宫腹腔镜检查在不孕女性疑似生殖器结核的应用价值

Application value of uterine laparoscopy in suspected genital tuberculosis in infertile women

目的:探讨宫腹腔镜检查在不孕女性疑似生殖器结核(female genital tuberculosis,FGT)的应用价值,为临床诊断、治疗提供参考。方法:选择2018年1月至2021年12月,就诊于陕西省结核病防治院结核菌素皮肤试验(PPD试验)强阳性及结核感染T细胞斑点试验(T-SPOT.TB试验)阳性高度怀疑为女性生殖器结核的62例不孕患者,行胸部+盆腔CT检查并进行腹腔镜检查或宫腹腔镜联合探查。分析患者的临床表现、胸部CT表现、盆腔CT表现、宫腹腔镜表现以及对女性生殖器结核的诊断价值。结果:本研究62例不孕患者中,原发不孕51例(82.3%)。胸部CT检查中有活动性肺结核表现者10例(16.1%),非活动性肺结核CT表现者41例(66.1%),胸部无病灶者11例(17.7%)。62例患者中,盆腔CT检查48例存在不同程度盆腔淋巴结钙化、双侧附件区点状钙化、双侧附件区密度不均的低密度包块、宫腔内点状钙化及不全肠梗阻。62例患者中,25例行宫腹腔镜联合探查,3例宫腔镜下诊断为子宫内膜结核;62例腹腔镜下诊断为FGT 40例。结论:对于不孕患者疑似生殖器结核行腹腔镜检查或宫腹腔镜联合探查可清晰显示FGT病灶的部位、大小、形态、病变周围情况、盆腔状态,诊断FGT具有重要意义,可为临床诊断、治疗提供参考。

Objective:To explore the application value of hysteroscopy in infertile women with suspected genital tuberculosis,and provide reference for clinical diagnosis and treatment.Methods:From January 2018 to December 2021,62 infertile patients of high suspicion of genital tuberculosis with strong positive tuberculin skin test(PPD test)and positive tuberculosis infection T-cell spot test(T-SPOT.TB test)were selected from the Tuberculosis Prevention and Treatment Hospital of Shaanxi Province.They all underwent chest+pelvic CT examination and laparoscopy or combined exploration of hysteroscopy and laparoscopy.The clinical manifestations,chest and pelvic CT results,hysteroscopy and laparoscopy of the patients were analyzed,as well as the diagnostic value of suspected genital tuberculosis.Results:Of the 62 patients,51(82.3%)were primary infertility.The chest CT showed that,10 cases(16.1%)had active pulmonary tuberculosis,41 cases(66.1%)had inactive pulmonary tuberculosis,and 11 cases(17.7%)had no lesions in the chest.Among the 62 patients,48 had pelvic lymph node calcification,bilateral adnexal spot calcification,low density mass with uneven density,intrauterine spot calcification and incomplete intestinal obstruction;25 patients underwent hysteroscopy combined with laparoscopy,and 3 patients were diagnosed as endometrial tuberculosis by hysteroscopy;all the 62 patients were diagnosed as suspected genital tuberculosis through laparoscopy,and 40 were diagnosed as FGT.Conclusion:The location,size,shape,peripheral conditions and pelvic status of the lesions in infertile patients with suspected genital tuberculosis could be clearly detected by laparoscopy or hysteroscopy combined with laparoscopy.This is of great significance for the diagnosis of female suspected genital tuberculosis and can provide reference for clinical diagnosis and treatment.