腹腔镜诊治女性结核性不孕52例临床分析

The Role of Laparoscopy in Diagnosis and Management of Female Genital Tuberculosis:A Clinical Analysis of 52 Infertile Women

目的:探讨腹腔镜在女性生殖器结核性不孕诊治中的价值及有效治疗策略。方法:回顾性分析北京协和医院近20年腹腔镜诊治的女性生殖器结核性不孕52例的临床资料,综合文献复习。结果:本组患者中诊断时平均年龄26.7岁。原发不孕36例,占69.2%;继发不孕患者16例,占30.8%。腹腔镜下病变表现为:粟粒腹水型13例,占25%;盆腔干酪样病变14例,占26.9%;卵巢输卵管包裹粘连形成包块21例,占40.4%;结节钙化型4例,占7.7%。双侧输卵管梗阻患者44例,占全部患者的84.6%,梗阻部位在双侧或单侧输卵管间质部的患者37例。本组患者自然妊娠率为1.92%,正常自然妊娠率为0。3例患者行IVF-ET,2例妊娠;1例失败。结论:女性生殖器结核性不孕患者的症状没有特异性,使早期诊断困难。腹腔镜手术可以提高本病的术中诊断率,抗结核治疗后,患者正常妊娠率低,控制结核后IVF-ET是一个较好的选择。

Objective：This study was performed to evaluate the diagnostic and treatment value of laparoscopy in infertility patients with genital tuberculosis. Methods： Fifty-two cases of female infertility patients with genital tuberculosis admitted in PUMC hospital diagnosed and treated with laparoscopy between 1984 and 2004 were analyzed retrospectively. Results： In this study the mean age of the patients at the time of diagnosis was 26.69 years. Four types of tuberculosis lesions were observed： military ascites （ 13 cases, 25% ）, pelvic cheesy lesions （ 14 cases, 26.9% ）, tubo-ovarian adherent mass （21 cases,40.4% ）, nodular sclerosis and calcification （4 cases,7.7% ）. In this group 44 cases were found bilateral tubal obstruction, they accounted for 84.6% of all patients. In our studY the natural conception rate was 1.92%, normal natural conception rate was 0. In three cases undergoing IVF-ET, 2 conceived, 1 failed. Conclusions： Laparascopy is a valuable procedure for the early diagnosis and management of infertility women with genital TB. The patients should be given chemotherapy after laproscopy diagnosis of TB, but the pregnant outcome of infertility with Female Genital TB is very poor,and IVF-ET offers some hope to them.