Tubal tuberculosis

Introduction to tubal tuberculosis Tuberculous salpingitis is caused by tuberculosis caused by salpingitis, often granuloma-like fallopian tubes, visible various types of chronic inflammatory changes such as ulcers, cheese type, miliary nodular type, isthmic nodular type, simple hypertrophy, Find tuberculosis or pathological examination to find unique changes in tuberculous nodules. And there is the performance of systemic tuberculosis. Most women who are 20 to 40 years old can also be seen in postmenopausal women. In recent years, due to the continuous improvement of diagnostic techniques, it has been confirmed that the incidence rate is on the rise. basic knowledge Sickness ratio: 0.1%-0.2% Susceptible people: women Mode of infection: non-infectious Complications: infertility

Tubal tuberculosis

Infection (38%)

Internal genital tuberculosis is generally considered to be secondary infection. After pelvic organ involvement, the lesion can directly spread to adjacent organs. First, the fallopian tube is invaded. The structure of the fallopian tube mucosa is conducive to the latent tuberculosis. Mycobacterium tuberculosis can be hidden for 1 to 10 years or even longer. Once the body's immunity is low, it can be reactivated and the disease occurs. The fallopian tube tuberculosis is mostly bilateral. The bilateral fallopian tubes may be infected at the same time or in succession. Due to the slow course of the disease, the symptoms are not easily overlooked.

Pathogenesis

The main pathogen of tubal tuberculosis is human tuberculosis, only 5% of the pathogens are bovine tuberculosis, tubal tuberculosis often involves bilateral fallopian tubes, and the umbrella end is not locked when tuberculosis is infected, which is easy to distinguish from the umbrella end of suppurative salpingitis.

1. Exudative tubal tuberculosis, tubal enlargement such as fists, containing cheese-like substances, little or no adhesion on the surface, easy to reverse, sometimes accompanied by grass yellow ascites.

2. Proliferation of adhesion tubal tuberculosis, more common, a small increase in the fallopian tube, thick wall, multiple miliary nodules on the surface, tight adhesion around, cheese-like substance, open the umbrella end, sometimes see the wrapped effusion.

Tubal tuberculosis prevention

BCG vaccination

Vaccination with BCG has a significant effect on the prevention of hematogenous disseminated tuberculosis in infants and children with cellular insufficiency, miliary tuberculosis and tuberculous meningitis. Strict implementation of the BCG vaccination system has a positive effect on reducing tuberculosis and extrapulmonary tuberculosis in infants and children.

Tuberculosis patient contact prevention

Pulmonary tuberculosis patients should follow the doctor's advice regularly, and the infection is generally reduced by 95% after 2 weeks of regular treatment. Contact with tuberculosis patients can go to the tuberculosis prescription unit for examination to rule out the possibility of illness. At the same time, do the following precautions:

Do a thorough disinfection. According to the characteristics of cold, heat and dry heat resistance of tubercle bacilli, boiled dishes, towels, clothes, handkerchiefs, masks and other items used by patients for 10 to 15 minutes; for books, quilts, chemical fiber clothing, etc. Cooked items can be exposed to sunlight for 4 to 6 hours or UV light for two hours. In addition, it can also be used for disinfection of disinfectant such as Sushui. The room where the patient lives can be sterilized by ultraviolet light.

Temporarily open the window to ventilate and keep the indoor air fresh. According to statistics, ventilation is ventilated every ten minutes. After 4 to 5 times, 99% of tubercle bacilli in the air can be blown off, and good hygiene habits can be cultivated. For example, the system of dispensing, washing utensils, special washing, washing hands, changing clothes , regular disinfection, etc.

Drug prevention

Strong positive tuberculin test (+ + + +), contact with open tuberculosis patients, silicosis patients, hemodialysis patients with renal disease, diabetic patients, long-term use of adrenal cortical hormone patients, in order to eliminate the more active dormant tuberculosis, available Isoniazid oral (1 mg/kg for adults and 10 mg/kg for children) for 1 year to reduce the chance of tuberculosis recurrence.

Purpose of drug prevention

The purpose of drug prevention is mainly to prevent the occurrence of tuberculosis by taking preventive medications for those who have been infected with tuberculosis and have a high incidence of disease. Because healthy people are not necessarily ill after being infected with tuberculosis, whether the disease is mainly affected by two factors: the size of the virulence of the infected tuberculosis and the strength of the body's resistance. Tuberculosis is highly toxic and low in resistance, and tuberculosis is prone to occur. On the contrary, it is not onset, but it may occur when the body's resistance is significantly reduced. The probability of developing tuberculosis in the lifetime of tuberculosis is about 10%.

Tubal tuberculosis complications Complications infertility

Close adhesions and infertility often occur around the fallopian tubes.

Tubal tuberculosis symptoms Common symptoms Mobile dullness and menstrual period postponed female infertility Uterine bleeding Menstrual period during low back pain low heat ascites fatigue abdominal pain

Tubal tuberculosis is mostly in women of childbearing age, mostly manifested as infertility, mild lower abdominal pain, poor general condition, such as low fever, weight loss, fatigue, menstrual disorders are common symptoms, initial factors of endometrial congestion and ulcers, more menstrual flow or menstrual period Prolonged, when the lesions involve the endometrium, menstrual scarcity or even amenorrhea, some patients may have increased vaginal secretions.

Such as with peritoneal tuberculosis, abdominal examination can have a facial sensation; if accompanied by ascites can produce mobile dullness, such as localized ascites can be sputum and cystic mass, gynecological examination of the attachment area thickened or there are packages of varying sizes Blocks, masses can be substantial, cystic or cystic, if involved in the pelvic cavity and large hard tissue, known as "ice pelvis."

The exudative tubal tuberculosis has a large diameter of 10-15 cm, containing cheese-like substances, and its surface is partially adhered or rarely adhered. If secondary infection occurs, the abdominal pain is more severe, and the contents of the fallopian tube are similar to pus.

Proliferative adhesion-type fallopian tube tuberculosis is more common, the fallopian tube is slightly thicker, the wall of the tube is thick, and most miliary tuberculosis lesions appear on the surface.

Tubal tuberculosis examination

Laboratory tests for white blood cell counts are not high, lymphocytosis, active erythrocyte sedimentation rate increased, the old tuberculin test positive indicates that there have been tuberculosis infection in the body, if strong positive indicates that there are still active lesions, but can not explain the lesions If there is no TB infection in the negative suggestion, the above tests are non-specific and can only be used as a reference for diagnosis. Ascites can be taken under conditions, vaginal membranes collect menstrual blood, uterine cavity aspirate, endometrial scraping, cervical live Tissue culture for tuberculosis, the positive rate of culture is closely related to the time and frequency of examination.

1. X-ray film, chest and abdomen and pelvic film, if necessary, digestive tract, urinary system examination to find the primary lesion, gastrointestinal angiography to help the diagnosis of tuberculous encapsulated cysts, abdominal plain film, such as the discovery of pelvic cavity There are isolated calcification points, suggesting that there are tuberculosis lesions; if necessary, the digestive tract or urinary system X-ray examination to find the primary lesion, pelvic X-ray film can find isolated calcification points, suggesting that there have been pelvic lymph node tuberculosis.

2. Uterine tubal lipiodol angiography

It can be seen that there are multiple stenosis parts of the fallopian tube lumen, which are typical beaded or show small and rigid lumen, which is equivalent to the calcification of the fallopian tube. When the lesion involves the endometrium or other parts of the pelvic cavity, the uterine cavity morphology changes. Stenosis, marginal jagged, pelvic, lymph node, ovarian and other parts of the calcification point, this test is helpful for the diagnosis of genital tuberculosis, but can bring the cheese-like substances in the fallopian tube lumen and tuberculosis to the abdominal cavity, so should be used before and after imaging Anti-tuberculosis drugs such as streptomycin and isoniazid.

3. Laparoscopy or laparotomy

Can directly observe the pelvic conditions, such as the serosal surface of the fallopian tube with or without miliary nodules, adhesion around the fallopian tube, tubal ovarian thickening, biopsy in the lesion to do pathological examination, but to avoid damage to the adhesion of the intestine, the above examination is still If you cannot be diagnosed, you can consider exploratory laparotomy.

4. Endometrial examination

This is the most reliable basis for diagnosis. It is usually used for diagnostic curettage within 12 hours of menstrual cramps or 2 to 3 days before menstruation. Anti-tuberculosis treatment should be performed 1 week after surgery for prevention of lesion spread, using streptomycin 0.75-1.0g muscle. Note, 1 time / d, or 2 injections, factor endometrial tuberculosis originated from the fallopian tube, so the curettage should pay attention to scrape the bilateral uterine horn, the scrape is sent to the pathological examination, such as see typical tuberculosis Nodules can be diagnosed, but negative results can not rule out tuberculosis, because tubal tuberculosis can exist alone, if the uterus is small and hard, can not scrape the tissue, should consider endometrial tuberculosis, such as suspected cervical tuberculosis, should be confirmed by biopsy.

Diagnosis and differentiation of tubal tuberculosis

diagnosis

Ask family history and past history in detail, 38% of patients have previous history of tuberculosis, 20% have family history of tuberculosis, so unmarried young women have pelvic inflammatory disease, married women have primary infertility with rare menstruation or amenorrhea and abnormal uterus Bleeding, lower abdomen pain, back pain, chronic pelvic inflammatory disease for a long time, combined with laboratory tests can be diagnosed.

Differential diagnosis

1. Non-specific chronic pelvic inflammatory disease: more childbirth, miscarriage, history of acute pelvic inflammatory disease, menstrual flow is generally more, amenorrhea is rare; genital tuberculosis is mostly infertility, menstrual flow is reduced or even amenorrhea, pelvic examination can touch the nodule .

2. Chronic salpingitis: clinical manifestations of abnormal menstruation, lower abdominal pain, lumbosacral pain, infertility, etc., should be differentiated from tuberculous salpingitis, chronic salpingitis, delivery, history of acute pelvic inflammatory disease after abortion, more menstrual flow, The manifestations of amenorrhea are relatively rare, and no other tuberculous salpingitis is seen in the typical examination. Endometrial biopsy has no tuberculosis.

3. Endometriosis: There are secondary, progressive dysmenorrhea, more menstruation, laparoscopic examination can confirm the diagnosis.

4. Ovarian tumor: tuberculous inflammatory accessory mass is uneven, with nodular or papillary protrusion, should be differentiated from ovarian cancer, can be diagnosed by laparoscopy or laparotomy.

5. Fallopian tube cancer: Fallopian tube cancer and tubal tuberculous mass are difficult to distinguish in gynecological examination. If there are yellow or bloody fluids in the vaginal discharge and the number is large, the fallopian tube cancer should be considered. When the laparotomy is performed, the specimen can be sent to the pathological examination to confirm the diagnosis.

6. Tubal pregnancy: clinical manifestations of menopause, abdominal pain and other easily confused with tubal tuberculosis, once the tubal pregnancy rupture or abortion, there are symptoms of internal bleeding, blood and urine pregnancy test, B-mode ultrasound, diagnostic curettage help For a clear diagnosis.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.