Tuberculous salpingitis

　　Tubal tuberculosis, such as this type of internal genital tuberculosis, is generally considered to be secondary infection. After the pelvic organs are involved, the lesion can spread directly to adjacent organs, first attacking the fallopian tubes. The structure of the fallopian tube mucosa is conducive to the latent tuberculosis bacillus. The tuberculosis bacillus can remain latent locally for 1-10 years or even longer. Once the body's immune function is low, it can be reactivated and cause the disease. Tubal tuberculosis is mostly bilateral, and both fallopian tubes may be infected simultaneously or sequentially. Due to the slow course of the disease and atypical symptoms, it is easy to be overlooked.

　　The main pathogen of tubal tuberculosis is human tubercle bacillus, with only 5% of the pathogenic bacteria being bovine tubercle bacillus. Tubal tuberculosis often involves both fallopian tubes. During tuberculosis infection, the ostium does not close, which can be distinguished from the closed ostium of purulent salpingitis.

　　In addition to general symptoms, tubal tuberculosis can also cause other diseases. This disease can cause tubal adhesion and infertility. Therefore, once detected, active treatment should be carried out, and preventive measures should also be taken in daily life.

　　Tubal tuberculosis is more common in women of childbearing age, mainly manifested as infertility, mild lower abdominal pain, poor general condition, such as low fever, weight loss, fatigue, and menstrual disorders are common symptoms. In the early stage, due to endometrial congestion and ulceration, there is often an increase in menstrual volume or prolonged menstrual period. When the lesion involves the endometrium, menstrual稀少even amenorrhea may occur, and some patients may have increased vaginal discharge.

　　If accompanied by peritoneal tuberculosis, abdominal examination may show a doughy feeling; if accompanied by ascites, mobile dullness can be auscultated. If it is localized ascites, a cystic mass can be palpated. Gynecological examination of the adnexal area shows thickening or the presence of masses of varying sizes. The masses can be solid, cystic, or cystic-solid. If the pelvis is involved, a large area of hardening tissue can be palpated, commonly known as 'frozen pelvis'.

　　In addition, exudative tubal tuberculosis has a larger diameter, up to 10-15 cm, containing caseous material. The superficial part is partially or rarely adherent. If secondary infection occurs, the pain in the abdomen is severe, and the contents of the fallopian tube resemble pus. The proliferative adhesion type of tubal tuberculosis is more common, with slightly thickened fallopian tubes, thickened walls, and multiple millet-like tuberculous foci on the surface.

　　To prevent tubal tuberculosis, regular physical examinations should be conducted to facilitate early detection and full-course treatment. Especially for susceptible individuals, such as women with a family history of tuberculosis or a history of other tuberculosis, it is necessary to pay attention to daily life.

　　Laboratory tests for tubal tuberculosis can only be used as a reference for diagnosis. Blood counts show that the white blood cell count is not high, and there is an increase in lymphocytes. A positive tuberculin skin test indicates that there has been previous tuberculosis infection in the body. If it is strongly positive, it suggests that there is still an active focus at present, but it does not indicate the location of the focus. If it is negative, it suggests that there has never been a tuberculosis infection, and the laboratory tests are non-specific. Confirmation requires the following examinations:

　　1. X-ray

　　When necessary, examine the digestive and urinary systems to discover the primary tumor site. Gastrointestinal contrast imaging is helpful for diagnosing tuberculous encapsulated cysts. If isolated calcification points are found in the pelvis on abdominal plain film, it suggests the presence of a tuberculous focus.

　　2. Uterine tube iodine oil contrast

　　The造影 can be seen in the fallopian tube lumen multiple narrow parts,呈 typical beaded or show the lumen is small and rigid, equivalent to the fallopian tube calcium spots can be seen when the lesion involves the endometrium or other parts of the pelvis, can be seen uterine cavity morphology changes, narrowing, the edge is serrated. Pelvic, lymph nodes, ovaries and other parts of calcification points, this examination is helpful for the diagnosis of genital tuberculosis, but can bring the caseous material and tuberculosis bacteria in the fallopian tube lumen to the peritoneal cavity, so streptomycin and isoniazid and other antituberculosis drugs should be used before and after the contrast.

　　3. Laparoscopic examination or laparotomy

　　This examination can directly observe the pelvic condition, such as the serosal surface of the fallopian tube for granuloma-like nodules, adhesions around the fallopian tube, and thickening of the fallopian tube and ovary. Take a biopsy for pathological examination at the site of the lesion, but avoid damaging the adherent intestinal tract during the operation. If the above examinations still cannot confirm the diagnosis, consider laparotomy.

　　4. Endometrial curettage examination

　　This is the most reliable diagnostic basis. Diagnosis is usually performed within 12 hours of the onset of menstruation or 2-3 days before menstruation. Antituberculosis treatment should be initiated 3 days before surgery and 1 week after surgery to prevent the spread of the focus. Use streptomycin 0.75-1.0g intramuscularly, once a day, or in two doses. Since endometrial tuberculosis originates from the fallopian tube, attention should be paid to scraping both cornual parts of the uterus during curettage, and all the scraped material should be sent for pathological examination. If typical tuberculous nodules are seen, the diagnosis can be confirmed, but a negative result cannot exclude tuberculosis, as salpingitis tubercularis can exist alone. If the uterus is small and hard, and no tissue can be scraped, endometrial tuberculosis should be considered. If there is a suspicion of cervical tuberculosis, a biopsy should be taken for confirmation.

　　This article mainly elaborates on the therapeutic diet for salpingitis tubercularis and the dietary taboos for patients, as follows:
　　First, therapeutic diet for salpingitis tubercularis
　　1. Fuling and lotus root drink
　　Composition: Fresh lotus root 120g, poria 12g, yam 12g, lily 10g, and jujube 10g.
　　Usage: Clean the lotus root, slice it, and add the latter ingredients to 1000mL of water to make a concentrated juice for tea.
　　2. Tonifying Decoction
　　Composition: 150g of turtle meat, 15g of stemonae, 15g of pericarpium perillae, 20g of raw earth, and 30g of astragalus.
　　Usage: Boil the above ingredients in 1000mL of water, remove the medicine residue, eat the meat, and drink the soup. Take one dose a day for 7-10 days in a row.
　　3. Lily Duck
　　Composition: Fresh lily 300g, a female duck, yellow wine, white sugar, and an appropriate amount of fine salt.
　　Usage: Clean the duck, wash the lily, place it in the duck's belly, pour yellow wine and fine salt over it, tie the duck's body tightly with white thread, and steam it over boiling water until the duck meat is tender. Eat it on an empty stomach before meals, one small bowl each time, twice a day, and reheat it the next day.
　　Second, suitable foods for salpingitis tubercularis
　　1. Zinc-rich foods: Plant foods with high zinc content include beans, peanuts, millet, radishes, and Chinese cabbage; among animal foods, oysters are the most zinc-rich, followed by beef, chicken liver, eggs, lamb chops, and pork, which also contain a significant amount of zinc.
　　2. Foods rich in arginine: According to research, arginine is an essential component for sperm formation and can enhance the activity of sperm, playing an important role in maintaining the normal function of the male reproductive system. Examples include eel, sea cucumber, cuttlefish, octopus, mackerel, sesame, peanuts, and walnuts.
　　3. Animal internal organs: These foods contain a large amount of cholesterol, of which about 10% are adrenal cortex hormones and sex hormones. Appropriate intake of these foods has a certain effect on enhancing sexual function. Foods rich in protein and vitamins, such as lean meat, eggs, fresh vegetables, and fruits.
　　Third, taboo foods for tubal tuberculosis
　　1. Excessive beta-carotene can affect the synthesis and secretion of lutein in the ovary, reducing the amount of secretion, and some may even cause the phenomenon of amenorrhea, anovulation, or irregular menstruation, increasing the possibility of female infertility. This condition was first found in anorexia nervosa patients, even if they do not eat anything, do not have a period, blood tests still show that beta-carotene in the blood is too high. Later, it was found in some female patients with non-psychogenic anorexia, if they eat a lot of carrots, it can cause beta-carotene in the blood to be high, and appear abnormal phenomena such as female infertility, amenorrhea, and anovulation.
　　2. Coffee, alcohol, and other substances can also cause female infertility. Women should avoid excessive intake. At the same time, women who want to get pregnant can eat more foods that are helpful for female fertility.

　　The treatment of tubal tuberculosis is similar to that of tuberculosis in other parts, including drug treatment and surgical treatment, and the specific content is as follows:
　　First, drug treatment
　　1. Long-term standard treatment: Using streptomycin, isoniazid, and sodium aminosalicylate in combination therapy, the course of treatment is 1.5-2 years. The lesions can be absorbed, stable, and reach the cure standard of no recurrence, but due to the long course of treatment, some patients may not continue taking medication due to the disappearance of symptoms, irregular treatment, which is often the cause of drug resistance, and ultimately incomplete treatment. The treatment plan is to use streptomycin, isoniazid, and sodium aminosalicylate daily for the first month, and then use isoniazid and sodium aminosalicylate for the next 10 months, or choose 2 months of streptomycin, isoniazid, and sodium aminosalicylate, 3 months using streptomycin twice a week, and isoniazid and sodium aminosalicylate daily, and 7 months using isoniazid and sodium aminosalicylate.
　　2. Short-term therapy: The treatment plan must have the effect of rapidly killing various bacterial populations of tuberculosis within the body, that is, to kill extracellular tuberculosis bacteria that rapidly reproduce in neutral environments and intermittently reproduce within a shorter course of treatment, while also eliminating intracellular tuberculosis bacteria with low metabolism in acidic environments and slow reproduction. According to this, the treatment plan must select drugs with bactericidal and sterilizing effects for combination. Short-term treatment plans include:
　　(1) Isoniazid 300mg, taken orally, once daily; rifampicin 10-20mg/kg, maximum dose 600mg, taken orally, once daily; the course of treatment for both drugs is 9 months.
　　(2) For severe conditions or those with tuberculous peritonitis, an intensive regimen should be adopted. Isoniazid 300mg, oral, once a day. Rifampicin 600mg, oral, once a day. Pyrazinamide is effective only for human tuberculosis, oral 30-40mg/(kg.d). The three drugs are used together for 2 months, followed by the combination of isoniazid and rifampicin for 7 months, with the same dose. The total course is 9 months.
　　(3) For those with drug resistance or severe conditions, add streptomycin, 0.75-1.0g/d, which is 10-20mg/kg, intramuscular injection, that is, the combination of four drugs, for a total of 2 months. Subsequently, based on the condition and drug sensitivity test, switch to 2 or 3 drugs and continue treatment for 4 months.
　　(4) Ethambutol is a selective drug, which can be used in combination with isoniazid and rifampicin, with a dose of 5mg/(kg/d). After the course of treatment, curetting should be performed, and if it is still negative, continue treatment. If necessary, change the regimen according to the drug sensitivity results, such as performing curetting again after 6 months if negative, and two negative results indicate clinical cure.
　　Second, Surgical Treatment
　　Surgical treatment has the following indications:
　　1. Formation of pelvic tuberculous masses, treatment has not been completely resolved.
　　2. Recurrence after regular and adequate anti-tuberculosis treatment.
　　3. Endometrial tuberculosis with extensive destruction of the endometrium, where drug treatment is ineffective.
　　4. Long-term fistulaes that do not heal.
　　5. Those who have formed larger encapsulated effusions.
　　6. Women over 40 years old with obvious pelvic masses and no need to preserve the uterus, and those with difficulty in treatment.
　　To avoid the spread of infection during surgery and to reduce adhesion beneficial to surgery, anti-tuberculosis drugs should be taken for 1-2 months before surgery. After surgery, according to the activity of tuberculosis and whether the focus is completely removed, continue to use anti-tuberculosis drugs for about 1 month to achieve complete cure. Bilateral adnexa and total hysterectomy is recommended for surgery, and ovarian function should be preserved as much as possible for young women. When the fallopian tube and ovary form a large mass and cannot be separated, the uterus and adnexa should be removed together. If there is no caseous necrosis or abscess in the ovary when it is incised, the ovary can be preserved. Due to the extensive and dense adhesions caused by genital tuberculosis, oral intestinal antiseptic drugs should be taken and clean enema should be performed before surgery. During surgery, attention should be paid to the anatomical relationship to avoid injury.