盆腔炎性疾病后遗症的中西医结合治疗专家共识

Expert consensus on integrated traditional Chinese and western medicine treatment for sequelae of pelvic inflammatory disease

摘要

盆腔炎性疾病后遗症(SPID)是盆腔炎性疾病未规范治疗或未完全治愈后引发的慢性阶段,以慢性盆腔痛、不孕、异位妊娠等为主要临床表现。本专家共识基于现有临床证据和专家经验,系统阐述了SPID的定义、流行病学、诊断标准(包括西医诊断和中医辨证分型)、治疗策略(涵盖西医的物理治疗、止痛剂、抗生素、手术及中医的内服外治、针灸等)、康复管理(心理、运动、食疗)及预防措施。本共识旨在规范SPID的中西医结合诊疗,强调中西医结合的综合治疗优势,为临床医师提供科学、实用的诊疗指导,以期提高SPID的诊治水平,改善患者生活质量。

Abstract

Sequelae of pelvic inflammatory disease (SPID) is a chronic stage caused by non-standard treatment or incomplete cure of pelvic inflammatory disease.The main clinical manifestations include chronic pelvic pain,infertility,ectopic pregnancy,etc.This expert consensus is based on existing clinical evidence and expert experience,systematically elaborating on the definition,epidemiology,diagnostic criteria (including western medical diagnosis and traditional Chinese medicine(TCM) syndrome differentiation and classification),treatment strategies (covering physical therapy,analgesics,antibiotics,surgery in western medicine and internal and external treatment in TCM,acupuncture,etc.),rehabilitation management (psychological,exercise,dietary therapy),and preventive measures of SPID.This consensus aims to standardize the integrated diagnosis and treatment of SPID in both western and traditional Chinese medicine,emphasizing the comprehensive treatment advantages of combining western and traditional Chinese medicine,providing clinical physicians with scientific and practical diagnostic and treatment guidance,with the aim of improving the diagnosis and treatment level of SPID and enhancing the quality of life of patients.

关键词

专家共识 / 中西医结合 / 盆腔炎性疾病后遗症 / 诊断标准 / 治疗方法 / 康复管理

Key words

expert consensus / integrated traditional Chinese and western medicine / sequelae of pelvic inflammatory disease / diagnostic code / therapeutic method / rehabilitation management

参考文献

[1] 陈瑶, 姜晓春, 杨鉴冰, 等. 盆炎消联合盆腔灌注治疗盆腔炎性疾病后遗症疗效研究[J]. 中国妇幼健康研究, 2018,29(2): 233-237.

[2] Chunxiao D,Jinxing L,Xiao Y, et al. Neutrophil-fibroblast crosstalk drives immunofibrosis in sequelae of pelvic inflammatory disease through neutrophil extracellular traps[J]. Mediators Inflamm,2025,2025: 3113542.

[3] Ji X, Hu Q, Yang C, et al. Exploring the therapeutic effect of pen yan kang fu decoction on SPID rats based on LIF/JAK2/STAT3 signaling pathway[J]. 3 Biotech, 2024,14(5): 134.

[4] Mitchell C M, Anyalechi G E, Cohen C R, et al. Etiology and diagnosis of pelvic inflammatory disease:looking beyond gonorrhea and chlamydia[J]. J Infect Dis, 2021,224(12 Suppl 2): S29-S35.

[5] Brun J L, Castan B, de Barbeyrac B, et al. Pelvic inflammatory diseases:updated french guidelines[J]. J Gynecol Obstet Hum Reprod, 2020,49(5): 101714.

[6] Hunt S, Vollenhoven B. Pelvic inflammatory disease and infertility[J]. Aust J Gen Pract, 2023,52(4): 215-218.

[7] 罗艺苹, 李茂雅, 魏绍斌, 等. 1601例盆腔炎性疾病及其后遗症患者中医证型分布特征[J]. 安徽中医药大学学报, 2024,43(1): 16-21.

[8] Mohseni M, Ghaderzadeh R, Bakhtiari K, et al. Tolerability and efficacy of duloxetine compared to amitriptyline in women with chronic pelvic pain syndrome:findings from a clinical trial[J]. Low Urin Tract Symptoms, 2025,17(4): e70023.

[9] 薛彩星. 中药联合低频脉冲电治疗盆腔炎症性疾病后遗症的临床研究[J]. 河北中医, 2023,45(4): 570-573.

[10] 《中成药治疗优势病种临床应用指南》标准化项目组. 中成药治疗盆腔炎性疾病后遗症临床应用指南(2020年)[J]. 中国中西医结合杂志, 2021,41(3): 286-299.

[11] 石琳子, 张启丽, 张欣欣. 穴位贴敷联合理冲汤加减治疗气虚血瘀型盆腔炎性疾病后遗症临床研究[J]. 河北中医, 2024,46(9): 1445-1449.

[12] 朱姝, 李淑萍, 黄素英. 桂枝茯苓丸合小柴胡汤化裁治疗盆腔炎性疾病后遗症临床疗效观察[J]. 中国医药科学, 2021,11(23): 9-12,52.

[13] 张兵, 刘金星. 逍遥散加减治疗气滞血瘀型盆腔炎性疾病后遗症[J]. 成都中医药大学学报, 2020,43(4): 48-50.

[14] 李京桦, 陈燕. 蒿芩清胆汤联合克林霉素磷酸酯治疗盆腔炎性疾病后遗症患者的临床效果[J]. 世界中医药, 2022,17(20): 2901-2904, 2910.

[15] 陈懿君, 陈彤, 梁银兰. 膈下逐瘀汤联合针刺治疗气滞血瘀型盆腔炎性疾病后遗症临床观察[J]. 中国中医药现代远程教育, 2025,23(9): 158-161.

[16] 梁双娥. 康妇消炎栓联合氧氟沙星治疗盆腔炎性疾病后遗症的效果分析[J]. 中国实用医药, 2026,21(4): 123-126.

[17] 李燕, 徐建阳, 金莎莎. 银甲丸加失笑散联合西药治疗湿热瘀结型盆腔炎性疾病临床研究[J]. 新中医, 2026, 58(3): 58-63.

[18] 董杨, 李燕, 张伟, 等. 柏薏灌肠液联合丹白颗粒治疗盆腔炎性疾病后遗症(湿热瘀结证)的临床研究[J]. 中国医院用药评价与分析, 2024,24(5): 549-552.

[19] 李昕, 马红霞, 潘丁玮, 等. 清热调血汤配合妇乐片治疗盆腔炎性疾病湿热瘀滞证效果观察[J]. 新疆中医药, 2021,39(4): 22-23.

[20] 汤捷, 陈赛英, 杨斌. 裸花紫珠颗粒联合莫西沙星治疗慢性盆腔炎的临床研究[J]. 现代药物与临床, 2025,40(4): 1014-1018.

[21] 袁少英, 容礎南, 王文, 等. 泌宁胶囊治疗慢性前列腺炎/慢性盆腔疼痛综合征(湿热瘀滞证)随机双盲安慰剂对照临床研究及机制探讨[J]. 中国男科学杂志, 2026,40(1): 126-132.

[22] 仇什, 吉冬梅. 仿生物电刺激联合少腹逐瘀汤对寒湿凝滞型慢性盆腔炎患者盆腔疼痛程度及炎症因子水平的影响[J]. 河北中医, 2025,47(3): 423-426, 430.

[23] 陈慧, 刘玉玲. 妇可靖胶囊联合抗生素治疗慢性盆腔炎临床观察[J]. 辽宁中医杂志, 2022,49(3): 146-148.

[24] 张艳明, 罗丽华, 王慧鸽, 等. 特定电磁波谱联合桂枝茯苓胶囊治疗老年寒湿瘀滞型盆腔炎性疾病后遗症的临床效果[J]. 中国医药导报, 2023,20(20): 162-165.

[25] 李志芳, 李静静, 李若涵, 等. 益气活血方治疗气虚血瘀型盆腔炎性疾病后遗症[J]. 中医学报, 2025,40(8): 1795-1800.

[26] 刘琼, 李晓艳, 文薇. 中药熏蒸联合妇炎康软胶囊及止痛化癥片治疗慢性盆腔炎临床观察[J]. 实用中医药杂志, 2023,39(11): 2119-2121.

[27] 赵翠巧, 路红燕. 温胞饮加减治疗肾虚血瘀型慢性盆腔炎临床疗效观察[J]. 亚太传统医药, 2016,12(5): 126-127.

[28] 班爱会. 妇宝颗粒对慢性盆腔炎的疗效[J]. 河南医学研究, 2020,29(22): 4154-4156.

[29] 邵娟, 党颖, 郑霞, 等. 火龙灸联合少腹逐瘀膏穴位贴敷治疗盆腔炎性疾病后遗症寒凝血瘀证的临床研究[J]. 国际中医中药杂志, 2024,46(12): 1577-1582.

[30] 于文晓, 孙宁, 杨立杰, 等. 外用通腑方联合中药灌肠治疗术后早期炎性肠梗阻临床疗效观察[J]. 中国妇幼健康研究, 2017,28(S3): 106-107.

[31] 吴周汉, 唐梅文, 许永辉, 等. 灸法联合中药保留灌肠治疗盆腔炎性疾病后遗症疗效的Meta分析[J]. 浙江中西医结合杂志, 2025,35(3): 275-280.

[32] 蔡福梅, 魏绍斌, 李茂雅, 等. 盆腔炎性疾病及其后遗症的中西医治疗现状及问题探析[J]. 现代中医临床, 2024,31(4): 1-7.

[33] 钟新丽, 路玲. 中西医结合疗法对湿热瘀结型慢性盆腔炎的治疗价值探讨[J]. 中国妇幼健康研究, 2017,28(S4): 387-388.

[34] Liu B, Yang F, Pu X, et al. TNF/NF-κB signaling pathway is involved in mechanisms of tongluo decoction on rat models with sequelae of pelvic inflammatory disease[J]. J Inflamm Res, 2025,18: 12949-12960.

[35] Liang Z, Wang X, Liu Y, et al. Analgesic effect of electroacupuncture on chronic pelvic pain in patients with sequelae of pelvic inflammatory disease[J]. Zhongguo Zhen Jiu, 2021,41(4): 395-399.

[36] 顿巨燕, 王芬, 田丽颖. 针刺联合穴位贴敷治疗盆腔炎性疾病后遗症慢性盆腔痛的临床疗效观察[J]. 四川大学学报(医学版), 2025,56(3): 672-677.

[37] Yang L, Li Y, Zhang S, et al. Efficacy of acupuncture combined with traditional Chinese medicine fumigation therapy in sequelae of pelvic inflammatory disease:a systematic review and meta-analysis[J]. Complement Med Res, 2024,31(2): 175-186.

[38] 樊帆, 赵中亭, 陈家涟, 等. 应用灸法治疗盆腔炎性疾病后遗症的现代研究进展[J]. 实用中医内科杂志, 2024,38(6): 65-68.

[39] 张洁怡, 王聪, 温明华, 等. 精灸治疗盆腔炎性疾病后遗症气滞血瘀型临床观察[J]. 中华中医药杂志, 2021,36(7): 4375-4378.

[40] Zhang J, Wang C, Wen M, et al. Clinical observation of refined moxibustion for sequelae of pelvic inflammatory disease with qi stagnation and blood stasis[J]. Zhongguo Zhen Jiu, 2021,41(7): 757-761.

[41] Dun J, Wang F, Tian L. Clinical efficacy of acupuncture combined with acupoint patching in treating chronic pelvic pain as a sequela of pelvic inflammatory disease[J]. Sichuan Da Xue Xue Bao Yi Xue Ban, 2025,56(3): 672-677.

[42] 赵亚, 郭梦娇, 许婵娟, 等. 中药热敷联合穴位按摩在气滞血瘀证盆腔炎性疾病后遗症中的应用效果[J]. 中国医药导报, 2022,19(4): 132-135, 148.

[43] 李钰欣, 石玲. 中医药治疗盆腔炎性疾病后遗症的研究进展[J]. 中医学, 2024,13(10): 2810-2819.

[44] Yang W, Liu H L, Lu S S, et al. Acupoint catgut embedding for treatment of chronic pelvic pain due to the sequelae of pelvic inflammatory disease[J]. J Vis Exp, 2024(207).

[45] Zhang S, Yuan L, Wang Y, et al. Effect of fu yan qing prescription on pelvic effusion,mass absorption and microenvironment of pelvic blood stasis in patients with sequelae of pelvic inflammatory disease of accumulation of dampness heat and blood stasis type[J]. Pak J Med Sci, 2022,38(5): 1376-1381.

[46] 谢群, 郭静, 秦泽红. 五行音乐对盆腔炎性疾病后遗症负面情绪及疼痛干预的临床护理研究[J]. 新疆中医药, 2022,40(6): 60-62.

[47] 常志方, 安红军. 盆腔炎性疾病行盆腔保健操运动联合中医辨证施护效果观察[J]. 实用中医药杂志, 2020,36(6): 816-817.

[48] 周瑶瑶, 白明华, 李竹青, 等. 从中医体质学理论探讨女性盆腔炎性疾病的三级预防方案[J]. 中华中医药杂志, 2023,38(1): 243-246.