Analysis of clinical manifestations and characteristics of laparoscopy and hysteroscopy in female genital tuberculosis

Objective To 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. Methods From 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. Results ①Among 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. Conclusions Laparoscopy 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. Key words: Tuberculosis, female genital; Mycobacterium tuberculosis; Laparoscopy; Hysteroscopy; Tuberculosis, fallopian; Tuberculosis, ovary; Female