国际妇产科学杂志

国际妇产科学杂志 ›› 2025, Vol. 52 ›› Issue (4): 467-473.doi: 10.12280/gjfckx.20250527

• 普通妇科疾病及相关研究:论著 • 上一篇    下一篇

成功妊娠的子宫内膜结核患者的宫腔镜图像特征分析

刘琳琳(), 黄晓武, 夏恩兰   

  1. 100038 北京，首都医科大学附属复兴医院宫腔镜诊治中心
  • 收稿日期:2025-05-19 出版日期:2025-08-15 发布日期:2025-09-08
  • 通讯作者: 刘琳琳，E-mail：wslinlin26@hotmail.com

Analysis of Hysteroscopic Imaging Characteristics of Endometrial Tuberculosis Patients with Successful Pregnancy

LIU Lin-lin(), HUANG Xiao-wu, XIA En-lan   

  1. Hysteroscopy Center, Fu Xing Hospital, Capital Medical University, Beijing 100038, China
  • Received:2025-05-19 Published:2025-08-15 Online:2025-09-08
  • Contact: LIU Lin-lin, E-mail: wslinlin26@hotmail.com

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摘要：

目的：总结成功妊娠的子宫内膜结核（endometrial tuberculosis，ETB）患者的宫腔镜图像特征，为临床诊疗提供参考。方法：回顾性分析2012年5月—2020年1月在首都医科大学附属复兴医院宫腔镜诊治中心就诊的111例ETB患者，随访截至2025年3月，筛选出36例最终成功妊娠者（32.4%，36/111），收集其病历、宫腔镜图像及妊娠结局资料，归纳其宫腔镜表现特征。结果：36例成功妊娠者中，原发性不孕者占83.3%（30/36）；妊娠方式包括体外受精-胚胎移植（in vitro fertilization-embryo transfer，IVF-ET）29例，自然妊娠7例。宫腔镜下表现包括宫腔形态正常8例（其中3例内膜充血），结核性结节2例，结核性息肉8例；另外18例存在不同程度的宫腔粘连（intrauterine adhesions，IUA），包括轻度1例，中度11例，重度6例，其中3例合并干酪样坏死。所有患者均接受规范的抗结核治疗，其中18例IUA者均在宫腔镜下行粘连分离术后妊娠成功。结论：成功妊娠的ETB患者的宫腔镜图像特征表现多样，包括内膜充血、结核性结节、结核性息肉、干酪样坏死和不同程度的IUA，部分病例多种病变并存。上述所见构成了妊娠背景下的ETB宫腔镜图像，可为术前生育能力评估和个体化管理提供参考。

关键词: 结核, 女性生殖器, 妊娠结局, 宫腔镜检查, 不孕, 预后, 子宫内膜结核, 宫腔粘连

Abstract:

Objective: To summarize the hysteroscopic imaging characteristics of endometrial tuberculosis (ETB)patients with successful pregnancy, and provide references for clinical diagnosis and treatment. Methods: A retrospective analysis was conducted on 111 ETB patients who visited the Hysteroscopy Center of Fuxing Hospital Affiliated to Capital Medical University from May 2012 to January 2020. Follow-up was carried out until March 2025. Among them, 36 patients (32.4%, 36/111) who finally achieved successful pregnancy were selected. Their medical records, hysteroscopic images and pregnancy outcome data were collected, and the characteristics of hysteroscopic manifestations were summarized. Results: Among the 36 patients with successful pregnancy, 83.3% (30/36) were primary infertile. The conception methods included 29 cases of in vitro fertilization-embryo transfer (IVF-ET) and 7 cases of natural conception. Hysteroscopic manifestations included normal uterine cavity morphology in 8 cases (3 of them had endometrial hyperemia), tuberculous nodules in 2 cases, and tuberculous polyps in 8 cases. In addition, 18 cases had different degrees of intrauterine adhesions (IUA), including 1 case of mild IUA, 11 cases of moderate IUA and 6 cases of severe IUA, among which 3 cases were complicated with caseous necrosis. All patients received standardized anti-tuberculosis therapy. Among the 18 patients with IUA, all achieved successful pregnancy after hysteroscopic adhesiolysis. Conclusions: The hysteroscopic findings in ETB patients with successful pregnancy are diverse, including endometrial hyperemia, tuberculous nodules, tuberculous polyps, caseous necrosis and different degrees of IUA, and multiple lesions coexist in some cases. These manifestations constitute the hysteroscopic imaging of ETB in the context of pregnancy, which can provided references for preoperative assessment of fertility and individualized management.

Key words: Tuberculosis, female genital, Pregnancy outcome, Hysteroscopy, Infertility, Prognosis, Endometrial tuberculosis, Intrauterine adhesions