结核性宫颈炎

　　一、发病原因

　　1、血行传播青春期时正值生殖器官发育，血供丰富，结核分枝杆菌易借血行传播。结核分枝杆菌感染肺部后，大约1年内可感染内生殖器官，由于输卵管黏膜有利于结核分枝杆菌的潜伏感染，结核分枝杆菌首先侵犯输卵管，然后依次扩散到子宫内膜及卵巢，侵犯宫颈、阴道或外阴者较少。

　　2、直接蔓延腹膜结核、肠结核可直接蔓延到内生殖器官。

　　2. Direct extension Peritoneal tuberculosis and intestinal tuberculosis can directly extend to the internal reproductive organs.

　　Secondly, pathogenesis

　　Generally, they can be divided into 4 types:

　　1. The ulcerative type is more common in cervical tuberculosis, with irregularly shaped ulcers that are relatively superficial and have harder edges. The base is not dry, with a grayish-yellow color and fragile tissue that is prone to bleeding.

　　2. The papillary type is relatively rare, presenting as papillary or nodular. It is grayish-red in color, fragile in texture, resembling the cauliflower-type cervical cancer, with purulent and bloody discharge.

　　3. The interstitial granulomatous type of lesions involve the cervix, causing the cervix to become明显肥大.

　　What complications can tuberculous cervicitis easily lead to?

　　1. Causes infertility due to cervical adhesions or the presence of endometrial tuberculosis and fallopian tube tuberculosis, leading to the inability of sperm to normally combine with eggs, or the fertilized egg cannot normally and smoothly implant, resulting in infertility.

　　3. Concurrent pelvic inflammation, symptoms such as lower abdominal坠痛 may occur.

　　4. Concurrent tuberculous vulvitis, etc.

　　1. Infertility

　　Most patients with genital tuberculosis seek medical attention due to infertility. Genital tuberculosis is one of the common causes of primary infertility. Due to the destruction and adhesion of the fallopian tube mucosa, the lumen is often blocked; or due to adhesions around the fallopian tube, the lumen may still maintain partial patency, but the mucosal cilia are destroyed, the fallopian tube becomes rigid, peristalsis is restricted, and the transportation function is lost. Endometrial tuberculosis may interfere with the implantation and development of the fertilized egg, and may also lead to infertility.

　　2. Menstrual disorders

　　In the early stage, due to endometrial congestion and ulceration, there may be excessive menstrual bleeding; in the late stage, due to varying degrees of destruction of the endometrium, menstrual periods may become sparse or amenorrheic. Most patients seek medical attention when they are already in the late stage.

　　3. Lower abdominal坠痛

　　Due to pelvic inflammation and adhesions, there may be varying degrees of lower abdominal坠痛, which worsens during menses.

　　4. General symptoms

　　During the active stage, general symptoms of tuberculosis may occur, such as fever, night sweats, fatigue, loss of appetite, and weight loss. In mild cases, systemic symptoms may not be obvious, and sometimes only menstrual fever is present, which is one of the typical clinical manifestations of genital tuberculosis. In severe cases, systemic toxic symptoms such as high fever may occur.

　　5. General and gynecological examination

　　There are significant differences due to varying degrees and scopes of lesions, and many patients undergo diagnostic curettage, uterine tubal iodine oil contrast, and laparoscopic examination due to infertility, where pelvic tuberculosis is found without obvious signs and other自觉 symptoms. If peritoneal tuberculosis is also present, the abdomen may have a soft and flexible feeling or signs of ascites during examination. The formation of encapsulated effusion may allow palpation of a cystic mass, which is unclear in boundary, inactive, and the surface, due to intestinal adhesions, produces a hollow sound upon percussion. Cervical tuberculosis may show papillary hyperplasia and small ulcers.

　　Performing BCG vaccination, enhancing physical fitness, actively preventing and treating pulmonary tuberculosis, lymph node tuberculosis, and intestinal tuberculosis. Do a good job of follow-up work after the treatment of tuberculous cervicitis;

　　Prognosis: Tuberculosis of the internal genitalia is one of the main causes of infertility. Since the tuberculosis bacteria also severely damage the fallopian tubes, although the reproductive organ tuberculosis can achieve good curative effect after drug treatment, the success rate of pregnancy after treatment is extremely low, and the opportunity to obtain a normal pregnancy after sufficient anti-tuberculosis drugs is also very rare. For those who hope to conceive, assisted reproductive technology can be used to assist in pregnancy.

　　First, tuberculin test

　　A positive tuberculin test indicates that there has been an infection with Mycobacterium tuberculosis in the body. If it is strongly positive, it indicates that there is currently an active tuberculosis focus, but it does not indicate the location of the focus. If it is negative, it generally indicates that there has been no infection with Mycobacterium tuberculosis.

　　Second, cervical tissue pathological examination

　　If the cervix is suspected of tuberculosis, a tissue biopsy should be performed for diagnosis. The presence of typical tuberculosis nodules in the pathological sections can establish the diagnosis, but a negative result does not exclude the possibility of tuberculosis.

　　Third, X-ray examination

　　1. Chest X-ray film, necessary to perform gastrointestinal or urinary system X-ray examination to detect the primary focus.

　　2. Pelvic X-ray film, the discovery of isolated calcification points, indicating that there may have been pelvic lymph node tuberculosis lesions.

　　3. Iodine oil uterine fallopian tube造影 may show the following signs.

　　(1) The uterine cavity presents different shapes and degrees of narrowing or deformation, with jagged edges.

　　(2) The fallopian tube lumen has multiple narrow parts, showing a typical bead-like appearance or displaying a small and rigid lumen.

　　(3) There are calcification foci in the pelvic lymph nodes, fallopian tubes, and ovary areas.

　　(4) If iodine oil enters the venous plexus on one or both sides of the uterus, it should be considered that there may be endometrial tuberculosis.

　　Fourth, laparoscopic examination

　　Direct observation of the uterus and whether the serosal surface of the fallopian tube has granuloma nodules can be made, and abdominal fluid can be collected for Mycobacterium tuberculosis examination, or tissue biopsy can be performed at the lesion site. Attention should be paid to avoid intestinal injury when performing this examination.

　　It is important to supplement vitamins A, B, C, and D. Vitamin A can enhance the body's immunity; vitamin D promotes calcium absorption; vitamin C is beneficial for wound healing and hemoglobin synthesis; B-group vitamins can accelerate various metabolic processes in the body and improve appetite. Fresh vegetables and fruits are the main sources of vitamins. Milk, eggs, and internal organs are rich in vitamin A; yeast, peanuts, beans, lean meat, etc., contain vitamin B6. Sunbathing or outdoor activities are good ways to increase vitamin D levels. Foods that patients can choose include milk, eggs, lean meat, fish, chicken, shrimp, beans, etc. Eels, turtles, jellyfish, pork lung, yam, lily, lotus seeds, white fungus, lotus starch, pears, water chestnuts, water caltrop, chestnuts, lotus root, green vegetables, potatoes, tomatoes, carrots, etc. are also available.

　　7

　　The conventional method of treating tuberculous cervicitis in Western medicine

　　The traditional Chinese medicine treatment method for tuberculous cervicitis:

　　1. Treatment with Qi and blood stasis. Formula:活血软坚汤 (Practical Manual of Clinical Handbook of Sexual Disease).

　　2. Prescription: 15 grams of salvia miltiorrhiza, 10 grams of angelica, 6 grams of cinnamon, 10 grams of yuan huo, 10 grams of cyperus rotundus, 12 grams of bupleurum, 12 grams of spatholobus suberectus, 10 grams of rhizoma et radix polygoni multiflori, 10 grams of safflower, 10 grams of soap, 15 grams of turtle shell, 15 grams of bupleurum, 15 grams of scutellaria baicalensis.

　　3. If there are masses, add 10 grams of tripterygium and 10 grams of rhizoma et radix curcumae to break blood stasis and eliminate swelling; if there is significant lower abdominal pain, add 10 grams of honeysuckle and 10 grams of houttuynia to detoxify and kill parasites.

　　2. Treatment with qi and blood deficiency. Formula: Astragalus Nourishing Soup (And剂局方).

　　1. Treatment with qi and blood nourishment. Formula: Ginseng Nourishing Soup (And剂局方).

　　2. Prescription: 90 grams of white peony root, 30 grams of angelica, tangerine peel, astragalus, ginseng, white atractylodes, heart-baked, licorice, 225 grams of raw earth, 5 grams of schisandra, 225 grams of poria, 15 grams of farol, 3 slices of ginger, 2 dates.

　　3. If the amount of menstrual blood is too little, add 30 grams of Spatholobus suberectus and 20 grams of Salvia miltiorrhiza to nourish blood and regulate the menstrual cycle.

　　1. Treatment with nourishing yin and clearing heat. Formula: Astragalus Turtle Shell Powder (Sanitation Mirror).

　　2. Prescription: 15 grams of astragalus, 15 grams of turtle shell, 10 grams of winter melon, 10 grams of ground bone, 10 grams of Qin Jiu, 10 grams of ginseng, 10 grams of pinellia, 10 grams of poria, 10 grams of aster, 15 grams of anemarrhena, 10 grams of raw earth, 10 grams of white peony root, 10 grams of mulberry bark, 6 grams of cinnamon, 10 grams of Platycodon grandiflorus, 6 grams of bupleurum, 6 grams of licorice. If there is significant night sweating, add 10 grams of schisandra and 30 grams of floating wheat to nourish yin and stop sweating; if there is excessive menstrual bleeding, add 15 grams of Salvia miltiorrhiza and 15 grams of rhizoma et radix polygoni multiflori to cool blood and stop bleeding.

　　4. Both yin and yang deficiency type

　　1. Treatment with both yin and yang tonification. Formula: modified Left Return Pill (Modern Integrated Western and Chinese Gynecology).

　　Prescription: 15 grams of raw and processed earth, 15 grams of Chinese wolfberry, 15 grams of yam, 12 grams of Chinese hawthorn fruit, 10 grams of deer antler glue (melted), 10 grams of turtle shell glue (melted), 20 grams of dodder seed, 20 grams of eucommia, 15 grams of huai niu膝, 10 grams of atractylodes, 6 grams of cinnamon, 30 grams of raw oyster shell (added first).