女性盆腔腹膜结核19例临床分析

Clininal analysis of 19 cases of female pelvic peritoneal tuberculosis

目的探讨女性盆腔腹膜结核的临床表现及诊断方法。方法对19例盆腔腹膜结核病例进行临床分析。结果女性盆腔腹膜结核常见症状为腹部胀痛,次为乏力盗汗、消瘦,少数有月经改变;5例有结核病史或伴发其他部位结核病;14例发现盆腔包块;16例CA125升高。16例行剖腹探查术,其中12例盆腹腔脏器及腹膜表面见广泛散在粟粒状结节、4例为包块型,病理确诊均为结核;3例行电视腹腔镜手术,镜下见输卵管肿胀变形,形成盆腔粘连,伴粟粒状结节、干酪样坏死,镜下改变符合盆腔结核诊断标准。19例确诊后均行抗结核治疗,预后良好。结论女性盆腔腹膜结核常见症状为腹胀腹痛,可伴有消瘦、不孕、月经改变等;术前诊断困难,剖腹探查或电视腹腔镜下探查活检是确诊的主要手段,治疗后少数可怀孕,但宫外孕的机会大大增加。

Objective To investigate the clinical presentation and diagnosis approach of female pelvic peritoneal tuberculosis. Methods A retrospective review of 19 cases of pelvic peritoneal tubemulosis was performed. Results The common presentation of female pelvic peritoneal tuberculosis are abdominal distension, 5 cases had history of tuberculosis, 14 cases had found mass in the pelvic;16 cases were diagnosed tuberculosis by the pathologic results from laparotomy;3 cases were diagnosed results from laparoscopy. All cases were treated alter being diagnosed tuberculosis. Condusions Female pelvic tuberculosis is hard to diagnosis before the operation. The laparotomy and laparoseopy are valuable for the diagnosis of female pelvic tuberculosis. Almost all women who have had pelvic peritoneal tuberculosis remain sterile alter treatment, and the risk of ectopic pregnancy is high.