{"paper_id":"040554c4-2986-4c5c-86ea-83df7cd706c2","body_text":"中华妇幼临床医学杂志(电子版) ›› 2018, Vol. 14 ›› Issue (01) : 62 -67. doi: 10.3877/cma.j.issn.1673-5250.2018.01.010\n所属专题： 文献；\n论著\n女性生殖器结核的临床表现及腹腔镜与宫腔镜检查特点分析\n- 1. 100006 首都医科大学附属北京妇产医院妇科微创中心\n- 1. Gynecology Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China\n目的\n探讨女性生殖器结核(FGT)的临床表现，以及在腹腔镜、宫腔镜检查的表现特点，提高临床对FGT的诊断和鉴别诊断能力。\n方法\n选择2010年1月至2016年12月，于首都医科大学附属北京妇产医院妇科微创中心进行腹腔镜和(或)宫腔镜检查，并经抗酸染色法和(或)活组织病理学检查，以及腹水培养病原学检查确诊为FGT的33例患者为研究对象。其年龄为17～73岁，平均为(31.4±5.6)岁。采用回顾性分析方法，收集所有患者的不孕、腹部异常症状、月经改变等临床表现，胸部X射线摄片、CT检查等影像学辅助检查结果，以及腹腔镜探查、宫腔镜检查、活组织病理学检查结果，并进行统计学分析。对于患者的不孕、腹部异常症状、月经改变等临床表现发生率，以及腹腔镜、宫腔镜检查结果所占比例等计量资料，采用率(%)表示。\n结果\n①本研究33例FGT患者的临床表现中，以不孕最为多见，为21例(63.6%，21/33)。其他临床表现包括：下腹胀痛为7例(21.2%，7/33)，腹水为5例(15.2%，5/33)，盆腔包块为5例(15.2%，5/33)，月经量过少或闭经为4例(12.1%，4/33)，月经不规律为2例(6.1%，2/33)，痛经为1例(3.0%，1/33)，绝经后出血为1例(3.0%，1/33)。②本研究33例FGT患者中，经活组织病理学检查确诊为FGT者为26例，其中，17例确诊为输卵管结核，3例确诊为输卵管结核合并卵巢结核，6例确诊为子宫内膜结核，病理学诊断FGT阳性率为78.8%(26/33)；1例(3%，1/33)抗酸染色结果呈强阳性，确诊为输卵管结核；4例(12.1%，4/33)经腹部X射线摄片检查确诊为输卵管结核；2例(6.1%，2/33)经诊断性抗结核治疗后，确诊为输卵管结核。③本研究33例FGT患者的影像学辅助检查结果提示，该检查对诊断FGT的符合率为21.2%(7/33)。④本研究33例FGT患者的腹腔镜检查结果如下：合并腹水者为7例(21.2 %，7/33)，腹膜粟粒样改变者为16例(48.5%，16/33)，输卵管积水与周围组织包裹成团者为10例(30.3%，10/33)，输卵管增粗，呈串珠样、腊肠样改变者为13例(39.4%，7/33)，输卵管伞端有黄色脓液流出者为1例(3.0%，1/33)，卵巢呈苍白样改变、质硬者为2例(6.1%，2/33)，盆、腹腔内可见干酪样坏死物者为13例(39.4%，13/33)。⑤本研究33例FGT患者中，25例因合并不孕或月经改变，接受腹腔镜检查的同时进行宫腔镜检查的结果显示，6例(24.0%，6/25)宫角局部子宫内膜增厚不平，输卵管开口细小；1例(4.0%，1/25)子宫内膜变薄，呈不规则苍白样改变；4例(16.0%，4/25)为宫腔黏连，其中1例(4.0%，1/25)可见干酪样钙化灶；其余14例(56.0%，14/25)宫腔镜检查结果均为正常宫腔形态。\n结论\n腹腔镜和(或)宫腔镜检查可清晰显示FGT病灶的部位、大小、形态及病变周围情况，对于FGT的诊断和鉴别诊断具有重要意义。\nObjective\nTo explore the clinical manifestations of female genital tuberculosis (FGT) and characteristics of FGT in laparoscopy and hysteroscopy, in order to improve the clinical abilities of diagnosis and differential diagnosis of FGT.\nMethods\nFrom January 2010 to December 2016, a total of 33 cases of patients who had taken the laparoscopy and (or) hysteroscopy, and diagnosed as FGT by acid fast staining and (or) biopsy and (or) ascites culture pathogenic examination in Gynecology Minimally Invasive Center of Beijing Obstetrics and Gynecology Hospital, Capital Medical University were selected as research subjects. They ranged from 17 to 73 years old, and the average age was (31.4±5.6) years old. The clinical manifestations, such as infertility, abdominal abnormalities, menstrual changes and so on, and results of imaging assisted examination, such as chest X-ray examination and CT examination and so on, and the results of laparoscopy, hysteroscopy and biopsy of all subjects were collected by retrospective analysis method and were analyzed by statistical methods. The incidences of clinical manifestations, such as infertility, abdominal abnormalities, menstrual changes, as well as the proportions of laparoscopy and hysteroscopy results were calculated.\nResults\n①Among these 33 patients with FGT, the most common clinical manifestation was infertility 21 cases (63.6%, 21/33). Others clinical manifestations included lower abdominal distending pain 7 cases (21.2%, 7/33), ascites 5 cases (15.2%, 5/33), pelvic mass 5 cases (15.2%, 5/33), hypomenorrhea or amenorrhea 4 cases (12.1%, 4/33), irregular menstruation 2 cases (6.1%, 2/33), dysmenorrhea 1 case (3.0%, 1/33) and postmenopausal bleeding 1 case (3.0%, 1/33). ②Among these 33 patients with FGT, 26 cases were diagnosed as FGT by biopsy, and 17 cases were diagnosed as tubal tuberculosis, 3 cases were diagnosed as tubal tuberculosis combined with ovarian tuberculosis, 6 cases were diagnosed as endometrial tuberculosis, and the positive FGT rate of pathological diagnosis was 78.8% (26/33). And 1 case (3%, 1/33) was diagnosed as tubal tuberculosis as the result of acid fast staining was strongly positive, 4 cases (12.1%, 4/33) were diagnosed as tubal tuberculosis by abdominal X-ray examination, 2 cases (6.1%, 2/33) were diagnosed as tubal tuberculosis after diagnostic anti-tuberculosis treatment. ③Imaging assisted examination results of these 33 patients with FGT suggested that the diagnostic accordance rate of assisted examination for FGT was 21.2% (7/33). ④The laparoscopy results of these 33 patients with FGT were as follows: ascites in 7 cases (21.2%, 7/33); peritoneal miliary changes in 16 cases (48.5%, 16/33); hydrosalpinx and surrounding wrapped tissues in 10 cases (30.3%, 10/33); thickening of fallopian tube beads like, sausage like changes in 13 cases (39.4%, 7/33); fallopian tube with yellow pus outflow in 1 case (3%, 1/33); pale change and hard ovary in 2 cases (6.1%, 2/33); abdominopelvic cavity wtih visible caseous necrosis in 13 cases (39.4%, 13/33). ⑤Among these 33 patients with FGT, 25 cases of patients who were combined with infertility or menstrual changes had taken laparoscopy and hysteroscopy at the same time. Among them, 6 cases (24%, 6/25) had uneven endometrial thickening in the corn and the opening of fallopian tube was fine; 1 case (4%, 1/25) had endometrial thin, irregular pale changes; 4 cases (16%, 4/25) were intrauterine adhesions, 1 case (4%, 1/25) showed caseous calcification; and the other 14 cases(56.0%, 14/25) were with normal uterine morphology.\nConclusions\nLaparoscopy and (or) hysteroscopy could clearly display the lesion of FGT from the location, size, morphous and the environment of lesion. And it has great significance for the diagnosis and differential diagnosis of FGT.\n| [1] |\nWorld Health Organization. Global TB report 2016[R]. Geneva: WHO, 2016.\n|\n| [2] |\nSharma JB. Current diagnosis and management of female genital tuberculosis[J]. J Obstet Gynaecol India, 2015, 65(6):362-371.\n|\n| [3] |\n张辉，孔北华. 女性生殖器结核的诊断方法[J]. 实用妇产科杂志，2006, 22(11):642-643.\n|\n| [4] |\n陈美群，龚美琴，高浩成，等. 女性生殖器结核的诊断和治疗[J]. 医学综述，2014, 20(11):2196-2199.\n|\n| [5] |\n荣昆. 女性盆腔结核诊断进展[J]. 现代诊断与治疗，2015, 26(9):2132-2133.\n|\n| [6] |\nShah HU, Sannananja B, Baheti AD, et al. Hysterosalpingography and ultrasonography findings of female genital tuberculosis[J]. Diagn Interv Radiol, 2015, 21(1):10-15.\n|\n| [7] |\n魏晗，郑立恒，张莹，等. 三种方法在盆腔结核诊断中的价值分析[J]. 标记免疫分析与临床，2016, 23(2):183-185.\n|\n| [8] |\n曹泽毅. 中华妇产科学(临床版)[M]. 北京：人民卫生出版社，2010.\n|\n| [9] |\n温宝宁，陈兰芳，车小群，等. 子宫内膜结核在宫腔镜下的图像特征[J]. 中国热带医学，2009, 9(8):1530-1531.\n|\n| [10] |\n童兴海. 腹腔镜在鉴别诊断女性盆腔结核和卵巢癌中的价值[J]. 中国微创外科杂志，2008, 8(3):210-211.\n|\n| [11] |\n张丹，梁占光，王世阆. 女性生殖器结核452例分析及腹腔镜诊断价值探讨[J]. 实用妇产科杂志，2006, 22(11):662-665.\n|\n| [12] |\nSharma JB, Goyal M, Kumar S, et al. Concomitant female genital tuberculosis and endometriosis[J]. Indian J Tuberc, 2017, 64(3):173-177.\n|\n| [13] |\n艾永航. 宫腔镜在子宫内膜癌诊断中的应用价值[J/CD]. 中华妇幼临床医学杂志(电子版), 2015, 11(1), 69-71.\n|\n| [14] |\n姚恒，谢世珍，效小莉. 阴道不规则流血2910例临床分析[J/CD]．中华妇幼临床医学杂志(电子版), 2012, 8(1):51-53.\n|\n| [15] |\n谭世桥，官立丽，侯震辉，等. 子宫内膜结核致阴道上端——宫颈闭锁1例[J/CD]．中华妇幼临床医学杂志(电子版), 2006, 2(3):155.\n|\n| [16] |\nBhanothu V, Theophilus JP, Rozati R. Use of endo-ovarian tissue biopsy and pelvic aspirated fluid for the diagnosis of female genital tuberculosis by conventional versus molecular methods[J]. PLoS One, 2014, 9(5):e98005.\n|\n| [17] |\n周凤琼，刘玉环，夏恩兰，等. 结核性宫腔黏连的临床诊治分析[J/CD]. 中华临床医师杂志(电子版), 2013, 7(4):1678-1679.\n|\n| [18] |\n郭丽娜，王旭平，吕翠婷，等. 生殖器结核不孕患者临床资料及IVF结局分析[J]. 山东医药，2016, 56(7):4-6.\n|\n| [1] | 张舒沁, 陈练. 产后宫腔内妊娠物残留的诊断和临床处理[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 493-497. |\n| [2] | 石皆春, 范子玉, 邢燕. 不同筛查方法预警宫颈原位腺癌的效能[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 575-581. |\n| [3] | 唐丹, 姚晓曦, 杨博文, 薛绍龙, 李梦瑶, 韦柳杏, 郄明蓉. 双肾上腺皮质激素样激酶1对子宫内膜样腺癌患者临床特征的影响[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 582-590. |\n| [4] | 魏艺, 周羽西, 杨烨, 凌秀凤, 赵纯. 微小RNA对子宫内膜容受性影响的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 266-270. |\n| [5] | 林琳, 田思萌, 于永华, 徐飞飞, 黄明莉. 干细胞及其外泌体治疗宫腔黏连的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 271-275. |\n| [6] | 李欣, 魏艺, 张娟, 张娟娟, 凌秀凤, 赵纯, 张媔秋. 高龄女性冻胚移植周期临床妊娠结局的影响因素分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 276-283. |\n| [7] | 高伟聪, 李丽, 张中华, 朱向辉, 刘素巧. 宫颈癌患者糖调节受损对改良根治术后2年内复发的影响作用[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(02): 231-237. |\n| [8] | 杨琳, 尹如铁. 外阴白色病变病因研究及治疗现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(02): 157-165. |\n| [9] | 王丽, 王月莺, 周芬, 郭宇堃, 魏丽娜. 促性腺激素释放激素拮抗剂对子宫内膜容受性影响的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2023, 19(06): 629-635. |\n| [10] | 武渊, 朱必清, 何丹, 王海蓉, 李倩. 采取调强放疗联合后装治疗宫颈癌患者的预后模型及危险分层系统构建[J/OL]. 中华妇幼临床医学杂志(电子版), 2023, 19(06): 734-744. |\n| [11] | 顾娟, 孙擎擎, 胡方方, 曹义娟, 祁玉娟. 子宫内膜容受性检测改善胚胎反复种植失败患者妊娠结局的临床应用[J/OL]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 582-587. |\n| [12] | 马敏榕, 李聪, 周勤. 宫颈癌治疗研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 497-504. |\n| [13] | 王振宁, 杨康, 王得晨, 邹敏, 归明彬, 王雅楠, 徐明. 机器人与腹腔镜手术联合经自然腔道取标本对中低位直肠癌患者远期疗效比较[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 437-442. |\n| [14] | 李海风, 战俊, 滕世岗, 尹鹏, 刘忠诚. 改良套扎法在腹腔镜完全腹膜外疝修补术中关闭腹膜破裂的临床应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 192-196. |\n| [15] | 胡小靖, 张华. 妊娠期卵巢囊肿蒂扭转的诊断与治疗[J/OL]. 中华产科急救电子杂志, 2024, 13(04): 197-201. |\n| 阅读次数 | |||||\n|\n全文 |\n|\n||||\n|\n摘要 |\n|\n||||\n版权所有 中华医学会 中华医学电子音像出版社有限责任公司 京ICP备14006079号-1 网络出版服务许可证：(署)网出证(京)字第075号\nAI\n小\n编\nAI小编","source_license":"CC0","license_restricted":false}