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结核性不孕患者宫腔镜下子宫内膜形态变化研究
董晓瑜, 冯旸子, 魏晗, 王香格, 王荣芹
中国实用妇科与产科杂志 ›› 2025, Vol. 41 ›› Issue (12) : 1240-1244.
PDF(8745 KB)
PDF(8745 KB)
结核性不孕患者宫腔镜下子宫内膜形态变化研究
Hysteroscopic endometrial morphological changes in infertile patients with tuberculosis
目的 探讨宫腔镜检查在结核性不孕患者子宫内膜病变诊断中的价值，分析镜下子宫内膜形态学特征、组织病理学及CD38、CD138的表达情况。 方法 选取2020年1月至2023年12月河北省胸科医院收治的75例行宫腔镜检查的结核性不孕患者，观察其子宫内膜形态特征，进行粘连分级，并对可疑病灶活检，组织标本行病理学检查及CD38、CD138免疫组化检测。 结果 宫腔镜下表现：宫腔粘连发生率为57.3%（43/75），以中重度为主（65.1%）；36.0%（27/75）的患者可见结核特异性改变（如结核增生结节、干酪样坏死或铺路石样结节）；89.3%（67/75）的患者可见子宫内膜点片状充血，表明继发性子宫内膜损伤广泛存在；32.0%（24/75）的患者出现子宫内膜息肉样改变；52.0%（39/75）的患者子宫内膜显著变薄，标志着子宫内膜基底层不可逆损伤。组织病理学及免疫组化表现：52.0%（39/75）的患者经病理确诊肉芽肿性病变。宫腔镜与病理诊断符合率为64.1%。免疫组化显示CD38/CD138总体阳性率达88.0%，提示普遍存在慢性子宫内膜炎。 结论 宫腔镜检查对子宫内膜结核的诊断具有重要临床价值，既可早期识别子宫内膜结核的特征性改变，全面评估宫腔形态并完成宫腔粘连分级，又能对可疑区域实施精准活检，得到组织病理学诊断的支持，并通过免疫组化辅助明确子宫内膜的慢性炎症状态。宫腔镜检查联合组织病理学及免疫组化检测可突破传统诊断方法的局限，显著提升检出效能，指导治疗并评估生殖预后。
Objective To evaluate the value of hysteroscopy in the diagnosis of endometrial lesions in infertile patients with tuberculosis，and to analyze the hysteroscopic morphological features，histopathological findings，and expression of CD38 and CD138. Methods A total of 75 infertile patients with tuberculosis who underwent hysteroscopic examination at Hebei Provincial Chest Hospital from January 2020 to December 2023 were included.Endometrial morphological characteristics were observed，intrauterine adhesions were classified，and targeted biopsies of suspicious lesions were performed.Tissue specimens were subjected to histopathological examination and immunohistochemical staining for CD38 and CD138. Results Hysteroscopic findings showed that the incidence of intrauterine adhesions was 57.3%（43/75），mostly moderate to severe（65.1%）.Tuberculosis-specific changes（such as tuberculous proliferative nodules，caseous necrosis，or paving-stone-like nodules）were observed in 36.0%（27/75）of patients.Patchy endometrial congestion was seen in 89.3%（67/75）of patients，indicating widespread secondary endometrial injury.Endometrial polypoid changes were found in 32.0%（24/75）of patients，and significant endometrial thinning-suggesting irreversible damage to the basal layer-was noted in 52.0%（39/75）.Histopathologically，granulomatous lesions were confirmed in 52.0%（39/75）of cases.The diagnostic concordance rate between hysteroscopy and pathology was 64.1%.Immunohistochemistry revealed an overall CD38/CD138 positivity rate of 88.0%，indicating a high prevalence of chronic endometritis. Conclusions Hysteroscopy plays a crucial role in the diagnosis of endometrial tuberculosis by enabling early detection of characteristic changes，comprehensive evaluation of the uterine cavity，adhesion grading，and precise targeting of biopsies for histopathological confirmation.When combined with histopathology and immunohistochemistry（e.g.，CD38/CD138），hysteroscopy significantly improves diagnostic accuracy，overcomes limitations of conventional methods，and provides valuable guidance for treatment and reproductive prognosis.
子宫内膜结核 / 不孕症 / 宫腔镜检查 / 慢性子宫内膜炎 / CD38 / CD138
endometrial tuberculosis / infertility / hysteroscopy / chronic endometritis / CD38 / CD138
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Global tuberculosis report 2024. Geneva:World Health Organization,2024. Licence:CC BY-NC-SA 3.0 IGO.[EB/OL].[2025-10-23]. https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024.
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To evaluate the hysteroscopic findings in female genital tuberculosis.It was a prospective study of hysteroscopic findings performed on 348 cases of female genital tuberculosis (FGTB).It was a prospective cross-sectional study in a tertiary referral centre.A total of 348 patients with infertility with FGTB on various tests.A total of 348 patients of infertility found to have FGTB on various investigations were enrolled in the study. A detailed history was taken. Clinical examination, endometrial sampling and diagnostic laparoscopy were performed was also performed in selected cases. All patients underwent hysteroscopy as part of evaluation for infertility and tuberculosis (TB) findings.The mean age, parity, body mass index and duration of infertility was 28.2 years, 0.31,23.1kg/m and 3.44 years respectively. Infertility was primary in 81.03% and secondary in 18.96% cases. Diagnosis of FGTB was made by endometrial aspirate findings of positive AFB on microscopy (4.02%), positive culture (4.88%), positive PCR (83.90%), epithelioid granuloma (14.65%), positive AFB on microscopy or culture of peritoneal cytology (1.14%) or epithelioid granuloma on peritoneal biopsy (1.72%), definitive findings of TB on laparoscopy (41.95%) or probable findings of TB on laparoscopy (58.05%). Various hysteroscopic findings observed were normal findings (28.16%), pale endometrial cavity (54.31%), features of active TB (7.47%), features of chronic TB (19.54%), features of TB sequelae like obstructed ostia (both ostia in 13.79%, one ostia 14.94%, periostial fibrosis; (bilateral 4.59%, unilateral 5.17%), endometrial glands atrophy (12.35%), small shrunken cavity (6.32%), distorted cavity (5.17%), various grades of intrauterine adhesions (29.88%). Hysteroscopy in FGTB was associated with increased difficulties and complications like failed procedures, difficult visualisation, false passage and uterine perforation.Hysteroscopy is useful modality to detect endometrial TB but is associated with increased difficulty and complications.Copyright © 2021 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.
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Female genital tuberculosis (FGTB) is a widespread infectious disease among young women. This meta-analysis aimed to investigate the prevalence of FGTB among infertile women and its contribution to primary and secondary infertility. PubMed, MEDLINE, WorldCat, The Lens, direct Google search, Google Scholar and ResearchGate were searched from 1971 to July 17, 2021 using the following terms: "prevalence", "epidemiology", "urogenital tuberculosis", "FGTB", "infertile women", "infertility complaints" and "FGTB testing methods". Data were extracted and a meta-analysis was performed. A total of 42 studies were selected with a total of 30,918 infertile women. Of these, the pooled prevalence of FGTB was 20% (95% confidence interval: 15-25%, I = 99.94%) and the prevalence of overall infertility, primary infertility and secondary infertility among FGTB population were 88%, 66% and 34%, respectively. The proportion of FGTB is remarkable among infertile women globally. The biggest burden of the disease is present in low-income countries followed by lower-to-middle- and upper-to-middle-income countries.© Copyright 2022, Sultan Qaboos University Medical Journal, All Rights Reserved.
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Female genital tuberculosis affects the quality of women's lives. One of the symptoms is amenorrhea. In our country, it is still underdiagnosed due to limited resources. Hysteroscopy is known as one of the diagnostic tools for this condition. We performed hysteroscopy and endometrial biopsy in four cases. Hysteroscopy findings show various signs. Histopathological examination showed typical features of tuberculosis in some cases. We also learned that hysteroscopy could evaluate the condition of the endometrium when ongoing and after treatment is accomplished. It is useful for further explanation to the client. Hysteroscopy can be utilized as a diagnostic tool for endometrial sampling, evaluate intracavity condition after treatment, and prognostic tool for future reproductive function.Copyright: © 2021 Gynecology and Minimally Invasive Therapy.
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