Shaheen Riffat, Subhan Fazli, Tahir Faheem
Department of Obstetrics and Gynecology, Federal Government Services Hospital, Islamabad.
J Pak Med Assoc. 2006 Jul;56(7):306-9.
To assess the frequency of genital tuberculosis in infertile women, its clinical presentation and association with socio-economic status and geographical latitude and to compare various modes of diagnosis and efficacy of therapy.
This cross-sectional study was carried out in the Gynaecology and Obstetric Department (Unit Ill), Federal Government Services Hospital, Islamabad for a period of two years, from January 1, 2001 to December 31, 2003. A protocol for fertility work-up included complete history, examination, monitoring of ovulation and assessment of male factor. During laparoscopy peritoneal fluid was obtained for cytology and Ziehl-Neelsen (ZN) staining in suspicious cases of chronic inflammation was carried out. Endometrial curettings were obtained for histopathology and culture in Lowenstein-Jensen (LJ) medium. After confirmation of diagnosis, anti-tuberculosis therapy (ATT) was started. Surgical management was done in advanced stage disease with tubo-ovarian masses.
Out of 7628 patients who attended the gynae out-patient department, 534 (7%) women were infertile, of which 2.43% had genital tuberculosis. Six patients had early stage disease (46.15%) and were completely cured, but three patients had successful pregnancy outcome (23%). Seven had advanced stage disease (53.85%) and required conservative surgery in addition to ATT. Among these patients, although tuberculosis was cured, yet fertility could not be achieved. All patients belonged to low socio-economic class, and 85% belonged to Northern areas of the country, who were poor and deprived of health facilities.
It is essential for a gynaecologist working in developing countries to anticipate possibility of genital tuberculosis in infertile patients.
评估不孕女性生殖器结核的发病率、临床表现及其与社会经济地位和地理纬度的关系，并比较各种诊断方法和治疗效果。
本横断面研究于2001年1月1日至2003年12月31日在伊斯兰堡联邦政府服务医院妇产科（第三单元）进行，为期两年。不孕症检查方案包括完整的病史、检查、排卵监测和男方因素评估。在腹腔镜检查时，对可疑慢性炎症病例获取腹腔液进行细胞学检查和萋-尼（ZN）染色。获取子宫内膜刮出物进行组织病理学检查和在罗-琴（LJ）培养基中培养。确诊后开始抗结核治疗（ATT）。对晚期伴有输卵管卵巢肿块的疾病进行手术治疗。
在7628名到妇科门诊就诊的患者中，534名（7%）女性不孕，其中2.43%患有生殖器结核。6名患者处于早期疾病（46.15%）并完全治愈，但3名患者有成功妊娠结局（23%）。7名患者处于晚期疾病（53.85%），除ATT外还需要进行保守手术。在这些患者中，尽管结核病已治愈，但仍未实现生育。所有患者均属于低社会经济阶层，85%来自该国北部地区，他们贫困且缺乏医疗设施。
对于在发展中国家工作的妇科医生来说，预测不孕患者生殖器结核的可能性至关重要。
