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1Within the year, internal reproductive organs can be infected, as the mucosa of the fallopian tube is favorable for latent infection of Mycobacterium tuberculosis. Mycobacterium tuberculosis first invades the fallopian tube, then spreads sequentially to the endometrium and ovary, and invasion of the cervix, vagina, or vulva is less common.

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

　　Secondly, pathogenesis

　　Generally, they can be divided into4Types:

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

　　2、Papillary type is less common, presenting as papillary or nodular. They are grayish-red,脆, resembling cauliflower-type cervical cancer, with purulent and bloody discharge.

　　3、Interstitial granulomatous lesions involve the cervix, causing the cervix to become明显肥大.

　　4、Mucosal type tuberculosis lesions are limited to the cervical canal and are caused by the spread of endometrial tuberculosis.

　　1、Causes of infertility Due to cervical adhesions or accompanied by endometrial tuberculosis and fallopian tube tuberculosis, sperms cannot normally combine with eggs, or the fertilized egg cannot normally and smoothly implant, leading to infertility.

　　2、Menstrual disorders In the early stage, due to endometrial congestion and ulcers, there may be excessive menstrual bleeding; in the late stage, due to varying degrees of destruction of the endometrium, it may manifest as oligomenorrhea or amenorrhea. Most patients seek medical attention when they are already in the late stage.

　　3、Complications such as pelvic inflammation, which may cause lower abdominal pain and other symptoms.

　　4、Complications such as extragenital tuberculosis, vulvar tuberculosis, etc.

　　1、Infertility

　　Most patients with genital tuberculosis seek medical attention due to infertility. In patients with primary infertility, genital tuberculosis is one of the common causes. Due to the destruction and adhesions of the fallopian tube mucosa, the lumen is often blocked; or due to adhesions around the fallopian tube, the lumen may still be partially patent, but the mucosal cilia are destroyed, the fallopian tube is rigid, peristalsis is restricted, and the transportation function is lost. Endometrial tuberculosis hinders the implantation and development of the fertilized egg, which can also lead to infertility.

　　2、Menstrual disorders

　　In the early stage, due to endometrial congestion and ulcers, there may be excessive menstrual bleeding; in the late stage, due to varying degrees of destruction of the endometrium, it may manifest as oligomenorrhea or amenorrhea. Most patients seek medical attention when they are already in the late stage.

　　3、Lower abdominal pain

　　Due to pelvic inflammation and adhesions, there may be varying degrees of lower abdominal pain, which worsens during the menstrual period.

　　4、Systemic 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 there may only be fever during the menstrual period. Menstrual fever is one of the typical clinical manifestations of genital tuberculosis. In severe cases, there may be high fever and other systemic toxic symptoms.

　　5、Overall and gynecological examination

　　Due to the varying degrees and scopes of lesions, many patients undergo diagnostic curettage, uterine salpingography with iodine oil, and laparoscopic examination due to infertility, and discover pelvic tuberculosis without obvious signs or自觉症状. If they also have peritoneal tuberculosis, during examination, there may be a soft and flexible feeling in the abdomen or signs of ascites, forming encapsulated effusions when there is palpable cystic masses, unclear boundaries, non-mobile, and the surface due to intestinal adhesions, produces an empty sound upon percussion. Cervical tuberculosis may show papillary hyperplasia and small ulcers.

　　做好卡介苗接种，增强体质，积极防治肺结核、淋巴结结核和肠结核。做好结核性宫颈炎治疗后的随访工作;

　　预后：内生殖器结核是导致不孕的主要原因之一。由于结核菌同时对输卵管的破坏较严重，虽然生殖器结核经药物治疗取得良好疗效，但治疗后的妊娠成功率极低，应用足够的抗结核药物后获得正常妊娠的机会也甚微。对希望妊娠者，可行辅助生育技术助孕。

　　一、结核菌素试验

　　结核菌素试验阳性说明体内曾有结核分枝杆菌感染，若为强阳性说明目前仍有活动性结核病灶，但不能说明病灶部位，若为阴性一般情况下表示未有过结核分枝杆菌感染。

　　二、宫颈组织病理检查

　　若宫颈可疑结核，应做活组织检查确诊，在病理切片上找到典型结核结节，诊断即可成立，但阴性结果并不能排除结核的可能。

　　三、X线检查

　　1、胸部X线拍片，必要时行消化道或泌尿系统X线检查，以便发现原发病灶。

　　2、盆腔X线拍片，发现孤立钙化点，提示曾有盆腔淋巴结结核病灶。

　　3、子宫输卵管碘油造影可能见到下列征象。

　　（1）宫腔呈不同形态和不同程度狭窄或变形，边缘呈锯齿状。

　　（2）输卵管管腔有多个狭窄部分，呈典型串珠状或显示管腔细小而僵直。

　　（3）在相当于盆腔淋巴结，输卵管，卵巢部位有钙化灶。

　　（4）若碘油进入子宫一侧或两侧静脉丛，应考虑有子宫内膜结核的可能。

　　四、腹腔镜检查

　　能直接观察子宫，输卵管浆膜面有无粟粒结节，并可取腹腔液行结核分枝杆菌检查，或在病变处做活组织检查，作此项检查时应注意避免肠道损伤。

　　应重点补充维生素A、B、C、D。维生素A能增强机体免疫力；维生素D能促进钙吸收；维生素C有利于病灶愈合和血红蛋白合成；B族维生素可加快机体内各个代谢过程，有改善食欲的作用。新鲜蔬菜和水果是维生素的主要来源。乳、蛋、内脏等含维生素A丰富；酵母、花生、豆类、瘦肉等含维生素B6Sonnenschutz oder户外活动是增进维生素D的好办法。患者可选择的食物有牛奶、鸡蛋、瘦肉、鱼、鸡、虾、豆类等。鳗鲡鱼、甲鱼、海蜇、猪肺、山药、百合、莲子、白木耳、藕粉、梨、荸荠、菱、芡实、藕、青菜、洋山芋、番茄、胡萝卜等。

　　Chinesische Behandlungsmethoden für tuberkulöse Zervizitis:

　　Eins, Qi und Blut sind gestaut

　　1、Behandlung durch die Regulation des Qi und die Aktivierung des Blutes. Rezept: Huoxue Ruanjian Tang (Shiyong Nanyin Bing Xingbing Linchuang Shoucang)

　　2、Rezept: Salvia miltiorrhiza15Gramm, Angelica sinensis10Gramm, Cinnamomum cassia6Gramm, Cyperus rotundus10Gramm, Cyperus rotundus10Gramm, Fructus tsaoko12Gramm, Mylabris12Gramm, Oxyopes cellarius10Gramm, Carthamus tinctorius10Gramm, Saponaria officinalis10Gramm, Ossuarygummi15Gramm, Brand-Biejia15，Gramm Prunella vulgaris15Gramm。

　　3、falls es Kugeln gibt, sollte Sparganium hinzugefügt werden10Gramm, Curcuma10Gramm, um die Zersetzung von Stauung und Abbau zu behandeln122？；falls Schmerzen im Unterleib明显, sollte Lonicera japonica hinzugefügt werden10Gramm, Houttuynia cordata10Gramm, um die Entgiftung und die Abtötung von Würmern zu behandeln.

　　Zwei, Qi und Blut sind beide geschwächt

　　1、Behandlung durch die Stärkung des Qi und die Nähung des Blutes. Rezept: Ren Shen Yang Rong Tang (He Ji Lu Fang)

　　2、Rezept: Radix paeoniae alba90 Gramm, Angelica sinensis, Citrus reticulata blanco, Astragalus membranaceus, Panax ginseng, Atractylodes macrocephala, Cinnamomum cassia, Herzbrandung, Glycyrrhiza uralensis30 Gramm, Radix rehmanniae, Schisandra chinensis, Poria225Gramm, Polygala tenuifolia15Gramm, frischer Ingwer3Blatt, Datteln2Stück.

　　3、falls die Menstruationsmenge gering ist, kann Spatholobus suberectus hinzugefügt werden30 Gramm, Salvia miltiorrhiza20 Gramm, um das Blut zu nähren und die Menstruation zu regulieren.

　　Drei, Yinmangel mit internem Hitze

　　1、Behandlung durch die Nähung des Körpers und die Kälteentfernung. Rezept: Huangqi Biejia San (Sheng Wang Baojian)

　　2、Rezept: Huangqi15Gramm, Trionyx sinensis15Gramm, Asparagus cochinchinensis10Gramm, Cortex periplocae10Gramm, Gentiana macrophylla10Gramm, Panax ginseng10Gramm, Rhizoma pinelliae10Gramm, Poria10Gramm, Anemarrhena asphodeloides10Gramm, Anemarrhena asphodeloides15Gramm, Radix rehmanniae10Gramm, Radix paeoniae alba10Gramm, Cortex mori10Gramm, Kassia6Gramm, Platycodon grandiflorus10Gramm, Bupleurum chinense6Gramm, Glycyrrhiza uralensis6Gramm, wenn der Schweiß heimlich erfolgt, sollten Schisandra chinensis hinzugefügt werden10Gramm,浮小麦30 Gramm, um den Körper zu nähren und den Schweiß einzusammeln; falls die Menstruationsmenge groß ist und nicht aufhört, sollte Polygonum multiflorum hinzugefügt werden15Gramm, Radix Rubiae15Gramm, um das Kühlen des Blutes und das Haltens des Blutes zu stoppen.

　　Vier, Yin und Yang sind beide schwach

　　1、Behandlung durch die Ergänzung von Yin und Yang. Rezept: Liu Gui Wan (Modernische und traditionelle chinesische Frauenheilkunde)

　　2、Rezept: frischer und gebrannter Rehbock15Gramm, Fructus Lycii15Gramm, Rhizoma Dioscoreae15Gramm, Fructus Corni12Gramm, Loricus cornutus (schmelzen)10Gramm, Ossuarygummi (schmelzen)10Gramm, Dodder20 Gramm, Eucheuma20 Gramm, Huai niuxi15Gramm, Aconitum10Gramm, Kassia6Gramm, frischer Austern (zuerst hinzufügen)30 Gramm.