“¬ß“πºŸâªÉ

(1)

√“¬ß“πºŸâªÉ«¬

Case Report

∫∑§—¥¬àÕ ºŸâªÉ«¬À≠‘ß‰∑¬‚ ¥ Õ“¬ÿ 39 ªï ÿ¢¿“æ·¢Áß·√ß ¡“‚√ßæ¬“∫“≈¥â«¬Õ“°“√¡’·º≈·≈–¡’ “√§—¥À≈—ËßÕÕ°

®“°·º≈∑’Ë∫√‘‡«≥Õ«—¬«– ◊∫æ—π∏ÿå¿“¬πÕ° ªØ‘‡ ∏ª√–«—µ‘°“√¡’‰¢âµË”Ê ‰Õ ‡∫◊ËÕÕ“À“√ πÈ”Àπ—°≈¥ ·≈–ª√–®”

‡¥◊Õπº‘¥ª√°µ‘ ‰¥â„Àâ¬“ªØ‘™’«π–‡ªìπ‡«≈“ 2 —ª¥“Àå·µàÕ“°“√‰¡à¥’¢÷Èπ ‰¥âµ√«®«‘π‘®©—¬·¬°‚√§‚¥¬«‘∏’Õ◊Ëπ ·≈–

µ—¥™‘Èπ‡π◊ÈÕ®“°·º≈ àßµ√«®∑“ßæ¬“∏‘«‘∑¬“ º≈°“√µ√«®∑“ßæ¬“∏‘«‘∑¬“æ∫«à“‡ªìπ«—≥‚√§∑’Ë·º≈¥—ß°≈à“«

ºŸâªÉ«¬‰¥â√—∫¬“µâ“π«—≥‚√§·∫∫ Ÿµ√√–¬– —Èπ‡ªìπ‡«≈“ 6 ‡¥◊Õπ °“√√—°…“‰¥âº≈¥’

§” ”§—≠: «—≥‚√§, Õ«—¬«– ◊∫æ—π∏ÿå¿“¬πÕ°¢Õß µ√’

«—≥‚√§Õ«—¬«– ◊∫æ—π∏ÿå¿“¬πÕ°¢Õß µ√’ :

√“¬ß“πºŸâªÉ«¬ 1 √“¬

™≠“¥“ «√ ∂‘µ¬å

°≈ÿà¡ß“π Ÿµ‘-π√’‡«™°√√¡ ‚√ßæ¬“∫“≈‡¡◊Õß©–‡™‘ß‡∑√“

∫∑π”

«—≥‚√§‡ªìπ‚√§´÷Ëß§√à“™’«‘µºŸâ§π∑’ËÕ¬Ÿà„π«—¬∑”ß“π

‡ªìπÕ—π¥—∫µâπ Ê „π°≈ÿà¡ª√–‡∑»°”≈—ßæ—≤π“ ¡“°°«à“

§√÷ËßÀπ÷Ëß¢ÕßºŸâªÉ«¬«—≥‚√§‡ªìπª√–™“°√„π·∂∫‡Õ‡™’¬-

·ª´‘øî° „π™à«ß∑»«√√…π’È«—≥‚√§¡’·π«‚πâ¡‡æ‘Ë¡¢÷Èπ

‡π◊ËÕß®“°§«“¡·ÕÕ—¥¢Õßª√–™“°√∑’Ë¡’∞“π–¬“°®π„π

‡¡◊Õß„À≠à °“√‡æ‘Ë¡¢÷Èπ¢ÕßºŸâµ‘¥‡™◊ÈÕ‡ÕÁ™‰Õ«’µ≈Õ¥®π°“√

∫√‘°“√ “∏“√≥ ÿ¢·≈–·ºπ°“√√—°…“«—≥‚√§ ¬—ß‰¡à

§√Õ∫§≈ÿ¡‡æ’¬ßæÕ⁽¹⁾ „π∑“ß°“√·æ∑¬å§“¥À«—ß°—π«à“

®– “¡“√∂°”®—¥«—≥‚√§„ÀâÀ¡¥‰ª‡¡◊ËÕ ‘Èπ»µ«√√…∑’Ë ºà“π¡“ ·µà‰¡à “¡“√∂∑”‰¥â „π∑“ßµ√ß°—π¢â“¡®“° ∂‘µ‘

æ∫«à“«—≥‚√§°≈—∫‡æ‘Ë¡¢÷Èπ„πÀ≈“¬ª√–‡∑»∑—Ë«‚≈° „π ª√–‡∑»‰∑¬°Á‡™àπ‡¥’¬«°—π ®”π«πºŸâªÉ«¬«—≥‚√§≈¥≈ß

∑ÿ°ªï¡“‚¥¬µ≈Õ¥ ®π°√–∑—Ëß∂÷ßæ.». 2535 ¡’√“¬ß“π«à“

®”π«πºŸâªÉ«¬«—≥‚√§‡æ‘Ë¡¢÷Èπ ‡π◊ËÕß®“°¡’ºŸâµ‘¥‡™◊ÈÕ‡ÕÁ™‰Õ-

«’¡“°¢÷Èπ⁽²⁾ «—≥‚√§ à«π„À≠à‡ªìπ∑’ËªÕ¥ ª√–¡“≥√âÕ¬≈–

10 ‡ªìπ∑’ËÕ«—¬«–Õ◊ËππÕ°ªÕ¥ (extrapulmonary tuberculosis) «—≥‚√§ªÕ¥æ∫¡“°„πºŸâ™“¬ ·µà«—≥‚√§πÕ°

ªÕ¥æ∫¡“°„π‡¥Á°·≈– µ√’⁽³⁾

”À√—∫«—≥‚√§Õ«—¬«– ◊∫æ—π∏ÿå µ√’π—Èπ °≈“ß

»µ«√√…∑’Ë 18 Morgagni ‰¥â√“¬ß“π‡ªìπ§√—Èß·√°⁽⁴⁾ ‡ªìπ

‚√§∑’Ëæ∫‰¥âπâÕ¬ Õÿ∫—µ‘°“√¢Õß‚√§‰¡à “¡“√∂∫Õ°‰¥â

(2)

Journal of Health Science 2008 Vol. 17 No. 2

166

·πàπÕπ ‡π◊ËÕß®“°ºŸâªÉ«¬®”π«π¡“°µ√«®æ∫‚¥¬∫—ß‡Õ‘≠

·≈–ºŸâªÉ«¬∫“ß√“¬‰¡à¡’Õ“°“√ πÕ°®“°π’È¬—ß¡’Õÿ∫—µ‘°“√

·µ°µà“ß°—π¡“°„π·µà≈–°≈ÿà¡ª√–™“°√·≈–‡»√…∞“π–⁽⁴⁾

°“√‡°‘¥«—≥‚√§Õ«—¬«– ◊∫æ—π∏ÿå µ√’‡°◊Õ∫∑—ÈßÀ¡¥‡ªìπ

°“√µ‘¥‡™◊ÈÕ·∫∫∑ÿµ‘¬¿Ÿ¡‘®“°Õ«—¬«–Õ◊Ëπ ‚¥¬‡©æ“–Õ¬à“ß

¬‘Ëß®“°ªÕ¥ ‡™◊ÈÕ«—≥‚√§®–·æ√à°√–®“¬¡“∑“ß°√–·

‡≈◊Õ¥ ∑“ßπÈ”‡À≈◊Õß À√◊Õ·æ√à°√–®“¬‚¥¬µ√ß¡“®“°

Õ«—¬«–¢â“ß‡§’¬ß^(4-6) °“√µ‘¥‡™◊ÈÕª∞¡¿Ÿ¡‘æ∫‰¥âπâÕ¬¡“°

æ¬“∏‘·æ∑¬å à«π„À≠à°≈à“«°—π«à“‰¡à¡’°“√µ‘¥‡™◊ÈÕª∞¡¿Ÿ¡‘

„π«—≥‚√§Õ«—¬«– ◊∫æ—π∏ÿå µ√’⁽⁴⁾

æ¬“∏‘ ¿“æ¢Õß«—≥‚√§Õ«—¬«– ◊∫æ—π∏ÿå µ√’∑’Ëæ∫

¡“°∑’Ë ÿ¥§◊Õ ∑àÕπ”‰¢à√âÕ¬≈– 90-100 √Õß≈ß¡“§◊Õ ¡¥≈Ÿ°

√—ß‰¢à ª“°¡¥≈Ÿ° ·≈–™àÕß§≈Õ¥ æ∫√âÕ¬≈– 50-60, 20- 30, 5-10, ·≈–√âÕ¬≈– 1 µ“¡≈”¥—∫⁽⁴⁾ à«π∑’ËÕ«—¬«–

◊∫æ—π∏ÿå¿“¬πÕ° (vulva) π—Èπæ∫πâÕ¬¡“° Ê ∫“ß

√“¬ß“π®–®—¥Õ¬Ÿà„π°≈ÿà¡‡¥’¬«°—∫«—≥‚√§¢Õß™àÕß§≈Õ¥

æ∫√«¡°—πª√–¡“≥√âÕ¬≈– 0-1^(4-6)

√“¬ß“πºŸâªÉ«¬

ºŸâªÉ«¬À≠‘ß‰∑¬‚ ¥ Õ“¬ÿ 39 ªï Õ“™’æ√—∫√“™°“√

ªØ‘∫—µ‘ß“π∑’ËÀÕºŸâªÉ«¬„π¢Õß‚√ßæ¬“∫“≈·ÀàßÀπ÷Ëß ¡“

√—∫°“√µ√«®∑’Ëß“πºŸâªÉ«¬πÕ° ·ºπ°π√’‡«™ ‚√ßæ¬“∫“≈

‡¡◊Õß©–‡™‘ß‡∑√“ ‡¡◊ËÕ«—π∑’Ë 8 °ÿ¡¿“æ—π∏å æ.». 2548 ¥â«¬

Õ“°“√ ”§—≠§◊Õ 2 ‡¥◊Õπ°àÕπ¡“‚√ßæ¬“∫“≈ ¡’ “√§—¥

À≈—Ëß‰À≈ÕÕ°®“°·º≈∫√‘‡«≥Õ«—¬«– ◊∫æ—π∏ÿå¿“¬πÕ°

≈—°…≥– “√§—¥À≈—Ëß‡ªìπ ’¢“«¢ÿàπ ‰¡à¡’°≈‘Ëπ ‰¡à¡’Õ“°“√

ª«¥∫√‘‡«≥·º≈ √–¥Ÿ¢“«ª√°µ‘ ª√–®”‡¥◊Õπ¡“ª√°µ‘

‰¡à¡’‰¢â ‰¡àÕàÕπ‡æ≈’¬ ‰¡à‡∫◊ËÕÕ“À“√ ‰¡à¡’πÈ”Àπ—°≈¥≈ß ‰¡à¡’

ª√–«—µ‘‰Õ‡√◊ÈÕ√—ß À√◊Õ‰Õ‡ªìπ‡≈◊Õ¥

°“√µ√«®√à“ß°“¬‡∫◊ÈÕßµâπ ºŸâªÉ«¬√Ÿª√à“ß ¡ à«π Ÿß 150 ‡´πµ‘‡¡µ√ πÈ”Àπ—° 47 °‘‚≈°√—¡ —≠≠“≥™’æª√°µ‘

‰¡à´’¥ ‰¡à‡À≈◊Õß §≈”∫√‘‡«≥Àπâ“∑âÕß‰¡àæ∫°âÕπº‘¥ª√°µ‘

µàÕ¡πÈ”‡À≈◊Õß∑’Ë¢“Àπ’∫∑—Èß Õß¢â“ß‰¡à‚µ

°“√µ√«®∫√‘‡«≥Õ«—¬«– ◊∫æ—π∏ÿå¿“¬πÕ° µ”·Àπàß

∑’Ë 7 π“Ãî°“ Àà“ß®“°ª“°™àÕß§≈Õ¥‰ª∑“ß¥â“πÀ≈—ß

ª√–¡“≥ 1.5 ‡´πµ‘‡¡µ√ æ∫¡’ “√§—¥À≈—Ëß ’¢“«¢ÿàπÕ¡

‡À≈◊Õß®“ß Ê ‰À≈ÕÕ°®“°√Ÿ‡ªî¥¢π“¥°«â“ßª√–¡“≥ 0.2

‡´πµ‘‡¡µ√ „™â 2 π‘È«§≈”„µâª“°·º≈æ∫«à“¡’°âÕπ‡π◊ÈÕ

≈—°…≥–·¢Áß‡ªìπ‰µ¢π“¥ª√–¡“≥ 0.6 ×0.6 × 3.0

‡´πµ‘‡¡µ√ ¢Õ∫‡¢µ‰¡à™—¥‡®π °âÕπ‡π◊ÈÕ¥—ß°≈à“«Õ¬Ÿà∑“ß

¥â“π„π≈÷°≈ß‰ª∑“ß¥â“πÀ≈—ß ·¬°‰¡à‰¥â«à“Õ“®¡’ à«π„¥

µàÕ°—∫≈”‰ âµ√ß (rectum) À√◊Õ‰¡à ®÷ß„™â “¬¬“ß„Àâ Õ“À“√¢π“¥‡≈Á° Õ¥„ àºà“π∑“ß√Ÿ‡ªî¥¢Õß·º≈¥Ÿæ∫«à“

·º≈≈÷°ª√–¡“≥ 2.5 ‡´πµ‘‡¡µ√ º≈°“√µ√«®¿“¬„π Õ◊Ëπ Ê ‰¡àæ∫§«“¡º‘¥ª√°µ‘¢ÕßÕ«—¬«– ◊∫æ—π∏ÿå¿“¬„π

°“√µ√«®∑“ß∑«“√Àπ—° §≈”æ∫°âÕπ≈—°…≥–·¢Áß

‡ªìπ‰µ∑“ß¥â“π∫π¢«“ ’¢ÕßÕÿ®®“√–ª√°µ‘ ‰¡àæ∫¡’

ÀπÕßªπÕÕ°¡“°—∫Õÿ®®“√–

√“¬ß“πº≈°“√‡æ“–‡™◊ÈÕ “√§—¥À≈—Ëß®“°·º≈-º≈

‰¡àæ∫‡™◊ÈÕ µ√«® CBC, VDRL, antiHIV º≈ª√°µ‘

¥—ßπ—Èπ ®“°°“√µ√«®¥—ß°≈à“«æÕ®–„Àâ°“√«‘π‘®©—¬

‡∫◊ÈÕßµâπ‰¥â«à“‡ªìπ·º≈‡√◊ÈÕ√—ß∑’ËÕ«—¬«– ◊∫æ—π∏ÿå¿“¬πÕ°

(chronic ulceration of vulva) ‰¥â„Àâ¬“ norfloxacin (400 ¡‘≈≈‘°√—¡) «—π≈– 2 ‡«≈“ ‡ªìπ‡«≈“ 10 «—π π—¥

µ√«®´È”æ∫«à“Õ“°“√‰¡à∑ÿ‡≈“≈ß ¬—ß§ß¡’ “√§—¥À≈—ËßÕÕ°

¡“µ≈Õ¥ àßª√÷°…“»—≈¬·æ∑¬å‡æ◊ËÕ„Àâ°“√«‘π‘®©—¬·¬°

‚√§®“°‚√§∑“ß»—≈¬°√√¡§◊Õ fistula in ano ·≈–‰¥â

‡ª≈’Ë¬π¬“ªØ‘™’«π–‡ªìπ ciprofloxacin (250 mg) «—π≈–

2 ‡«≈“ ‡ªìπ‡«≈“ 5 «—π

√–À«à“ßπ’È ‰¥â∑”°“√µ√«®¿“æ∂à“¬√—ß ’∑√«ßÕ° ©’¥

’∑“ß∑«“√Àπ—° (barium enema) º≈ª√°µ‘ °“√©’¥ ’

‡¢â“√Ÿ‡ªî¥·º≈ (fistulogram) ‡æ◊ËÕ¥Ÿ®ÿ¥ ‘Èπ ÿ¥¢Õß·º≈

æ∫«à“∑àÕ°≈«ß (fistula) ¿“¬„π·º≈ ≈÷°ª√–¡“≥ 2.5- 3.0 ‡´πµ‘‡¡µ√ ª≈“¬µ—π (blind fistula) ‰¡àµàÕ‰ª¬—ß Õ«—¬«–Õ◊Ëπ ·≈–ºŸâªÉ«¬Õ“°“√‰¡à¥’¢÷Èπ ®÷ß‰¥âπ—¥ºà“µ—¥‡æ◊ËÕ µ—¥™‘Èπ‡π◊ÈÕ®“°·º≈ àßµ√«®∑“ßæ¬“∏‘«‘∑¬“·≈–‡æ◊ËÕ

‡≈“–‡Õ“∑àÕ°≈«ß (fistula) „π·º≈ÕÕ°

®“°°“√ºà“µ—¥æ∫«à“≈—°…≥–‡π◊ÈÕ‡¬◊ËÕ‚¥¬√Õ∫·º≈

¡’≈—°…≥–‡ªóòÕ¬¬ÿà¬ ‡ªìπ¢ÿ¬À¬“∫√à«π ™‘Èπ‡≈Á° Ê ¢π“¥

ª√–¡“≥ 2 ¡‘≈≈‘‡¡µ√®”π«π¡“° ‰¡à “¡“√∂‡≈“–‡Õ“

(3)

∑àÕ°≈«ß„π·º≈ÕÕ°‰¥â ‡π◊ËÕß®“°‡π◊ÈÕ‡¬◊ËÕ‡ªóòÕ¬¬ÿà¬¡“°

®÷ß‡°Á∫™‘Èπ‡π◊ÈÕ àßµ√«®∑“ßæ¬“∏‘ àßµ√«®∑“ßÀâÕß ªØ‘∫—µ‘°“√·≈–‰¥â«“ß∑àÕ√–∫“¬ (drain) ‰«â À≈—ßºà“µ—¥

ºŸâªÉ«¬¬—ß§ß¡’ “√§—¥À≈—ËßÕÕ°®“°·º≈‡æ‘Ë¡¢÷Èπ ‡®Á¥«—π À≈—ß°“√ºà“µ—¥·º≈¬—ß‰¡àÀ“¬ ·µà “√§—¥À≈—Ëß∑’ËÕÕ°®“°

∑àÕ√–∫“¬≈¥≈ß®÷ß‰¥â‡Õ“∑àÕ√–∫“¬ÕÕ°

º≈°“√‡æ“–‡™◊ÈÕ·∫§∑’‡√’¬®“°ÀâÕßªØ‘∫—µ‘°“√ - ‰¡à æ∫‡™◊ÈÕ

º≈µ√«®∑“ßæ¬“∏‘«‘∑¬“‡ªìπ¥—ßπ’È pathological diagnosis-chronic caseating granulomatous inflammation suggestive of tuberculosis ·≈–µ√«®∑“ß histrochemical study with acid-fast bacilli stain º≈

negative in acid-fast bacilli

®“°º≈°“√µ√«®∑“ßæ¬“∏‘«‘∑¬“ “¡“√∂ √ÿª°“√

«‘π‘®©—¬‰¥â«à“‡ªìπ tuberculosis of vulva ·≈–„Àâ°“√

√—°…“¥â«¬¬“µâ“π«—≥‚√§·∫∫√–¬– —Èπ§◊Õ 6 ‡¥◊Õπ ‚¥¬

√Ÿª∑’Ë 3 ¿“æ∂à“¬∑“ßæ¬“∏‘«‘∑¬“¢Õß™‘Èπ‡π◊ÈÕ ¿“æ 20X central caseous necrosis with epithelioid cells

√Ÿª∑’Ë 2 fistulogram „π·π« right posterior oblique view

√Ÿª∑’Ë 1 fistulogram „π·π« anteroposterior view

√Ÿª∑’Ë 4 ¿“æ∂à“¬∑“ßæ¬“∏‘«‘∑¬“¢Õß™‘Èπ‡π◊ÈÕ ¿“æ 40X ¡’

Langhan giant cell ·≈– giant cells ·∫∫µà“ß Ê

(4)

168

2 ‡¥◊Õπ·√° „™â¬“ 4 ™π‘¥ ‰¥â·°à isonazid 300 ¡‘≈≈‘°√—¡

+ rifampicin 450 ¡‘≈≈‘°√—¡ + ethambutol 800 ¡‘≈≈‘°√—¡

+ pyrazinamide 1,500 ¡‘≈≈‘°√—¡µàÕ«—π ‡¡◊ËÕ§√∫·≈â«

®÷ßµàÕ¥â«¬ isonazid + rifampicin „π¢π“¥‡¥‘¡Õ’° 4 ‡¥◊Õπ À≈—ß®“°‡√‘Ë¡√—°…“¥â«¬¬“µâ“π«—≥‚√§·≈â« ·º≈¥’

¢÷Èπ‚¥¬≈”¥—∫ ·≈–À“¬¥’À≈—ß®“°‰¥â√—∫¬“µâ“π«—≥‚√§‰ª

·≈â«ª√–¡“≥ 6 —ª¥“Àå ·µà¬—ß§ß°‘π¬“µàÕ‰ªÕ’°®π

§√∫µ“¡·ºπ°“√√—°…“

«‘®“√≥å

ºŸâªÉ«¬À≠‘ß‰∑¬‚ ¥Õ“¬ÿ 39 ªï ¡“‚√ßæ¬“∫“≈¥â«¬

Õ“°“√ 2 ‡¥◊Õπ°àÕπ¡’ “√§—¥À≈—Ëß‰À≈ÕÕ°®“°·º≈∑’Ë

∫√‘‡«≥ª“°™àÕß§≈Õ¥ ‰¡à¡’Õ“°“√ª«¥ ∫«¡ ·¥ß √âÕπ

∫√‘‡«≥·º≈ °“√«‘π‘®©—¬‚√§µâÕßπ÷°∂÷ß‚√§∑’ËÕ“®∑”„Àâ

‡°‘¥·º≈∫√‘‡«≥¥—ß°≈à“«‰¥â¥—ßπ’È

1. µàÕ¡∫“√å‚∏≈‘πÕ—°‡ ∫‡√◊ÈÕ√—ß‡π◊ËÕß®“°µ”·Àπàß

¢Õß·º≈„πºŸâªÉ«¬√“¬π’ÈÕ¬Ÿà„°≈â‡§’¬ßµ”·Àπàß¢ÕßµàÕ¡

∫“√å‚∏≈‘π ·µàºŸâªÉ«¬‰¡à¡’ª√–«—µ‘°“√Õ—°‡ ∫¢ÕßµàÕ¡∫“√å-

‚∏≈‘π¡“°àÕπ ·≈–°âÕπ∑’Ë§≈”‰¥â¡’≈—°…≥–·¢Áß‡ªìπ≈”

¬“«≈÷°≈ß‰ª ∂â“µàÕ¡∫“√å‚∏≈‘πÕ—°‡ ∫‡√◊ÈÕ√—ß®–§≈”æ∫

‡ªìπ∂ÿßπÈ”„π™—Èπ„µâº‘«Àπ—ß ·≈–®–¡’°“√Õ—°‡ ∫‡©’¬∫æ≈—π

‡°‘¥¢÷Èπ‰¥â‡ªìπ§√—Èß§√“« ´÷ËßºŸâªÉ«¬®–µâÕß¡’Õ“°“√ª«¥

°âÕπ¥—ß°≈à“«∫â“ß⁽⁷⁾

2. ·º≈ª∞¡¿Ÿ¡‘´‘øî≈‘ (primary syphilis) ¡—°

æ∫∫√‘‡«≥Õ«—¬«– ◊∫æ—π∏ÿå¿“¬πÕ°¢Õß µ√’ (vulva)

≈—°…≥–·º≈Õ“®®–°≈¡À√◊Õ√’ ¢Õ∫·º≈πŸπ·¢Áß µ√ß

°≈“ß‡«â“≈ß ‰¡à¡’Õ“°“√ª«¥ Àπâ“µ—¥¢Õß·º≈‡ªìπ ’·¥ß À√◊ÕπÈ”µ“≈·¥ß ·≈–¡—°æ∫¡’µàÕ¡πÈ”‡À≈◊Õß∑’Ë¢“Àπ’∫

Õ—°‡ ∫√à«¡¥â«¬ ´÷Ëß≈—°…≥–·º≈¢ÕßºŸâªÉ«¬√“¬π’È ‰¡à —¡æ—π∏å°—∫·º≈ª∞¡¿Ÿ¡‘´‘øî≈‘ ‡æ√“–·º≈‡ªìπ√Ÿ≈÷° ¢Õ∫

·º≈‰¡à¡’≈—°…≥–πŸπ·¢Áß ·≈–‰¡à¡’Õ“°“√Õ—°‡ ∫¢Õß µàÕ¡πÈ”‡À≈◊Õß∑’Ë¢“Àπ’∫⁽⁸⁾

3. Ωï¡–¡à«ß (lymphogranuloma venereum)

¡—°®–‡√‘Ë¡‡ªìπ·º≈∑’Ë™àÕß§≈Õ¥ ª“°¡¥≈Ÿ° À√◊ÕÕ«—¬«–

◊∫æ—π∏ÿå¿“¬πÕ° ·º≈®–À“¬‰ª‚¥¬∑’ËºŸâªÉ«¬‰¡à∑—π —ß‡°µ

·≈–µ“¡¥â«¬¡’µàÕ¡‡À≈◊Õß∑’Ë¢“Àπ’∫Õ—°‡ ∫‡ªìπÀπÕß ´÷Ëß

‚√§Ωï¡–¡à«ßπ’È‡ªìπ‚√§∑’Ë¡’º≈µàÕ√–∫∫πÈ”‡À≈◊Õß ¡—°®–¡’

µàÕ¡πÈ”‡À≈◊Õß‚µ‰¥â¡“°Ê À√◊Õ¡’·º≈·µ°ÕÕ° ·µàºŸâªÉ«¬

√“¬π’È§≈”‰¡àæ∫µàÕ¡πÈ”‡À≈◊Õß∑’Ë¢“Àπ’∫ ®÷ß∑”„Àâπ÷°∂÷ß

‚√§π’ÈπâÕ¬⁽⁸⁾

4. à«π°“√Õ—°‡ ∫Õ◊Ëπ Ê ∑’ËÕ«—¬«– ◊∫æ—π∏ÿå µ√’

‡™àπ ·º≈√‘¡ÕàÕπ (chancroid) ‡√‘¡ (herpes genitalis) π÷°∂÷ßπâÕ¬ ‡æ√“–‚√§‡À≈à“π’È¡—°®–¡’Õ“°“√ª«¥¡“°⁽⁸⁾

5. ‚√§¢ÕßÕ«—¬«–¢â“ß‡§’¬ß ‡™àπ fistula in ano

‡π◊ËÕß®“°·º≈¡’¢π“¥‡≈Á° ¡’≈—°…≥–‡ªìπ∑àÕ≈÷°≈ß‰ª®“°

™—Èπº‘«Àπ—ß Õ“®®–µàÕ‡¢â“‰ª¬—ß≈”‰ âµ√ß (rectum) ‰¥â⁽⁹⁾

‡π◊ËÕß®“°ºŸâªÉ«¬‡ªìπ·º≈‡√◊ÈÕ√—ß ≈—°…≥–¢Õß·º≈

‰¡à —¡æ—π∏å°—∫·º≈¢Õß‚√§∑“ßπ√’‡«™∑’Ëæ∫∫àÕ¬ ·≈–

‰¡àµÕ∫ πÕßµàÕ¬“ªØ‘™’«π–∑’Ë√—°…“ ®÷ß‰¥â àßµ√«®

fistulogram ‡æ◊ËÕ¥Ÿ«à“√Ÿ∑’Ë≈÷°≈ß‰ª®“°ª“°·º≈π—Èπµ‘¥µàÕ

‰ª¬—ßÕ«—¬«–Õ◊Ëπ ‡™àπ ≈”‰ âµ√ß (rectum) À√◊Õ‰¡à º≈

ª√“°Ø«à“®“°¿“æ∂à“¬∑“ß√—ß ’·º≈¡’≈—°…≥–‡ªìπ·º≈

ª≈“¬µ—π (blind fistula) °“√µ√«®©’¥ ’‡¢â“∑“ß∑«“√Àπ—°

(barium enema) º≈ª√°µ‘ ®÷ß‰¥âµ—¥™‘Èπ‡π◊ÈÕ®“°·º≈

‡æ◊ËÕ àßµ√«®∑“ßæ¬“∏‘«‘∑¬“

º≈°“√µ√«®∑“ßæ¬“∏‘«‘∑¬“ chronic caseating granulomatous inflammation suggestive of tuberculosis Õ∏‘∫“¬‰¥â«à“πà“®–π÷°∂÷ß«—≥‚√§ ¥—ß‰¥â°≈à“«

¡“·≈â««à“Õÿ∫—µ‘°“√¢Õß«—≥‚√§Õ«—¬«– ◊∫æ—π∏ÿå µ√’æ∫‰¥â πâÕ¬ ·≈–‡¡◊ËÕ»÷°…“‡©æ“–«—≥‚√§Õ«—¬«– ◊∫æ—π∏ÿå¿“¬πÕ°

¢Õß µ√’ (tuberculosis of vulva) æ∫Õÿ∫—µ‘°“√„π À√—∞Õ‡¡√‘°“ √âÕ¬≈– 1⁽⁴⁾ ¢Õß ‡ªπÕÿ∫—µ‘°“√√âÕ¬≈–

0.07⁽¹⁰⁾ ·≈– À√“™Õ“≥“®—°√Õÿ∫—µ‘°“√√âÕ¬≈–»Ÿπ¬å⁽⁶⁾ ®÷ß

‡ÀÁπ‰¥â«à“«—≥‚√§Õ«—¬«– ◊∫æ—π∏ÿå¿“¬πÕ°π—Èπæ∫‰¥âπâÕ¬

¡“° ·≈–‡°◊Õ∫∑—ÈßÀ¡¥‡ªìπ°“√µ‘¥‡™◊ÈÕ·∫∫∑ÿµ‘¬¿Ÿ¡‘ à«π πâÕ¬‡ªìπ°“√µ‘¥‡™◊ÈÕª∞¡¿Ÿ¡‘∑“ß‡æ» —¡æ—π∏å ¡’√“¬ß“π

«à“µ‘¥µàÕ∑“ß‡æ» —¡æ—π∏å ‚¥¬ —¡º— ‚√§®“°ΩÉ“¬™“¬ ´÷Ëß

¡’°“√µ‘¥‡™◊ÈÕ∑’Ë epididymis À√◊Õ®“°πÈ”Õ ÿ®‘⁽¹¹⁾ ‡Àµÿ∑’Ë æ∫°“√µ‘¥‡™◊ÈÕ·∫∫ª∞¡¿Ÿ¡‘πâÕ¬‡π◊ËÕß®“°‡´≈≈åº‘«Àπ—ß (squamous epithelium) ¡’§«“¡ “¡“√∂ªÑÕß°—π‡™◊ÈÕ

(5)

«—≥‚√§‰¥â¥’ ·≈–®“°√“¬ß“π‡¥’¬«°—ππ’Èæ∫Õÿ∫—µ‘°“√¢Õß

°“√µ‘¥‡™◊ÈÕª∞¡¿Ÿ¡‘√âÕ¬≈–11⁽¹²⁾

°“√µ‘¥‡™◊ÈÕª∞¡¿Ÿ¡‘®–„Àâ°“√«‘π‘®©—¬‰¥â‡¡◊Ë Õ ¡’

§ÿ≥≈—°…≥– 2 ¢âÕ ¥—ßπ’È

1. √Õ¬‚√§ π—Èπ§«√®–‡ªìπ∑’Ëµ”·Àπàß·√°∑’Ë¡’

°“√µ‘¥‡™◊ÈÕ„π√à“ß°“¬

2. °“√¥”‡π‘π‚√§¢Õß«—≥‚√§µàÕ¡πÈ”‡À≈◊ÕßÕ¬Ÿà

„π√–¬–‡¥’¬«°—π°—∫∑’ËÕ«—¬«– ◊∫æ—π∏ÿå

´÷Ëß∂â“„™âµ“¡§ÿ≥≈—°…≥–π’È °Á®–æ∫«à“‰¡à¡’√“¬ß“π

°“√µ‘¥‡™◊ÈÕª∞¡¿Ÿ¡‘‡≈¬⁽⁴⁾

«—≥‚√§¢ÕßÕ«—¬«– ◊∫æ—π∏ÿå¿“¬πÕ°¢Õß µ√’¡—°®–

‡√‘Ë¡¥â«¬‡ªìπµÿà¡∫π·§¡À√◊Õ∫√‘‡«≥„°≈â‡§’¬ß µàÕ¡“¡’

·º≈¢Õ∫‰¡à‡√’¬∫ ∫“ß§√—Èß·µ°ÕÕ°‡ªìπÀπÕß¡’‡¬◊ËÕ (caseous material)(3,4,12,13)

ªπÕÕ°¡“À√◊Õ∫“ß§√—Èß Õ“®¡’≈—°…≥–§≈â“¬ÀŸ¥¢π“¥„À≠à¡“° Ê ‰¥â⁽¹⁴⁾

‡π◊ËÕß®“°«—≥‚√§Õ«—¬«– ◊∫æ—π∏ÿå µ√’ à«π„À≠à

‡ªìπ°“√µ‘¥‡™◊ÈÕ∑ÿµ‘¬¿Ÿ¡‘®“°Õ«—¬«–Õ◊Ëπ´÷Ëß à«π„À≠à§◊ÕªÕ¥

®÷ß®”‡ªìπµâÕß∂à“¬¿“æ√—ß ’∑√«ßÕ°¥â«¬ ´÷Ëßº≈¿“æ∂à“¬

√—ß ’∑√«ßÕ°„πºŸâªÉ«¬√“¬π’Èª√°µ‘ ‚¥¬¿“æ∂à“¬√—ß ’

∑√«ßÕ° “¡“√∂æ∫√Õ¬‚√§¢Õß«—≥‚√§‰¥â√âÕ¬≈– 30- 50⁽¹⁵⁾ ·µà®“°√“¬ß“π¢Õß‚√ßæ¬“∫“≈√“¡“∏‘∫¥’ ‰¡àæ∫

√Õ¬‚√§∑’ËªÕ¥‡≈¬⁽¹⁶⁾ ∑—Èßπ’È‡æ√“–‡™◊ÈÕ«—≥‚√§ “¡“√∂Õ¬Ÿà

„π√à“ß°“¬‰¥âπ“π Ê ‚¥¬∑’Ë¬—ß‰¡àª√“°ØÕ“°“√‡ªìπ‡«≈“

1-10 ªï À√◊ÕÕ“®®–¡“°°«à“π’È ‰¥â ∑—Èßπ’È‡¡◊ËÕ‡™◊ÈÕ«—≥‚√§∑’Ë ß∫Õ¬Ÿà„πÕ«—¬«– ◊∫æ—π∏ÿå‡ªìπ‡«≈“π“π Ê °≈—∫¡“°àÕ

‚√§Õ’°§√—Èß √Õ¬‚√§∑’ËªÕ¥Õ“®®–À“¬‰ª·≈â«⁽¹¹⁾

”À√—∫ºŸâªÉ«¬√“¬π’Èµ√«®‰¡àæ∫ acid-fast bacilli

®“°√“¬ß“π¢Õß Nogales-Ortiz ·≈–§≥–æ∫ acid-fast bacilli ‡æ’¬ß√âÕ¬≈– 2 ‡∑à“π—Èπ⁽¹⁰⁾ Sutherland·π–π”

«à“°“√√—°…“«—≥‚√§§«√‡√‘Ë¡µâπ∑—π∑’∑’Ë√Ÿâº≈∑“ßæ¬“∏‘-

«‘∑¬“‚¥¬‰¡à®”‡ªìπµâÕß√Õº≈°“√«‘π‘®©—¬∑“ß·∫§∑’‡√’¬⁽⁶⁾

‡™àπ‡¥’¬«°—∫ Falk ·≈–§≥–⁽¹⁷⁾ ‡æ√“–‡ÀÁπ«à“‚√ßæ¬“∫“≈

à«π„À≠à°Á‰¡à‰¥â√Õº≈°“√«‘π‘®©—¬∑“ß·∫§∑’‡√’¬°àÕπ∑’Ë

®–‡√‘Ë¡°“√√—°…“ „πºŸâªÉ«¬√“¬π’È°Á‡™àπ‡¥’¬«°—π À≈—ß®“°

√Ÿâº≈°“√µ√«®∑“ßæ¬“∏‘«‘∑¬“®÷ß‡√‘Ë¡√—°…“¥â«¬¬“µâ“π

«—≥‚√§∑—π∑’ ‚¥¬‰¡à‰¥â√Õº≈°“√¬âÕ¡ acid-fast bacilli⁽¹⁶⁾

‡π◊ËÕß®“°°“√µ‘¥‡™◊ÈÕª∞¡¿Ÿ¡‘Õÿ∫—µ‘°“√πâÕ¬¡“°„π

∑ÿ°√“¬ß“π(4,6,10,11)

¥—ßπ—Èπ°“√µ‘¥‡™◊ÈÕ«—≥‚√§∑’ËÕ«—¬«–

◊∫æ—π∏ÿå¿“¬πÕ°¢ÕßºŸâªÉ«¬√“¬π’È∂â“‡ªìπ°“√µ‘¥‡™◊ÈÕ∑ÿµ‘¬

¿Ÿ¡‘°Á‡ªìπ ‘Ëß∑’Ë‡ªìπ‰ª‰¥â‡æ√“–ºŸâªÉ«¬ªØ‘∫—µ‘ß“πÀÕºŸâªÉ«¬

„π¢Õß‚√ßæ¬“∫“≈¡’‚Õ°“ —¡º— ‚√§‰¥âßà“¬ ∫ÿ§≈“°√

∑“ß°“√·æ∑¬åπ—Èπ‡æ‘Ë¡§«“¡‡ ’Ë¬ßµàÕ°“√µ‘¥‡™◊ÈÕ«—≥‚√§

‰¥â¡’°“√∑” tuberculin test „Àâ°—∫∫ÿ§≈“°√∑’Ë∑”ß“π„π

‚√ßæ¬“∫“≈√–¥—∫µµ‘¬¿Ÿ¡‘À≈“¬·Ààß„πª√–‡∑»‰∑¬ æ∫

«à“ tuberculin test „Àâº≈∫«° Ÿß §à“‡©≈’Ë¬√âÕ¬≈– 53

‚√ßæ¬“∫“≈‚√§∑√«ßÕ°„Àâº≈∫«° Ÿß ÿ¥ §◊Õ√âÕ¬≈– 98,

‚√ßæ¬“∫“≈æ√–ª°‡°≈â“ ®—ßÀ«—¥®—π∑∫ÿ√’ ∫ÿ§≈“°√„π

‚√ßæ¬“∫“≈∑’Ë∑”ß“π —¡º— ºŸâªÉ«¬„Àâº≈∫«°√âÕ¬≈–

72⁽¹⁸⁾ ·≈–¡’√“¬ß“π«à“™à«ßªï æ.». 2547-2548 ·ºπ°

„π·ºπ°ªÉ«¬‡ªìπ«—≥‚√§ 5 √“¬ ®“°®”π«π∫ÿ§≈“°√

∑—ÈßÀ¡¥ 147 §π⁽¹⁹⁾ Õ“™’æ∑’ËªÉ«¬‡ªìπ«—≥‚√§ Ÿß ÿ¥„π

‚√ßæ¬“∫“≈®ÿÃ“≈ß°√≥å §◊Õ Õ“™’ææ¬“∫“≈⁽²⁰⁾ „π À√—∞Õ‡¡√‘°“π—°®ÿ≈™’««‘∑¬“∑’ËªØ‘∫—µ‘ß“πÀâÕßªØ‘∫—µ‘°“√

¥â“π‡™◊ÈÕ√“·≈–«—≥‚√§ ¡’¿“«–¡’∫ÿµ√¬“° ‡π◊ËÕß®“°‡ªìπ

«—≥‚√§∑’Ë‡¬◊ËÕ∫ÿ‚æ√ß¡¥≈Ÿ°⁽²¹⁾

ºŸâªÉ«¬∑’Ëπ”‡ πÕ„π√“¬ß“ππ’È·¡â ‰¡àÕ“®√–∫ÿ‰¥â«à“

—¡º— ‡™◊ÈÕ®“°∑’Ë„¥ ·µà°“√ªØ‘∫—µ‘ß“π„π‚√ßæ¬“∫“≈°Á

‡æ‘Ë¡§«“¡‡ ’Ë¬ßµàÕ°“√µ‘¥‡™◊ÈÕ«—≥‚√§^(18-21) ®÷ß§«√

µ√–Àπ—°«à“Õ“®®–µ‘¥‡™◊ÈÕ®“°„π‚√ßæ¬“∫“≈‰«â¥â«¬

à«π°“√√—∫¬“µâ“π«—≥‚√§π—Èπªí≠À“ ”§—≠§◊Õ°“√

µâÕß‰¥â√—∫¬“µàÕ‡π◊ËÕß®π§√∫µ“¡·ºπ°“√√—°…“ ºŸâªÉ«¬

√“¬π’È‡ªìπ∫ÿ§≈“°√∑“ß°“√·æ∑¬å ´÷Ëßª√°µ‘¡’Àπâ“∑’Ë„π

°“√„Àâ∫√‘°“√ºŸâªÉ«¬Õ¬Ÿà·≈â«ªí≠À“¢âÕπ’È®÷ß‰¡àπà“‡ªìπÀà«ß

°“√√—°…“«—≥‚√§Õ«—¬«– ◊∫æ—π∏ÿå µ√’π—ÈπµâÕß∂◊Õ«à“

«—≥‚√§Õ«—¬«– ◊∫æ—π∏ÿå µ√’‡ªìπÕ“°“√∑’Ëª√“°ØÕÕ°¡“

‡æ’¬ßÕ¬à“ßÀπ÷Ëß¢Õß°“√µ‘¥‡™◊ÈÕ«—≥‚√§∑—Èß√–∫∫ (genera- lized systemic infection) ·≈–°“√°”®—¥‡™◊ÈÕ«—≥‚√§

®“°Õ«—¬«– ◊∫æ—π∏ÿå§«√∂◊Õµ“¡À≈—°°“√‡¥’¬«°—π°—∫À≈—°-

°“√¡“µ√∞“π∑’Ëæ‘ Ÿ®πå·≈â««à“√—°…“«—≥‚√§„π∑’ËÕ◊Ëπ¢Õß

(6)

170

√à“ß°“¬‰¥âº≈ ‡¡◊ËÕ‡√‘Ë¡°“√√—°…“∑“ß¬“‡ªìπÀ≈—°·≈â«

®”‡ªìπµâÕß¥Ÿ·≈¥â“π√à“ß°“¬ ®‘µ„® °“√æ—°ºàÕπ Õ“À“√

∑’Ë‡À¡“– ¡ µ≈Õ¥®π¥â“π ÿ¢Õπ“¡—¬Õ◊Ëπ Ê ∑—Ë«‰ª¥â«¬⁽²²⁾ ºŸâªÉ«¬√“¬π’È‡ªìπ«—≥‚√§∑’ËÕ«—¬«– ◊∫æ—π∏ÿå¿“¬πÕ°

´÷Ëßßà“¬µàÕ°“√µ√«®µ‘¥µ“¡Õ“°“√ ·º≈∑’ËÀ“¬∫àß∂÷ß°“√

µÕ∫ πÕßµàÕ¬“∑’Ë„™â„π°“√√—°…“ ºŸâªÉ«¬Õ“°“√¥’¢÷Èπ

‡√◊ËÕ¬ Ê ·≈–·º≈À“¬ª√–¡“≥ 6 —ª¥“ÀåÀ≈—ß‰¥â√—∫¬“

µâ“π«—≥‚√§ ·µà®”‡ªìπµâÕß°‘π¬“µàÕ®π§√∫µ“¡·ºπ°“√

√—°…“ ¢≥–π’ÈºŸâªÉ«¬ ÿ¢¿“æ·¢Áß·√ß¥’

∂“π°“√≥å¢Õß«—≥‚√§„πª√–‡∑»‰∑¬„π™à«ß 10

°«à“ªï∑’Ëºà“π¡“π’È¡’·π«‚πâ¡ Ÿß¢÷Èπ ‡π◊ËÕß®“°°“√‡æ‘Ë¡¢÷Èπ

¢ÕßºŸâµ‘¥‡™◊ÈÕ‡ÕÁ™‰Õ«’⁽²⁾ ∫ÿ§≈“°√„π‚√ßæ¬“∫“≈‚¥¬

«—≥‚√§ Ÿß°«à“ª√–™“°√∑—Ë«‰ª^(18-20) √“¬ß“ππ’Èπ”‡ πÕ

´÷Ëß∂◊Õ‡ªìπ°≈ÿà¡‡ ’Ë¬ß∑’Ë®–µ‘¥‡™◊ÈÕ«—≥‚√§ ∫ÿ§≈“°√∑’Ë ªØ‘∫—µ‘ß“π„π‚√ßæ¬“∫“≈¢Õß‰∑¬ ¡’Õÿ∫—µ‘°“√µ‘¥‡™◊ÈÕ

«—≥‚√§ Ÿß¡“°⁽¹⁸⁾ πà“®–‰¥â¡’°“√»÷°…“§âπ§«â“µàÕ‰ª‡æ◊ËÕ À“·π«∑“ß„π°“√ àß‡ √‘¡ ÿ¢¿“æ„ÀâºŸâªØ‘∫—µ‘ß“π „π

∞“π–ºŸâ„Àâ∫√‘°“√¥â“π ÿ¢¿“æ ¡’ ÿ¢¿“æ∑’Ë¥’°«à“π’È

√ÿª

ºŸâªÉ«¬À≠‘ß‰∑¬‚ ¥ Õ“¬ÿ 39 ªï ¡“µ√«®∑’Ë‚√ß- æ¬“∫“≈¥â«¬‡√◊ËÕß¡’·º≈‡√◊ÈÕ√—ß∫√‘‡«≥Õ«—¬«– ◊∫æ—π∏ÿå

¿“¬πÕ° 2 ‡¥◊Õπ°àÕπ¡“‚√ßæ¬“∫“≈ ‰¥â„Àâ°“√√—°…“

¥â«¬¬“ªØ‘™’«π– ·µà·º≈‰¡à πÕßµÕ∫µàÕ¬“ªØ‘™’«π– ®÷ß

∑”°“√µ—¥™‘Èπ‡π◊ÈÕ®“°·º≈ àßµ√«®∑“ßæ¬“∏‘«‘∑¬“ º≈

°“√µ√«®æ∫«à“‡ªìπ«—≥‚√§∑’Ë·º≈¥—ß°≈à“« µ√«®¿“æ-

∂à“¬√—ß ’∑√«ßÕ°‰¡àæ∫√Õ¬‚√§∑’ËªÕ¥ ‰¥â„Àâ°“√√—°…“

¥â«¬¬“µâ“π«—≥‚√§·∫∫ Ÿµ√√–¬– —Èπ ≈—°…≥–¢Õß·º≈

¥’¢÷Èπ ºŸâªÉ«¬√—∫¬“§√∫µ“¡·ºπ°“√√—°…“ ¢≥–π’È·º≈À“¬¥’

·≈–ºŸâªÉ«¬¡’ ÿ¢¿“æ·¢Áß·√ß

°‘µµ‘°√√¡ª√–°“»

¢Õ¢Õ∫§ÿ≥ ºŸâªÉ«¬∑’Ë°√ÿ≥“„Àâπ”ª√–«—µ‘¡“π”‡ πÕ

√“¬ß“π ·≈–¢Õ¢Õ∫§ÿ≥ π“¬·æ∑¬å∑√ß§ÿ≥ «‘≠êŸ«√√∏πå

∑’Ë°√ÿ≥“‡Õ◊ÈÕ‡øóôÕ¿“æ∂à“¬∑“ßæ¬“∏‘«‘∑¬“

‡Õ° “√Õâ“ßÕ‘ß

1. Shimouchi A. Tuberculosis problems in the Asia-Pa- cific region. Respirology 2001; 6 :75-8.

2. Palwatwichai A. Tuberculosis in Thailand. Respirology 2001; 6:65-70.

3. Vani R, Kuntal R, Pralhad K. A rare location of extrapulmonary tuberculosis : the vulva. Tuber Lung Dis 1993; 74:64-7.

4. Schaefer G. Tuberculosis of the female genital tract.

Clin Obstet Gynecol 1970; 13:965-98.

5. Hassoun A, Jacquette G, Huang A, Anderson A, Smith MA. Female genital tuberculosis : uncommon presen- tation of tuberculosis in the United States. Am J Med 2005; 118:1295-9.

6. Sutherland AM. Gynaecological tuberculosis since 1951. J Obstet Gynaecol 1997; 17:119-22.

7. Adams Hillard PJ. Benign diseases of the female re- productive tract. In: Berek JS, editor. Berek & Novakûs gynecology.14th ed. Philadelphia: Lippincott Williams

& Wilkins; 2007. p. 431-504.

8. Soper DE. Genitourinary infections and sexually trans- mitted diseases. In: Berek JS, editor. Berek & Novakûs gynecology.14th ed. Philadelphia: Lippincott Williams

& Wilkins; 2007. p. 541-59.

9. Kdner IJ, Fry RD, Fleshman JW, Birnbaum EH, Read TE. Colon, rectum, and anus. In: Schwartz SI, Shires GT, Spencer FC, Daly JM, Fischer JE, Galloway AC, editors. Principles of surgery. 7th ed. New York:

McGraw-Hill; 1999. p. 1265-382.

10. Nogales-Ortiz F, Tarancon I, Nogales FF. The pathololgy of female genital tuberculosis. A 31- year study of 1436 cases. Obstet Gynecol 1979; 53:422-8.

11. Anderson JR. Genital tuberculosis. In: Jones III HW, Wenta ZC, Burnett LS, editors. Novakûtextbook of gynecology. 11th ed. Baltimor : Williams & Wilkins;

1988. p. 557-69.

12. Crossley J, Husain OA. Tuberculosis of the vulva, BMJ 1958; 1:1286.

13. Millar JW, Holt S, Gilmaour HM, Robertson DH. Vul- val tuberculosis. Tubercle 1979; 60:173-6.

(7)

Abstract Tuberculosis of the Vulva : A Case Report Chayada Worasatit

Department of Obstetrics and Gynaecology, Chachoengsao Hospital, Chachoengsao Journal of Health Science 2008; 17:165-71.

A healthy single 39-year-old woman presented with chronic ulceration and discharge from vulva. She denied any history of fever, cough or menstrual irregularity. In addition, she lost neither her weight nor her appetite. She had taken the antibiotics for about 2 weeks. However, there was no response to the treatment. Additional investigations including excisional biopsy were applied. The pathological finding was chronic caseating granulomatous inflammation which suggested tuberculosis. She was therefore treated with a short course therapy of tuberculosis for 6 months and pro- nounced cured.

Key words: tuberculosis, vulva

14. Bhattacharya P. Hypertrophic tuberculosis of the vulva.

Obstet Gynecol 1978; 51 (suppl 1) : 21s-22s.

15. Eschenbach DA. Pelvic infections and sexually trans- mitted diseases. In : Scott JR, Disain PJ, Hammond CB, Spellacy WN, editors. Danforthûs obstetrics and gynecology. 7th ed. Philadelphia : JB Lippincott; 1994.

p. 641-4.

16. Weerakiet S, Rojanasakul A, Rochanawutanon M. Fe- male genital tuberculosis : clinical features and trend.

J Med Assoc Thai 1999; 82:27-32.

17. Falk V, Ludviksson K, Agren G. Genital tuberculosis in women analysis of 187 newly diagnosed cases from 47 Swedish hospitals during the ten-year period 1968 to 1977. Am J Obstet Gynecol 1980; 138:974-7.

18. Wiwanitkit V. Prevalence rate of positive tuberculin

test among Thai hospital personnel : a summery. J Hosp Infect 2006; 62:119-20.

19. «‘‚√®πå ‡®’¬¡®√— √—ß…’, √“«ÿ≤‘ Õ¬Ÿàƒ∑∏‘Ï. °“√ª√–‡¡‘π·≈–°“√

®—¥°“√§«“¡‡ ’Ë¬ßµàÕ°“√·æ√à‡™◊ÈÕ«—≥‚√§„π‚√ßæ¬“∫“≈ ≥

‚√§∑√«ßÕ°·≈–‡«™∫”∫—¥«‘°ƒµ 2549; 27:35-46.

20. Jiamjarasrangsi W, Hirunsuthikul N, Kamolratanakul P. Tuberculosis among health care workers at King Chulalongkorn memorial hospital, 1998-2002. Int J Tuberc Lung Dis 2005; 9:1253-8.

21. Shireman PK. Endometrial tuberculosis acquired by a health care worker in a clinical laboratory. Arch Pathol Lab Med 1992; 116:521-3.

22. Schaefer G. Female genital tuberculosis. Clin Obstet Gynecol 1976; 19:223-39.