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目的探讨女性盆腔结核性包块的临床表现及其诊断方法。方法回顾分析44例女性盆腔结核患者伴有盆腔包块的临床资料。结果 44例患者平均年龄34.5岁,13例有结核病史或接触史,24例不孕或月经不调,21例患者有腹胀腹痛症状,14例伴有腹水和/或胸水。44例均经剖腹探查,腹腔镜检查或宫、腹腔镜联合探查术明确诊断为盆腔结核。术中探查,44例中有盆腔粘连31例,腹腔粘连28例,其中,盆腹膜病变27例为粘连型,15为渗出型例。20例术中输卵管切除,5例行一侧附件切除,2例行全子宫及附件切除,17例仅取活检,2例因术中肠壁损伤行肠修补术。2例肠瘘患者保守治疗痊愈。术后所有患者转专科医院抗结核治疗。结论女性盆腔结核性包块患者有不孕或月经不调、腹胀腹痛、腹水等表现,术前诊断困难,剖腹探查或腹腔镜检查是明确诊断的重要手段,但手术有发生肠管损伤的风险。
Objective To investigate the clinical manifestations and diagnosis of pelvic tuberculosis in women. Methods Retrospective analysis of 44 cases of pelvic tuberculosis patients with pelvic mass clinical data. Results The average age of 44 patients was 34.5 years. Thirteen patients had a history of TB or exposure history, 24 infertility or irregular menstruation, 21 patients had abdominal distension symptoms and 14 patients had ascites and / or pleural effusion. All 44 cases were diagnosed as pelvic tuberculosis by laparotomy, laparoscopy or combined with laparoscopy. Intraoperative exploration, 44 cases of pelvic adhesions in 31 cases, abdominal adhesions in 28 cases, of which 27 cases of pelvic peritoneal adhesions, 15 cases of exudation. 20 cases of tubal resection, 5 cases of one side of the attachment resection, 2 cases of hysterectomy and attachment resection, 17 cases only biopsy, 2 cases of intestinal injury due to intraoperative intestinal repair. 2 patients with intestinal fistula conservative treatment cured. All patients were transferred to specialist hospitals after anti-TB treatment. Conclusions Female patients with pelvic tuberculosis have infertility or irregular menstruation, abdominal distension and ascites. Preoperative diagnosis is difficult. Laparotomy or laparoscopy is an important means of diagnosis. However, there is a risk of bowel injury during operation.