms. However, pelvic cavity empyema formed gradually due to chronic endometritis may not have obvious symptoms.

　　During gynecological examination, it can be found that the uterus is spherical in shape, soft, tender, with marked tenderness, the parauterine connective tissue may be thickened significantly, and there may be inflammatory masses of the adnexa simultaneously present, with purulent secretion visible in the cervical canal.

　　Older women with the above conditions should particularly consider the existence of pelvic cavity empyema.

　　First, there are two necessary conditions for the occurrence of pelvic cavity empyema:

　　1, Pus formation:Or it may initially be pus, or it may start as non-inflammatory effusion or hemorrhage, followed by infection.

　　2, Cervical canal stenosis and closure:Endometritis is the most direct cause of this disease.

　　In fact, endometritis in young women is not uncommon, but the formation of pelvic cavity empyema is rare, the reason being that the cervical canal can play a good drainage role. After menopause, with the decline in estrogen levels, the cervix atrophies, glandular secretion decreases, vaginal function diminishes, and pathogenic microorganisms can invade upwards from the vagina, causing adhesions, stenosis, or closure of the cervical canal, eventually leading to pelvic cavity empyema. In addition, invasion of the cervical canal by endometrial cancer or cervical cancer can also lead to cervical stenosis or closure, followed by infection, resulting in pelvic cavity empyema.

　　In addition, it was found that a considerable number of patients with uterine abscess have chronic pelvic inflammation, diabetes, etc., or there is still an intrauterine device in the uterine cavity, indicating that the whole body immune status and local inflammation play a role in the formation and development of uterine abscess.

　　Accurate diagnosis, reasonable treatment: elderly women have a slow reaction and are not sensitive to symptoms, so the onset is hidden and the symptoms are atypical, which is very easy to misdiagnose. Small uterine abscesses are often not easy to misdiagnose, but large abscesses can make the uterine wall thin and the volume increase, which is easy to misdiagnose as ovarian, bladder tumors, or pelvic abscess. The author believes that to determine the relationship between the uterus and the mass, a uterine cavity probe can be placed vaginally under ultrasound guidance, and once pus is drained, the diagnosis can be established.

　　The operation can be a total hysterectomy with bilateral adnexectomy. It is worth mentioning that a vaginal pelvic drain should be placed during the operation, and a semi-recumbent position should be adopted for broad-spectrum antibiotic treatment after the operation.

　　Prognosis:After active treatment, general inflammatory uterine abscess can be cured; the prognosis of cancerous uterine abscess is poor.

　　II. Health care:

　　1. Estrogen:In the past, many surgeons have given postoperative estrogen-progesterone sequential medication to promote endometrial growth, because normal large amounts of exogenous hormones entering the body will go through negative feedback to inhibit the production of endogenous hormones, turning a physiological state person into a pathological state.

　　2. Application of electrocuting:Electrocuting is prone to form new injuries and cause a new round of abscess, so it is best to use cold instruments to separate the abscess, and plasma knife is the best.

　　3. Number of surgeries:Generally, it is determined according to the situation, without being restricted to one-time separation, that is, doing it in stages is better.

　　4. Prolongation fluid:Saline is superior to glucose. Those with uterine abscess should immediately dilate the cervical canal and drain the pus. After the operation, a rubber drain tube is placed in the cervical canal until no pus is drained, while applying the aforementioned medication. To rule out cancer, after draining the pus, the cervical canal and uterine cavity can be gently scraped, and the tissue obtained can be sent for pathological examination. If diagnosed as cancer, it should be treated as cancer. The pus should be sent for bacterial culture and drug sensitivity testing for reference in selecting antibiotics. Non-cancerous uterine abscess can be treated with uterine lavage, using disinfectant solutions such as potassium permanganate solution (1:5000) or iodine alcohol solution (3% iodine dissolved in physiological saline, the alcohol content should be less than 50%). The pressure during lavage should be low, and the speed should be slow. If there is no uterine lavage tube, a catheter can be inserted into the uterine cavity, and a 100ml syringe is used to inject the medication. The amount of lavage solution once depends on the amount of abscess, generally 30-50ml, and it must be ensured that the lavage solution is completely drained before injecting the medication again. This process should be repeated multiple times until the outflowing liquid is relatively clear, and then a rubber tube is placed for drainage. This should be done once a day.

　　5, If the uterine abscess is not treated thoroughly, it can also cause uterine adhesion, and it is best not to try to get pregnant:The uterus is the cradle for the fetus's development, just like a seed needs fertile soil to take root and sprout, grow robustly. Uterine abscess is equivalent to soil being corrupted, even if it勉强 takes root, the sprouts will not be good. No matter how old a woman is, she should first treat the uterine abscess or uterine adhesion, and then get pregnant, providing a good growth environment for the child. Uterine abscess can damage the endometrium, causing decreased menstrual flow, and there is also a certain possibility of pregnancy, but it is best to get treated before getting pregnant.

　　White blood cell count increased, neutrophils increased.

　　1. Tissue pathological examination.

　　2. B-ultrasound shows uterine enlargement, liquid shadow area in the uterine cavity, and bright light spots inside.

　　3. Laparoscopy, hysteroscopy examination.

　　First, dietary therapy for endometrial abscess

　　1, Sophora flower Job's tears porridge (from 'Cong porridge'):10 grams of sophora flowers, 30 grams of Job's tears, 20 grams of winter melon seeds, and an appropriate amount of rice. Boil the sophora flowers and winter melon seeds into a decoction, remove the residue, add Job's tears and rice, and cook into porridge for consumption. This recipe has the effect of invigorating the body and removing dampness.

　　2, Raw rehmannia chicken (from 'Yanshan Zhengyao'):250 grams of raw rehmannia, 1 hen, 150 grams of molasses. Remove the feathers of the hen, clean the intestines and stomach, finely chop, mix the rehmannia and sugar evenly, stuff them into the hen's abdomen, steam them over water, and do not use salt, vinegar, and other seasonings. This recipe has the effect of nourishing yin and clearing heat.

　　Second, what is good for patients with endometrial abscess

　　There are no strict requirements for diet.

　　Third, what is bad for the body for patients with endometrial abscess

　　It is enough not to eat spicy and刺激性 food in the diet.

　　Early diagnosis and active treatment should be carried out for infectious diseases; for malignant disease patients, the 'three-level' preventive work for tumor patients should be done well.

　　Prevent childbearing women from developing gynecological diseases after entering old age due to the atrophy of reproductive organs, the cessation of estradiol secretion by the ovaries, and the gradual decline of immune function at the same time.

　　The following preventive measures are proposed specifically for the characteristics of this disease:

　　26. Strengthen health education for post-menopausal women, take a bath frequently, change underwear frequently, and keep the vulva clean and dry.

　　25. Participate in sports and physical exercises appropriately.

　　24. Keep a cheerful mood and enhance immune ability.

　　23. Remove the intrauterine device during the perimenopausal period, and seek medical attention in case of discomfort.

　　22. Have an annual routine gynecological examination, and pay attention to control self diseases such as diabetes.