女性盆腔结核性包块44例临床分析

Clinical analysis of 44 cases of female pelvic tuberculous mass

目的探讨女性盆腔结核性包块的临床表现及其诊断方法。方法回顾分析44例女性盆腔结核患者伴有盆腔包块的临床资料。结果 44例患者平均年龄34.5岁,13例有结核病史或接触史,24例不孕或月经不调,21例患者有腹胀腹痛症状,14例伴有腹水和/或胸水。44例均经剖腹探查,腹腔镜检查或宫、腹腔镜联合探查术明确诊断为盆腔结核。术中探查,44例中有盆腔粘连31例,腹腔粘连28例,其中,盆腹膜病变27例为粘连型,15为渗出型例。20例术中输卵管切除,5例行一侧附件切除,2例行全子宫及附件切除,17例仅取活检,2例因术中肠壁损伤行肠修补术。2例肠瘘患者保守治疗痊愈。术后所有患者转专科医院抗结核治疗。结论女性盆腔结核性包块患者有不孕或月经不调、腹胀腹痛、腹水等表现,术前诊断困难,剖腹探查或腹腔镜检查是明确诊断的重要手段,但手术有发生肠管损伤的风险。

Objective To investigate the clinical manifestations and diagnosis of female pelvic tuberculous mass. Methods Retrospective analysis was made on the clinical data of 44 female patients with pelvic tuberculosis（ TB） complicated with pelvic mass. Results The average age of patients was 34. 5 years. Out of 44 patients,13 had a history of TB or TB exposure,24 suffered from infertility or abnormal menstruation,21 had symptoms of abdominal pain and abdominal distension,14 had ascites and / or pleural effusion. All patients were confirmed as pelvic TB by exploratory laparoscopy,laparoscopy or hysteroscopy joint laparoscopy. The laparoscopy exploration found that there were pelvic adhesion in 31 cases and abdominal adhesions in 28 cases in all 44 cases. In pelvic peritoneal lesions,exudative type and adhesive type were found in 15 cases and 27 cases,respectively. Salpingectomy was performed in 20 cases; one side accessory resection was performed in 5cases; total hysterectomy and accessories resection were performed in 2 cases; biopsy alone was performed in 17 cases; intestinal repair was performed due to intraoperative injury of the intestinal wall in 2 case; 2 patients with intestinal fistula were cured by conservative treatment. All patients were transferred to the specialist hospital after operation to perform anti-tuberculosis treatment. Conclusion Female patients with pelvic tuberculous mass could have manifestations including infertility or abnormal menstruation,abdominal pain and abdominal distension,ascites,etc. Preoperative diagnosis of female pelvic tuberculous mass is difficult. Exploratory laparotomy or laparoscopy is important methods confirming diagnosis,however,there is the risk of bowel injury in surgery.