陆文睿 倪观太

【摘  要】目的：探讨女性生殖器结核（FGT）的临床特点及误诊原因。方法：对2011～2018年皖南医学院第一附属医院收治的FGT 23例患者，回顾性分析其病史、临床表现及诊治经过，总结误诊原因。结果：入院初步诊断FGT4例，诊断准确率17.4%;6例剖腹探查病理确诊，13例腹腔镜探查病理确诊，2诊断性刮宫病理确诊，2例抗结核治疗有效而确诊。结论：FGT临床表现多样，需综合分析病史、症状及辅助检查，特别是腹腔镜探查术，有助于诊断。提高诊断准确率。

【关键词】女性生殖器结核;临床诊断;腹腔镜检查;误诊

【中图分类号】R275.983      【文献标识码】B      【文章编号】1004-7484（2019）03-0116-02

【Abstract】objective：to investigate the clinical characteristics and misdiagnosis causes of female genital tuberculosis （FGT）.Methods：23 FGT patients admitted to the first affiliated hospital of wannan medical college from 2011 to 2018 were retrospectively analyzed for their medical history， clinical manifestations， diagnosis and treatment， and the causes of misdiagnosis were summarized.Results：4 cases of fgtwere initially diagnosed in hospital， and the diagnostic accuracy was 17.4%.6 cases were confirmed pathologically by laparotomy，13 cases were confirmed pathologically by laparoscopy， 2 cases were confirmed pathologically by curettage， and 2 cases were confirmed effectively and effectively by anti-tuberculosis treatment.Conclusion：the clinical manifestations of FGT are diverse， and comprehensive analysis of history， symptoms and auxiliary examinations， especially laparoscopic exploration， is helpful for diagnosis.Improve diagnostic accuracy.

【Keywords】female genital tuberculosis;Clinical diagnosis;Laparoscopy;misdiagnosis

女性生殖器結核（FGT）由结核分枝杆菌引起的女性生殖器炎症。因起病隐匿，缺乏典型的临床症状及体征，易被误诊。现将我院2011～2018年收治确诊的23例女性生殖器结核病例进行临床分析。

1 临床资料

1.1一般资料

本组23例，年龄25～71岁，平均38.2岁。生育年龄患者20例。绝经患者3例。有明确患肺结核病史2例（4.35%）。有结核接触病史1例（4.35%）。其父有肺结核病史。可疑结核病史2例，其中1例6年前患胸膜炎，1例入院前1年因发热咳嗽2月，外院诊断为肺炎。

1.2临床症状及体征（见表1）

1.3辅助检查

1.3.1超声检查 盆腔囊实性包块14例，盆腔积液6例。内膜毛糙，边缘欠光整4例。

1.3.2 x线检查 23例均行胸部x线摄片，有4例异常，其中提示陈旧性钙化结节1例，提示胸腔少量积液3例。

1.3.3 CT检查或MRI检查 13例行CT或MRI检查，其中6例提示腹膜及大网膜增厚，强化，考虑恶性肿瘤可能性较大。

1.3.4 PPD试验 2例PPD试验强阳性，余阴性。

1.3.5卵巢肿瘤标记物  14例患者行血清肿瘤标记物CEA、CA125、CA199、CEA、AFP及HE4的检测检查者中CA125升高为12例。……