急性附件炎

　　急性附件炎多为混合感染，主要病原体有淋球菌、沙眼衣原体、大肠埃希杆菌、克雷白杆菌、变形杆菌、需氧性链球菌、厌氧菌等。诱因为机体抵抗力低下、月经期或产褥期卫生不良、妇科手术、计划生育手术、性传播疾病或临近器官炎症的蔓延等。

　　急性附件炎可导致女性不孕症或宫外孕。附件炎的炎症刺激会引起输卵管水肿，黏膜变薄，不利于精子和卵子的结合。不及时治疗，病情加重，输卵管会因为黏膜上皮细胞的坏死，出现粘连、堵塞，影响精子的通过，即使和卵子结合了也不能及时到达子宫，可能会引起宫外孕，威胁女性的健康。

　　急性附件炎主要表现为发热和腹痛。发病时即出现高热，39℃～40℃，可能有恶寒或寒战，随之体温呈不规则的弛张热，提示炎症蔓延扩展或产生化脓性病灶。腹痛多局限于下腹痛，多为双侧性，少有呕吐，与阑尾炎转移性疼痛不同。此外，大便时腹痛加重，有时伴有尿痛，常有便秘、腹胀。

　　To prevent acute adnexitis, attention should be paid to the following aspects in daily life:
　　1. Women should pay attention to their own and their sexual partners' personal hygiene during sexual activity. Before sexual intercourse, both parties' external genitalia should be washed to prevent the smooth invasion of bacteria. When women have vaginal bleeding symptoms, they should self-restrain and prohibit sexual activity.
　　2. Women should pay attention to their own vulvar hygiene and personal cleanliness; prevent infections from household utensils and toilets.
　　3. Women of all ages should pay attention to their own nutrition and health care, strengthen nutrition during the menstrual period, after artificial abortion, and after delivery; enhance their physical fitness, increase their resistance and immunity, and reduce the chance of getting sick.
　　4. When undergoing artificial abortion, delivery, insertion and removal of intrauterine devices, and other intrauterine procedures, strict disinfection should be carried out to avoid introducing bacteria into the vagina and uterus through surgery, thereby causing infection artificially.
　　5. Female patients with acute salpingitis should rest in a semi-recumbent position to prevent and limit the movement of inflammatory fluid due to changes in body position. Eat high-nutrition, easy-to-digest foods rich in vitamins.

　　The diagnosis of acute adnexitis not only relies on clinical manifestations but also on auxiliary examination, which is an indispensable method for diagnosis. The commonly used examination methods are as follows:

　　One, Total white blood cell count and classification count
　　Total white blood cell count (20-25)×10^9/L, neutrophils 0.8-0.85 (80%-85%), left shift, indicating that the inflammatory focus has not been completely surrounded. Isolation or toxins have been absorbed, and purulent or other inflammatory fluids exist. If the total white blood cell count continues to rise, it indicates the formation of abscesses and abscesses. If the total count drops to (10-15)×10^9/L, there is generally no abscess formation, and even if there is an abscess, it lacks virulence.

　　Two, Erythrocyte sedimentation rate measurement (erythrocyte sedimentation rate)
　　Erythrocyte sedimentation rate measurement is a non-specific reaction, which should be compared with body temperature, pulse rate, and total white blood cell count, but the acceleration of erythrocyte sedimentation rate has great reference value for the clinical manifestations of concealed lesions that are not significant. It is necessary to further search for potential inflammatory foci. The acceleration of erythrocyte sedimentation rate in acute pelvic inflammatory disease is often >30-40mm/h.

　　Three, Posterior fornix puncture
　　1. Routine examination: If the inflammatory lesion is still in the limited stage, thin serous puncture fluid can often be obtained, and white blood cell count and smear can be performed, and Gram staining can be done directly. The examination of the number of neutrophils and the identification of bacterial types, in addition to helping with diagnosis, can also serve as a basis for selecting antibiotics.
　　2. Bacterial culture: aerobic and anaerobic bacterial cultures are performed on the puncture fluid.

　　Four, Ultrasound and CT examination
　　For patients with severe abdominal muscle tension, who refuse palpation and are not satisfied with pelvic examination, auxiliary diagnosis can be made through ultrasound or CT. The ultrasound echo characteristics of adnexal inflammatory masses can be summarized into three types:
　　1. Solid Type, there may be non-homogeneous solid mass next to the uterus, and the boundary of the mass is unclear.
　　2. Cystic Type, when the mass has pus, it appears as irregular non-homogeneous cystic mass.
　　3. Semi-cystic and Semi-solid Type, in the early stage of acute or subacute infection, it is not very helpful for diagnosis, and it can be examined by color Doppler ultrasound, showing rich blood vessels,呈网状或团块状.

　　In addition to routine treatment, dietary adjustments are also needed for patients with acute appendicitis. Patients should eat light and nutritious food, and eat more vegetables and fruits. In addition, patients should reduce spicy and other stimulating foods to avoid exacerbation of the condition.

　　In addition to the use of Western medicine in the treatment of acute appendicitis, it is also possible to try traditional Chinese medicine therapy. The specific TCM differential diagnosis therapy is as follows:

　　1. Damp-heat Descending Type
　　Zhi Dai Formula with Modifications: Take Zhu Ling, Che Qian Zi (baked), Chi Shao each 12 grams, Huang Bai, Niuxi, Dan Pi, Cang Zhu each 10 grams, Ze Xie, Yin Chen each 6 grams; if there is obvious abdominal pain, add 10 grams of Yuan Hu and Chuan Liang Zi to promote Qi and relieve pain; if there is poor appetite and loose stools, change Cang Zhu to Stir-fried Bai Zhu 10 grams, add 20 grams of Sheng Yi Ren and 18 grams of Yun Ling, which has the effects of invigorating the spleen and removing dampness, clearing heat and promoting diuresis.

　　2. Blood Stasis and Heat Interweaving Type
　　Gui Yuan Hu Decoction: Bai Zao Cao 20 grams, Dang Gui, Yuan Hu, Jiudan, Chi Shao, Tao Ren each 15 grams, Xiang Fu 12 grams, decocted for oral administration; if there is obvious stabbing pain in the lower abdomen, add 10 grams of Ru Xiang and Mo Yao to resolve blood stasis and stop bleeding; for patients with appendicitis with obvious abdominal distension and pain, add 10 grams of Chuan Liang Zi and Zhishi to promote Qi and relieve pain; if there is less menstrual blood, dark in color with clots, add 20 grams of Yi Mu Cao to promote blood circulation and resolve blood stasis. If there is a lot of leukorrhea, yellow in color, add 15 grams of Yin Chen and 12 grams of Ze Xie, which has the effects of clearing heat and dampness, promoting blood circulation to resolve blood stasis, and clearing heat and detoxifying.

　　3. Cold and Damp Retention Type
　　Shao Fu Zhu Yu Decoction: Take Yun Ling 15 grams, Dang Gui, Chi Shao each 12 grams, Mo Yao, Ai Ye, Bai Cao Shu, Ze Lan, Hong Teng each 10 grams, Xiao Huang Xiang, Chuan Xiong, Gui Zhi each 9 grams, Gan Jiang 6 grams, decocted for oral administration; if there is a lot of leukorrhea, white in color and thin in quality, add 10 grams of Rou Dou Kou and Bai Guo to warm the kidney and stop leukorrhea; if there is obvious lower back pain, add 20 grams of Chuan Duan and 10 grams of Du Zhong, which has the effects of benefiting the kidney, strengthening the waist, warming Yang and dispelling cold, and promoting blood circulation to remove dampness.