女性盆腔结核性包块的诊断及治疗

女性盆腔结核性包块是临床上较常见的妇科疾病，容易与其他盆腔包块和肿瘤相混淆，造成误诊或漏诊。在临床工作中，为提高对女性盆腔结核性包块诊断的准确性，应全面、综合分析患者病史、症状，完善有关的辅助检查，包括结核菌素试验、病原学检查、诊断性刮宫、血清癌抗原125检测、腹腔积液及影像学检查；诊断方法上有结核病免疫学诊断、分子生物学检查，为肺外结核的诊断提供了快速检查技术；对诊断困难者进行腹腔镜或剖腹探查术也是必要的。女性盆腔结核性包块需要与盆腔炎性疾病、卵巢子宫内膜异位囊肿、卵巢良恶性肿瘤，尤其应与卵巢癌进行鉴别；也需要与腹腔其他恶性肿瘤以及其他发热性疾病鉴别。女性盆腔结核性包块治疗上主要是全身化学治疗，对临床高度怀疑生殖器结核患者可行诊断性治疗；必要时辅以手术治疗，术中注意防止损伤发生；对结核中毒症状严重者可考虑加用糖皮质激素治疗。

Diagnosis and treatment of female mass with pelvic tuberculosis

Pelvic tuberculous mass is a clinically common gynecologic diseases, which is often to confound with other’s pelvic mass and tumor and easy to be misdiagnosed and missed diagnosed. To improve the diagnostic accuracy of female mass with pelvic tuberculosis, the patients’ history, symptoms and signs should be analyzed comprehensively. At the same time, we should perfect associated examinations, including tuberculin test, etiological examination, diagnostic curettage,cancer antigen 125, seroperitoneum and imaging examination. Tuberculosis immunological diagnosis and molecular biology detection provide fast examination technology for extrapulmonary tuberculosis. Laparoscope or exploratory laparotomy is necessary to patients who hard to make definite diagnosis. It is better to distinguish this disease from pelvic inflammatory disease, ovarian endometriotic cyst, benign and malignant ovarian tumors, especially from ovarian cancer, and it should be distinguished from abdominal tumor and febrile di-sease. The treatment of pelvic tuberculosis is totally based on chemical drug therapy. To highly suspected of genital tuberculosis, we can do diagnostic treatment. Surgical treatment can be used if necessary. When patients with severe tubercular toxic symptom, glucocorticoid adjunctive therapy should be used.