26例女性生殖器结核临床分析

The clinical analysis of 26 cases with female genital tuberculosis

目的:探讨女性生殖器结核(FGTB)和卵巢癌(OC)临床鉴别诊断的改进措施。方法:选取皖南医学院附属弋矶山医院2013年1月至2018年10月收治的26例FGTB为研究组,2017年1~6月收治的40例OC为对照组,比较两组患者的临床特征。结果:FGTB组的15~35岁(38.5%,10/26)患者占比及存在结核病史(34.6%,9/26)、继发性闭经(34.6%,9/26)和不孕(38.5%,10/26)患者占比均高于OC组(P<0.01)。FGTB组结核斑点试验(T.SPOTTB)阳性率(92.3%,12/13)和肺部CT肺结核检出率(46.2%,12/26)均高于OC组(P<0.05)。经腹手术探查中,FGTB组输卵管僵硬、增粗或积脓、积水(60.9%,14/23)及腹盆腔粟粒或干酪样结节(72.9%,17/23)的检出率均高于OC组(P<0.01),卵巢器质性病变明显少于OC组(13.0%vs 80.0%,P<0.01)。结论:临床医师应重视存在继发性闭经、不孕、结核病史或合并肺结核的患者特别是年轻育龄患者,采取包括T.SPOTTB、肺部CT和腔镜探查在内的综合措施,提高FGTB与OC的临床鉴别诊断。

Objective:To improve the differential diagnoses between female genital tuberculosis(FGTB)and ovarian cancer(OC).Methods:Retrospective analyses and comparison were conducted between 26 cases with FGTB obtained from January 2013 to October 2018 and 40 cases with OC from January 2017 to July 2017 who underwent gynecological surgeries in the First Affiliated Hospital of Wannan Medical College.Results:Proportions of patients 15~35 years old(38.5%,10/26)and those with history of tuberculosis(34.6%,9/26),secondary amenorrhea(34.6%,9/26)or infertility(38.5%,10/26)were all significantly increased in the FGTB group compared to OC group(P<0.01).FGTB group had a higher proportion of positive T.SPOTTB(92.3%,12/13)and comorbidity with pulmonary tuberculosis(46.2%,12/26)either(P<0.05).During the abdominal surgical exploration,thickening-stiff tubes or hydrosalpinx(60.9%,14/23)and military or caseous nodules(72.9%,17/23)were more observed in FGTB group along with fewer organic ovarian lesions(13.0%,3/23)compared to OC group(P<0.01).Conclusions:It's recommended to give more attention to patients with high risk of TB infection(e.g.,secondary amenorrhea,infertility,history of tuberculosis and comorbidity with pulmonary tuberculosis)especially the young females of childbearing age.A comprehensive diagnostic strategy that included the timely T.SPOTTB,chest CT and laparoscopic or hysteroscopic exploration,is essential for differential diagnoses of the two diseases.