18. 骨盤炎症性疾患 - jsog.umin.ac.jp

1 18. (Pelvic inflammatory disease : PID) 65 2013 5 10 (pelvic inflammatory disease : PID) PID 25 PID ( intrauterine device : IUD) (BakkenIJ et al, 2009 : BMC infect dis) PID PID ( PID { } { PID } C CRP CDC : MMWR, 2010 PID (CDC) Centers for Disease Control and Prevention : CDC { } MRI PID CDC : MMWR, 2010 PID (CDC) Centers for Disease Control and Prevention : CDC { }1. 2. / { }1. 38 C2. { }1.)

2 MRI 2. 3. PID ( - 2011) 1. 2. PID hCG ( -)( -)( + )( + )( + )( + )( -)( -)( 2011 ) 15 : Escherichia Coli Bacteroides Peptostreptococcus PID (PCR TMA SDA ) 38 C 11,000 / l (The Stanford guide to antimicrobial therapy 2009) PID ( - 2011) PID ( 2011) PID 1) 1 1,000mgX1 1 -- A2) SR 1 2gX1 1 -- B3) 1 200mgx2 7 -- A B4) 1 500mgx1 7 -- B( 2011) PID.

3 ( - 2011) PID 1) 300mg3X 5 ~ 7 2) ( 300mg3X 5 ~ 7 3) ( 300mg3X 5 ~ 7 1. 1) 500mg1X 5 ~ 7 2) ( 450mg3X 5 ~ 7 3) ( 300mg3X 5 ~ 7 2. ( - 2011) PID 1) 1~2g 2X 5 ~ 7 2) ( 1~2g 2X 5 ~ 7 3) ( 1~2g 2X 5 ~ 7 4) ( 1~2g 1~2X 5 ~ 7 1. 2. ( - 2011)1) ~1g 2X 5 ~ 7 2) ( ~ 2~3X 5 ~ 7 PID (PID) (tubo-ovarian abscess) PID PID ( IUD 25 50 * (Angus DC et al, CritCare Med : 2001)(DombrovskiyVY et al, CritCare Med : 2003)* CT 2g 2mg/kg/body 8 900mg 93 GjellandK et al, 2005: Am J ObstetGynecol) 90 95 (Henty-SuchetJ et al, 1984.

4 J ReprodMed)(Henty-SuchetJ et al, 2002 : J Am AssocGyneLaparoscopy) PID