绝经后子宫内膜结核的临床诊断与治疗策略：1例罕见病例分析

Clinical Diagnosis and Treatment Strategies for Postmenopausal Endometrial Tuberculosis: Analysis of a Rare Case

摘要: 绝经后子宫内膜结核临床表现隐匿且不典型，常以宫腔积脓为首发症状，易与子宫内膜炎、子宫内膜癌等疾病混淆，导致误诊。本研究报道1例55岁绝经后女性子宫内膜结核合并宫腔积脓的罕见病例，患者无典型结核中毒症状，以“绝经7年，阴道流液1周”为首发表现。经妇科超声、宫腔镜检查、病理活检及结核特异性检测(TB-DNA CT值20.30，T-SPOT阳性)确诊。治疗上采用“抗感染 + 宫腔镜病灶切除 + 宫腔引流术 + 规范抗结核治疗”的综合方案，患者病情稳定后出院。本病例强调了绝经后子宫内膜结核的诊断难点在于缺乏典型结核中毒症状，需通过宫腔镜联合病理活检和结核特异性检测进行综合诊断；治疗上应避免术前仅行抗感染治疗，而应尽早启动规范抗结核治疗。本研究为临床医生提高对该罕见疾病的认知及诊疗水平提供了重要参考。

Abstract: Postmenopausal endometrial tuberculosis often presents with insidious and atypical clinical manifestations, frequently presenting as pyometra as the initial symptom, and easily confused with endometritis, endometrial cancer, and other diseases, leading to misdiagnosis. This study reports a rare case of endometrial tuberculosis complicated by pyometra in a 55-year-old postmenopausal woman. The patient did not present with typical tuberculosis intoxication symptoms, presenting with “vaginal discharge for 1 week after 7 years of menopause”. Diagnosis was confirmed by gynecological ultrasound, hysteroscopy, pathological biopsy, and tuberculosis-specific testing (TB-DNA CT value 20.30, T-SPOT positive). Treatment involved a comprehensive approach of “anti-infection + hysteroscopic lesion resection + uterine drainage + standard anti-tuberculosis therapy”, and the patient was discharged in stable condition. This case highlights the diagnostic challenge of postmenopausal endometrial tuberculosis due to the lack of typical tuberculosis intoxication symptoms, necessitating a comprehensive diagnosis through hysteroscopy combined with pathological biopsy and tuberculosis-specific testing. Treatment should avoid solely relying on anti-infection therapy preoperatively; instead, standard anti-tuberculosis therapy should be initiated as early as possible. This study provides important references for clinicians to improve their understanding and treatment of this rare disease.