tuberculous cervicitis
Introduction
Introduction to tuberculous cervicitis Almost all tuberculous cervicitis is secondary to endometrial tuberculosis and tubal tuberculosis. Cervical tuberculosis is a type of female genital tuberculosis, and female genital tuberculosis is a series of chronic inflammation caused by tuberculosis in the genital organs. Sexual diseases, slow course, rarely acute symptoms of inflammation, or few symptoms, often due to infertility, irregular menstruation, chronic pelvic inflammatory disease, systemic examination was found, the lesions can be localized as papillary hyperplasia Or ulcers, if there is ulceration, there may be increased vaginal discharge or blood, and bleeding when examined. For systemic examination and biopsy of the lesion, see typical tuberculous nodules and necrosis of cheese to confirm the diagnosis. basic knowledge The proportion of the disease: 0.03% of the specific population Susceptible people: women Mode of infection: non-infectious Complications: vulvar tuberculosis
Cause
Causes of tuberculous cervicitis
(1) Causes of the disease
Cervical tuberculosis is often spread by endometrial tuberculosis or transmitted through the lymphatic or blood circulation.
1. Blood transmission: puberty is the development of reproductive organs, blood supply is rich, Mycobacterium tuberculosis is easy to spread by blood, M. tuberculosis infection of the lungs, can affect the internal reproductive organs within about 1 year, because the fallopian tube mucosa is beneficial to tuberculosis The latent infection of mycobacteria, Mycobacterium tuberculosis first invades the fallopian tube, and then spreads to the endometrium and ovaries in turn, invading the cervix, vaginal or vulva.
2. Direct spread: peritoneal tuberculosis, intestinal tuberculosis can spread directly to the internal reproductive organs.
(two) pathogenesis
The lesions may be manifested as papillary hyperplasia or ulceration. At this time, the appearance is easily confused with cervical cancer, and generally can be divided into four types:
1. Ulcer type: It is more common in cervical tuberculosis. The shape of the ulcer is irregular, the surface is relatively shallow, the edge is hard, the base is not dry, the color is grayish yellow, and the tissue is fragile and easy to bleed.
2. Nipple type: relatively rare, papillary or nodular, gray-red, crisp, cauliflower-like cervical cancer, secretion into pus and blood.
3. Interstitial: The miliary lesion affects the cervix and causes the cervix to become hypertrophied.
4. Cervical mucosa type: tuberculosis is limited to the cervical canal, which is caused by the spread of endometrial tuberculosis.
Prevention
Tuberculous cervicitis prevention
Do a good job in inoculation of BCG, enhance physical fitness, actively prevent tuberculosis, lymph node tuberculosis and intestinal tuberculosis, and follow up after treatment of tuberculous cervicitis.
Complication
Tuberculous cervicitis complications Complications vulvar tuberculosis
Often accompanied by vaginal tuberculosis, vulvar tuberculosis
Symptom
Tuberculous cervicitis symptoms Common symptoms Lower abdominal pain, menstrual scarcity, fatigue, high heat, amenorrhea, loss of appetite, night sweats, ascites, cystic mass, chronic pelvic pain
Due to the severity of the disease, the duration of the disease varies, some patients have no symptoms, and some patients have severe symptoms.
1. Infertility:
Most genital tuberculosis is treated for infertility. In patients with primary infertility, genital tuberculosis is one of the common causes. Because of the destruction and adhesion of the fallopian tube mucosa, the lumen is often blocked. Or because of adhesion around the fallopian tube, sometimes the lumen remains. Unobstructed, but the mucous membrane cilia is destroyed, the fallopian tube is stiff, the peristalsis is limited, and the transportation function is lost; endometrial tuberculosis hinders the implantation and development of the fertilized egg, and can also cause infertility.
2. Menstrual disorders:
Early factors of endometrial congestion and ulceration may have excessive menstrual flow; late stage endometrium is damaged to varying degrees and manifests as menstrual scarcity or amenorrhea, and most patients are advanced at the time of presentation.
3. Lower abdomen pain:
Due to pelvic inflammation and adhesions, there may be varying degrees of lower abdominal pain and increased menstruation.
4. Systemic symptoms:
If it is active, there may be general symptoms of tuberculosis, such as fever, night sweats, fatigue, loss of appetite, weight loss, etc., mild systemic symptoms are not obvious, sometimes only menstrual fever, menstrual fever is one of the typical clinical manifestations of genital tuberculosis, Patients with severe symptoms may have symptoms of systemic poisoning such as high fever.
5. Whole body and gynecological examination:
Because of the different extent and extent of the lesions, there are large differences. More patients with diagnostic curettage due to infertility, uterine tubal iodine angiography and laparoscopy found pelvic tuberculosis without obvious signs and other symptoms. At the same time, suffering from peritoneal tuberculosis, the abdominal abdomen has a sense of flexibility or ascites, when the formation of encapsulated effusion, can reach the cystic mass, the boundary is unclear, inactive, the surface due to intestinal adhesions, percussion empty, cervical tuberculosis visible nipple Proliferative and small ulcers.
Examine
Tuberculous cervicitis examination
1. Mycobacterium tuberculosis examination
Take menstrual blood or cervical scrapings or peritoneal fluid for M. tuberculosis examination, common methods:
(1) Smear acid-fast staining to find M. tuberculosis.
(2) Mycobacterium tuberculosis culture, this method is accurate, but Mycobacterium tuberculosis grows slowly, usually only 1 to 2 months to get results.
(3) Molecular biological methods, such as PCR technology, are rapid and simple, but may have false positives.
(4) Inoculation of animals, the method is complicated, it takes a long time, and it is difficult to promote.
2. Tuberculin test
A positive tuberculin test indicates that there is a Mycobacterium tuberculosis infection in the body. If it is strongly positive, there is still active tuberculosis, but it does not indicate the location of the lesion. If it is negative, it indicates that there is no M. tuberculosis infection.
3. Other
The white blood cell count is not high, and the lymphocytes in the classification increase, which is different from the purulent pelvic inflammatory disease; the blood cell sedimentation rate increases during the active period, but the normal can not exclude the tuberculosis lesions. These tests are non-specific and can only be used as a diagnostic reference.
4. Cervical pathology examination
If the cervix is suspicious of tuberculosis, it should be confirmed by biopsy. The typical tuberculous nodules can be found on the pathological section. The diagnosis can be established, but the negative result does not rule out the possibility of tuberculosis.
5. X-ray inspection
(1) Chest X-ray filming, if necessary, X-ray examination of the digestive tract or urinary system to find the primary lesion.
(2) pelvic X-ray film, found isolated calcification points, suggesting that there were pelvic lymph node tuberculosis lesions.
(3) The following signs may be seen in uterine tubal iodine angiography:
1 The uterine cavity is stenotic or deformed in different forms and degrees, and the edges are serrated.
2 The fallopian tube lumen has multiple narrow parts, which are typically beaded or show that the lumen is small and stiff.
3 in the equivalent of pelvic lymph nodes, fallopian tubes, ovarian sites have calcification.
4 If lipiodol enters the uterus or bilateral venous plexus, the possibility of endometrial tuberculosis should be considered.
Hysterosalpingography is helpful for the diagnosis of genital tuberculosis, but it is also possible to bring the cheese-like substance in the tubal lumen and M. tuberculosis to the abdominal cavity. Therefore, before and after the angiography, intramuscular injection of streptomycin and oral isoniazid should be used to prevent tuberculosis. drug.
6. Laparoscopy
Can directly observe the uterus, there are no miliary nodules on the serosal surface of the fallopian tube, and can be taken for examination of Mycobacterium tuberculosis in the peritoneal fluid, or biopsy at the lesion. Care should be taken to avoid intestinal damage during this examination.
Diagnosis
Diagnosis and diagnosis of tuberculous cervicitis
diagnosis:
The surface of the cervix is granular or ulcerated. A few are papillary or nodular, with obvious contact bleeding. Tuberculous nodules can be seen in pathological sections. Due to necrotic tissue, epithelial cells, multinucleated giant cells, and outer layer Lymphocyte infiltration, cervical tissue pathology is the most reliable basis for diagnosis.
Differential diagnosis:
1. Endometriosis: There are many similarities between the clinical manifestations of endometriosis and genital tuberculosis, such as low fever, dysmenorrhea, pelvic adhesions, thickening and nodules, etc., but endometriosis Dysmenorrhea is secondary and progressively aggravated, with a large amount of menstruation.
2. Cervical cancer: Cervical tuberculosis may have papillary hyperplasia or superficial ulcer, which is sometimes difficult to distinguish from cervical cancer. Cervical cytology and cervical biopsy should be performed.
3. Amoebic cervicitis: The amoebic trophozoites can be distinguished in the secretions.
