女性盆腔结核的10年临床诊治经验分析

目的通过对女性盆腔结核的临床资料进行分析，为盆腔结核的临床诊治及生育建议提供参考。方法回顾性分析北京协和医院妇产科2003年1月至2012年2月间收治并经手术和（或）病理检查确诊的69例女性盆腔结核患者的临床资料、诊治经过，并随访生育情况。结果本组患者中位年龄30岁（范围14～67岁）。临床表现多样，但缺乏特异性临床表现，常见的有不育（81．2％）、月经异常（36．2％）、痛经（31．9％）和盆腔包块（23．2％）。传统检查结果缺乏特异性，而结核感染T细胞斑点实验检查敏感性、特异性均较高，可为诊断提供依据。官腔镜和腹腔镜加活检是诊断盆腔结核的有效方法，病理检查阳性率约76％，但子宫内膜病理检查阳性率很低。31例有生育要求者至今仅妊娠10例，且均为体外授精一胚胎移植（IVF-ET）受孕，妊娠率32．3％。结论盆腔结核多见于育龄女性，缺乏典型临床症状，易误诊。宫、腹腔镜检查和病理相结合，可提高诊断率。生育机会低，相对而言IVF-ET是该类患者获得妊娠的最佳选择。

Pelvic tuberculosis in 69 women

Objective. To accumulate clinical experience （TB）by analysis of their clinical data. for the treatment of patients with pelvic tuberculosis Methods. There were 69 patients diagnosed as female pelvic TB in the Department of Gynecology in Peking Union Medical College Hospital from January 2003 to February 2012. The clinical data, therapy and reproductive results were analyzed retrospectively. Results： The medium age was 30 years old（range 14-67）. With a variety of clinical manifestation, lacking of typical symptoms, patients commonly complained with infertility （81.2 ~）, menstrual disorders （36.2%） ,dysmenorrhea（31.9%）and pelvic masses（23.2~）. Specificity of conventional examination was rarely poor,while T-SPOT-TB had a relative higher sensitivity and specificity which may be helpful for the diagnosis. Hysteroscopic or laparoscopic biopsy was an effective method for diagnosis of female pelvic TB. Generally positive rate of pelvic biopsy pathologic examination was 76% but that of endometrium biopsy was extremely low. Among the 31 patients with fertility request,a total of 10 patients had successful pregnancy,all of them underwent in vitro fertilization and embryo transfer （IVF-ET）, with 30.3% of pregnancy rate. Conclusions. Female pelvic TB is common in the reproductive age women. Lacking of typical clinical presentations, it is common to be misdiagnosed. Laparoscopy and hysteroscopy may be helpful to confirm the diagnosis. Pregnancy rate is quite low even after operation. IVF-ET may be the best choice to pregnancy for patients with pelvic TB.