女性生殖器结核不孕患者腹腔镜检查特点及临床疗效评估价值

Characteristics of laparoscopy in infertile patients with female genital tuberculosis and its clinical efficacy evaluation

目的探讨女性生殖器结核(FGT)不孕患者腹腔镜检查特点,分析其在临床疗效评估中的应用价值。方法选取2015年3月至2017年3月乌鲁木齐市妇幼保健院妇科收治的42例经病理学+腹水培养病原学+腹腔镜/宫腔镜确诊的FGT不孕患者作为研究对象。回顾性分析患者腹部异常症状、不孕以及月经改变等临床表现。对比不同结核类型和治疗效果腹腔镜特点情况。结果42例FGT不孕患者中输卵管结核25例、盆腔结核10例、卵巢结核3例、输卵管结核伴卵巢结核4例;患者的主要症状表现为月经不调、腹部压痛、下腹坠痛、腹部肿块、身体乏力和低热等。腹腔镜下的共性表现为组织粘连、有栗粒型结节、干酪样组织钙化等。治疗后随访1年无复发,患者生殖系统组织栗粒结节吸收、组织质地、颜色均逐渐恢复正常,自然受孕患者输卵管、卵巢病灶完全吸收,器官功能恢复正常。结论宫腔镜能够清晰显示FGT病灶的形态、大小等情况,在FGT诊断鉴别以及疗效评估中均有重要意义。

Objective To investigate the characteristics of laparoscopy in infertile patients with female genital tuberculosis(FGT)and analyze its application value in clinical efficacy evaluation.Methods 42 cases of FGT,diagnosed by pathology,ascites culture etiology and laparoscope/hysteroscopy from March 2015 to March 2017 in Urumqi Maternal and Child Health Care Hospital were selected.Clinical manifestations such as abdominal abnormal symptoms,infertility,and menstrual changes were retrospectively analyzed.The laparoscopic characteristics of different nodule types and therapeutic effects were compared.Results In 42 patients with FGT infertility,there were 25 cases of tubal tuberculosis,10 cases of pelvic tuberculosis,3 cases of ovarian tuberculosis,and 4 cases of tubal tuberculosis with ovarian tuberculosis.The main symptoms of the patient are irregular menstruation,abdominal tenderness,lower abdominal pain,abdominal mass,weakness and low fever.The common manifestations under laparoscopy are tissue adhesion,chestnut nodules,caseous tissue calcification,etc.After treatment,there was no recurrence for 1 year.The absorption,texture and color of the chestnut nodules in the reproductive system of the patient gradually returned to normal.In patients with natural fertility,fallopian tubes and ovarian lesions were completely absorbed,and organ function returned to normal.Conclusions Hysteroscopy can clearly show the morphology,size and other conditions of FGT lesions,and it is of great significance in the diagnosis and evaluation of FGT.