Pelvic inflammatory disease is the most important cause of pelvic pain. The pelvic inflammatory disease is a general term for inflammation of the female internal genitalia and its surrounding connective tissue, pelvic peritoneum, including myometritis, endometritis, tubo-ovarian inflammation, pelvic connective tissue inflammation and pelvic peritonitis, whose lesions can be confined to one site, or distributed to several sites, or even the entire pelvic organs, with acute pelvic inflammatory disease and chronic pelvic inflammatory disease. Acute pelvic inflammatory disease has an acute onset and is mainly characterized by acute lower abdominal pain with high fever and rectal irritation, which can be life-threatening in severe cases due to sepsis. The chronic pelvic inflammatory disease is prolonged due to the incomplete treatment of acute pelvic inflammatory disease, with recurring episodes of pain and swelling in the lower abdomen or lumbar region, which can also affect the physical and mental health of the patient. Therefore, how to correctly diagnose pelvic inflammatory pain in a timely manner and give effective treatment is a problem that obstetricians and gynecologists often encounter and urgently need to solve. The mechanism of pelvic inflammatory pain is caused by local tissue congestion, edema and accumulation of inflammatory exudates and adhesions, followed by increased tension in the pelvic tissues, coupled with bacterial toxins and inflammatory reactions to generate and release various chemical pain-causing substances, such as: ethacholine, bradykinin, 5 a transthyretin, prostaglandins and histamine, which act on the nerve endings of the pelvic organs, causing diffuse and imprecise localized visceral pain. When the inflammation spreads to the pelvic cavity and even the peritoneum of the abdominal wall, it can cause precisely localized somatic pain, such as sharp pain like needling in the lower abdomen. 2.1 Clinical characteristics of acute pelvic inflammatory pain Acute pelvic inflammatory disease mostly has genital tract infection triggers, such as postpartum, post-abortion, uterine or vaginal operations, frequent unclean sexual activity, etc. Pathogenic bacteria invade the pelvic organs through the blood, lymphatic system or along the genital mucosa upstream spread, and the onset is more acute. Acute pelvic inflammatory pain can have different performance characteristics depending on the severity of the inflammation, the extent and degree of the lesion and the strength of the pathogenic bacterium toxin. In general, the degree of pain is proportional to the extent of lesion involvement and the severity of the disease. Acute endometritis and myometritis are mainly characterized by pain in the lower abdomen, falling sensation and swelling of the waist, accompanied by fever, increased leucorrhea in the form of watery or purulent leucorrhea, and an enlarged uterus with pressure pain on gynecological examination. If the inflammation spreads to the fallopian tubes and ovaries, acute tubo-ovarian and pelvic connective tissue inflammation occurs, which is characterized by pain on one or both sides of the lower abdomen, severe pain in the lesion, often refusing to press; fever is more pronounced, with a temperature of 39-40°C; there are also symptoms of bladder and rectal irritation, tenderness in the vaginal fornix during gynecological examination, painful cervical lifting, swaying pain, an enlarged uterus, restricted movement, thickening of the adnexa bilaterally or There are thickening or masses in the adnexa bilaterally, and pressure pain is obvious. When the inflammatory exudate collects relatively confined in the interstitial space of adhesions to form an abscess, such as a tubal abscess, or in the rectal fossa of the uterus to form a pelvic abscess, there is still severe pain on one or both sides of the lower abdomen, abdominal distension, local pressure pain, and on gynecological examination, there is a fluctuating mass in the posterior fornix with obvious tenderness. If further development of acute connective tissue inflammation, or abscess rupture to pelvic peritonitis, the whole lower abdomen severe pain, peritoneal irritation signs are obvious, lower abdominal pressure pain, rebound pain causing patients to refuse to press, acute inflammatory toxicity symptoms more serious, and even develop into sepsis life-threatening. 2.2 Clinical features of chronic pelvic inflammatory pain Chronic pelvic inflammatory disease often has a history of acute inflammation and recurrent episodes, but can also start more slowly without obvious acute passage. Chronic pelvic inflammatory disease causes adhesions between the internal genitalia and adjacent organs and tissues, together with tissue fibrosis and hyperplasia, and changes in tension, patients experience persistent lower abdominal and lumbar skeletal swelling and vague pain, which often increases before and after menstruation, after sexual intercourse or after exertion. The systemic symptoms are mostly insignificant, and some patients have symptoms of neurasthenia, such as mental depression, peripheral discomfort and insomnia. The degree of pain is not necessarily proportional to the degree of inflammatory lesions. (l) Chronic endometritis and chronic myometritis: most of them have a history of using intrauterine devices, mild lower abdominal pain, often with irregular menstruation and increased leucorrhea as the main manifestation; gynecological examination: uterus slightly larger, with tenderness. (2) Chronic tubal and ovarian inflammation: lower abdominal pain, lumbago, aggravated by exertion, sometimes increased leucorrhea, irregular menstruation, often with infertility; gynecological examination: the uterus is mostly posterior, with restricted mobility, thickened fallopian tubes and tenderness in the adnexal area, cystic masses can be palpated if tubo-ovarian cysts or fluid in the fallopian tubes have formed. (3) Chronic pelvic connective tissue infection: generally asymptomatic, but in severe cases or after exertion, there may be more serious lower abdominal cramps, lumbago and painful intercourse. Gynecological examination:Uterus posteriorly tilted and retroflexed, thickened skeletal ligaments of the uterus, hypertrophy and tenderness of the parametrial tissues, if the lesions are extensive, or even forming a frozen pelvis, the mobility of the uterus may be completely restricted. 2.3 Auxiliary examination Inflammation of pelvic organs rarely exists alone and is a mixed infection of multiple pathogens. The diagnosis of pelvic inflammatory pain is not complete based on history and clinical features alone, but requires clarification of the type of causative agent and determination of the site and extent of inflammatory spread. Therefore, appropriate ancillary tests: routine blood, urine, cervical secretion bacterial culture, ultrasound, and even laparoscopy are needed to increase the specificity of diagnosis. 2.3.1 Bacterial culture of cervical secretion or posterior fornix puncture fluid and drug sensitivity test Bacterial culture of cervical secretion and drug sensitivity test not only help to diagnose, but also can indirectly find out the type of causative agent and select effective therapeutic drugs through drug sensitivity test. However, in patients with negative bacterial culture of cervical secretions and a history of recurrent episodes, gonorrhea, chlamydia, and desmoplastic chlamydia should be tested using the vicodin technique. Many data show that the proportion of Chlamydia trachomatis, mycoplasma, gonorrhea and other infections in pelvic inflammatory infections is on the rise, and they are often subclinical or insidious infections with mild pain symptoms and atypical clinical manifestations, often not diagnosed and treated in a timely manner. 2.3.2 Ultrasound examination is a safe and reliable non-invasive auxiliary examination method. When there is inflammation in the pelvic cavity, ultrasound can be seen in the pelvic cavity with fluid accumulation and thickening of the fallopian tubes and other sonograms. If inflammatory masses of the fallopian tubes and ovaries are formed, the ultrasound may suggest a cystic-solid mixed mass with disorganized internal echogenicity, which can be easily confused with ovarian malignant tumors. 2.3.3 Laparoscopic surgery has been improved and developed in the past 10 years, making it an indispensable tool for diagnosis and treatment of gynecological diseases, with the advantages of small trauma, high diagnosis rate and fast postoperative recovery. Acute and chronic pelvic inflammatory pain is often confused with other acute abdominal diseases and chronic pelvic pain, and there are about 20%-30% false positive or false negative results in clinical or experimental diagnosis of pelvic inflammatory disease. It is also important to take pus specimens from inflammatory lesions for bacterial culture to find the causative microorganisms, which can provide a strong basis for clinical selection of effective and specific antibiotics. It has been reported that 60% of patients with chronic pelvic pain of unknown origin have been diagnosed by laparoscopy, with the main causes being pelvic adhesions, endometriosis, chronic pelvic inflammatory disease, and pelvic tumors [z]. However, laparoscopy is contraindicated in patients with intestinal obstruction or incomplete obstruction to avoid damage to the pelvic and abdominal organs. 3 Treatment of pelvic inflammatory pain 3.1 Treatment of acute pelvic inflammatory pain The principles of treatment of acute pelvic inflammatory pain are:Avoid the use of analgesics before diagnosis to avoid delays, and use broad-spectrum highly effective antibiotics and other methods reasonably to achieve complete cure and prevent conversion to chronic pelvic inflammatory disease. 3.1,1 Supportive treatment and symptomatic management of patients with acute pelvic inflammatory disease are advised to rest in bed in a semi-sitting position, which facilitates the discharge of cervical inflammatory secretions from the uterine cavity and the accumulation of pelvic exudate in the rectal fossa of the uterus to limit inflammation. Give a high protein or semi-liquid diet and pay attention to water-electrolyte and acid-base balance. Give physical cooling in case of high fever. Abuse of glucocorticoids is forbidden, and they should not be used as a measure to reduce hyperthermia to avoid the spread of infection. 3.1.2 Active anti-infection The application of broad-spectrum high-efficiency antibiotics is the most important method to reduce acute pelvic inflammatory pain. Only when the infection is controlled can the pain be reduced or relieved. The reasonable use of broad-spectrum high-efficiency antibiotics can completely cure most acute inflammatory diseases in clinical practice. The actual antibiotics are usually used before the drug sensitivity test is made, according to the medical history and clinical characteristics combined with the kind of antibiotics used before the onset of the disease, the choice of antibiotics for both aerobic and anaerobic bacteria; to be made after the drug sensitivity test, according to the bacterial sensitivity drug selection. In addition, the use of antibiotics to follow the drug to be less toxic, the amount and duration of treatment to be sufficient, the principle of combined medication, the route of administration to intravenous drip is preferred. However, the clinical diagnosis is not standardized, the treatment is not regular, the result caused by the increase of drug-resistant strains and mixed infections, so that the pathogens on some commonly used antibiotics are not effective “refractory” cases are common. It is worth noting that the drug-resistant strains of mycoplasma are also increasing, according to Feng Huaying et al [3j reported that 258 cases of mycoplasma-positive patients were only 59.70% sensitive to 10 drugs, of which 89.30% were positive for Mycoplasma antibiotics, so a comprehensive pathogen examination, select sensitive antibiotics, standardize and rationalize treatment, eliminate the abuse of various drugs, and at the end of the course of treatment regularly The patient should be followed up regularly after the course of treatment to review the pathogens and other clinical indicators, and to prevent chronic pelvic inflammatory disease from developing. Recently, some authors reported that the efficiency of acute pelvic inflammatory disease treated with azithromycin alone or the combination of azithromycin and metronidazole reached more than 97%, while the efficiency of the control group treated with metronidazole + doxycycline + Cef6xitin was 94.6% Chuan. At present, our hospital commonly used antibiotic combination program has the first generation of head hold bacteriocin and metronidazole wow combination, clindamycin and aminoglycoside II combination, wow nandrolone drugs and metronidazole combination, its therapeutic effect are more ideal, most of the treatment after 3 a 4d abdominal pain can be significantly reduced or alleviated, and the body temperature gradually decreased, when the body temperature returned to normal 24 a 48h after, before discontinuing intravenous drugs, change to oral continue 10 a 14d. If chlamydia or mycoplasma infection is considered, doxycycline 100rng should be added orally once every 12h, and continue for 10-14d after the condition improves or azithromycin 250mg once a day for 7 I4do3.1.3 Surgery is generally not required for acute pelvic inflammatory pain before mass formation, but surgery should be considered in the following cases: (1) after antibiotic treatment (1) abdominal pain is not reduced or increased by antibiotic treatment for 48 to 72h, the temperature continues not to decrease, and the mass does not disappear but gradually expands; (2) there is a sudden increase in abdominal pain, chills, high fever, abdominal distension, abdominal pressure pain, rebound pain is obvious, and abscess rupture is suspected; (3) limited abscess, so as to avoid another acute attack in the future, timely surgical dissection or laparoscopic surgery can be considered. The principle of surgery is based on excision of the lesion, flushing of the abdominal cavity, and placement of drainage. The surgical modalities are decided mainly according to the patient’s age, delivery, degree of lesion and general condition and include:(1) transabdominal abscess drainage; (2) posterior fornix excision and drainage; (3) lesion or unilateral adnexal resection; (4) total hysterectomy; (5) laparoscopic surgery, and the application of laparoscopy in acute suppurative pelvic inflammatory disease is not well reported in the literature [5], with regard to acute pelvic inflammatory disease of khat exudation, suppuration, laparoscopic management is effective in reducing inflammation in all stages of acute pelvic inflammation of cicatricial exudation, suppuration, adhesions and abscess formation. If early incision and drainage, full pelvic cleaning, and focal resection can be performed in some cases, it can not only promote inflammation and reduce pain symptoms, but also shorten the course of treatment, reduce pelvic adhesions, and greatly improve the fertility of patients. 1.4 Traditional Chinese medicine treatment for acute pelvic inflammatory pain is to clear heat and detoxify the toxins, drain dampness and drain pus, and break cavities and disperse knots if masses are formed. The formula used is such as gentian diarrhea liver soup with addition and subtraction, abdominal distension and pain with addition of yuan hu and frankincense, etc. 2 Treatment of chronic pelvic inflammatory pain Due to irregular medication or insufficient treatment time for acute pelvic inflammatory disease, bacteria have developed a certain degree of drug resistance, while the local chronic inflammation makes the drug not easily absorbed, so the antibiotics are not effective, and a combination of systemic and local comprehensive treatment should be taken. 3.2.1 General treatment for patients with chronic pelvic inflammatory pain need to strengthen the education, relieve the patient’s ideological concerns, enhance the confidence of treatment, pay attention to nutrition, strengthen exercise, pay attention to the combination of work and rest, and enhance physical fitness. 3.22 Physiotherapy promotes blood circulation in pelvic local tissues through warm stimulation, improves local tissue metabolism to facilitate the absorption and remission of inflammation and reduce pain. Commonly used physiotherapy methods are: ultrashort wave, microwave, high ion guide, etc. However, when applying physiotherapy, attention should be paid to its contraindications: (1) menstruation and pregnancy; (2) malignant tumors in reproductive organs; (3) with bleeding; (4) combined with heart, liver and kidney insufficiency; (5) active tuberculosis; (6) high fever; (7) allergic constitution and other conditions, are not given physiotherapy. 3.2.3 Surgery can be considered for patients who are not cured for a long time, who are older (>40 years old), who do not have fertility requirements, who have frequent lower abdominal pain, and who have pelvic mass formation in particular, which is ineffective for conservative treatment and seriously affects their health and work. Surgery is based on the principle of complete cure, such as total hysterectomy plus excision of the lesion. In the case of young patients who urgently want to have children, tuboplasty can be performed according to the situation when there is single or bilateral tubal obstruction or hydrocele. 3.2.4 Other medications are applied along with anti-inflammatory treatment with prednisone or dexamethasone, with attention to gradual reduction of dosage before stopping. 3.2.5 The treatment of chronic pelvic inflammatory disease is due to residual evil and fetish accumulation in the cell. The treatment is to warm the menstruation and disperse cold, regulate Qi and activate blood circulation, resolve fetish and relieve pain, and the formula can be added or subtracted by Gui Zhi Hua Tang or Shao Belly and Fatigue Soup. As the lesion is in the pelvis, Chinese medicine can also be used to retain the enema; drug prescription: red vine, septoria, dandelion, purple groundnut, yuan hu, thick decoction, 100mL, once a day.