先天性宫颈闭锁的诊疗策略分析(1)
[摘要]目的:探讨先天性宫颈闭锁的术前评估、手术方案的选择及对术后的影响。方法:对2005至2008年收治的12例先天性宫颈闭锁患者的临床资料进行分析和评估,以探讨该疾病最佳的治疗方法。结果:12例患者的年龄13～19岁,12例合并阴道闭锁,其中有4例合并子宫畸形, 4例合并卵巢宫内膜囊肿。对5例患者行宫颈整形及阴道成形术,4例行子宫切除术,3例行子宫内膜切除术。结论:先天性宫颈闭锁的患者术前应尽早诊断,根据子宫内膜发育情况,仔细评估手术成功率及预后,选择个性化治疗方案,恢复生育功能,减少再手术的风险,术后应定期随访是手术后成功的重要环节。
[关键词]先天性宫颈闭锁;整形术,卵巢宫内膜囊肿;子宫畸形
[中国分类号]R713[文献标识码]A[文章编号]1008-6455(2010)05-0652-03
Clinical study of diagnosis and treatment of congenital cervix atresia
, http://www.100md.com
CHEN Ming,LIU Jian-hua,KANG Jian,RUAN Zheng-yi,LU Li-li
(Department of Obstetrics and Gynecology, Affiliated Ninth People's Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200011,China)
Abstract:ObjectiveTo investigate the preoperative evaluation, the choice of operative procedures and surgical effects in the treatment of congenital cervical atresia.MethodsThe data of diagnosis and treatment in 12 cases of congenital cervical atresia, from 2005 to 2008, were retrospectively studied, in order to approach the appropriate treatment for the congenital cervical atresia.ResultsThe ages of the cases ranged from 13 to 19 years. All cases suffered from vaginal atresia at once. Among them 4 cases had uterine malformation and 4 ovarian chocolate cyst. 5 cases underwent cervical plastic and vaginal reconstructive procedures, 4 vaginal reconstruction and hysterectomy, and 3 vaginal reconstruction and endometrium removal.ConclusionsCongenital cervical atresia should be diagnosed as early as possible. A careful evaluation of the cases must be made before the operations according to the endometrial developing conditions, for the choice of individual plastic surgical procedures to get higher success rate and more probable recovery of reproductive function. The postoperative management and follow-up are also imperative for the surgical success.
, 百拇医药
Key words:congenital cervical atresia; plastic surgery;ovarian chocolate cyst; uterine malformation
先天性宫颈闭锁是女性生殖器官在形成、分化过程中,由于某些因素的影响,正常管道腔化受阻所致,如果同时伴有副中肾衍生物发育不全或融合障碍,可致无子宫、无阴道、始基子宫或双子宫、鞍状子宫等发育异常,临床较罕见。目前的诊断主要根据Buttram的分类标准:部分或完全性宫颈闭锁合并先天性闭锁阴道或有阴道,子宫内膜有功能[1]。主要临床表现为原发性闭经和周期性下腹痛。及时的诊断及选择合适的治疗方法对预后影响较大。先天性宫颈闭锁合并先天性阴道闭锁,要求保留生育功能的患者,处理尤为棘手。我院自2005年～2008年共收治12例先天性宫颈闭锁合并先天性阴道闭锁患者,现将临床资料进行总结和分析。
1一般资料
, http://www.100md.com 笔者收集的12例先天性宫颈闭锁患者均合并先天性阴道闭锁,年龄13～19岁,平均年龄15.42±2.19岁,染色体检查为46xx。8例患者(8/12)在入院前有不同程度周期性下腹痛的症状,无月经血流出。12例患者的尿道下方均有一浅凹,无阴道。通过腹部超声、CT或磁共振检查,发现12例患者均有子宫,5例患者子宫饱满,有宫腔积液,另外7例有宫腔少量积液;4例合并卵巢宫内膜囊肿,4例合并子宫畸形。这12例病例符合Buttram的诊断标准,在青春期无月经来潮或伴有急性或慢性下腹痛。通过肛查、B超检查、CT、MRI诊断为先天性宫颈闭锁及合并的其他畸形,如子宫畸形。笔者发现5例宫腔积液较多的患者,年龄较轻,周期性下腹痛发作的时间较早,疼痛持续时间3～4天,提示子宫内膜的发育及功能良好,术中发现有功能的子宫内膜面积正常。而另外7例患者青春期周期性下腹痛发作的时间较晚,在17岁左右才诊断宫颈闭锁的患者,最迟19岁。下腹痛症状轻微或不明显,在术前检查时发现宫腔少量积液,术中证实子宫内膜菲薄,宫腔面积小,宫颈发育差。
2手术方法与结果
, 百拇医药
选择合适的治疗方案,关键是判断子宫内膜的发育情况及功能。通过询问病史,如下腹痛发生的年龄、症状的轻重,及影像学检查,可以在术前明确子宫内膜的情况。笔者根据Buttram的分类标准,将12例患者分为两类。
2.1 一类为子宫内膜功能正常的5例患者,笔者选择宫颈整形及阴道成形术,同时对其中的4例行卵巢宫内膜囊肿剥除术。1例(1/5)先在阴道浅凹处做一弧形切口,分离尿道及直肠间腔隙、人工造穴,探及子宫下极后钻孔,直至见暗红色经血流出。取大腿外侧皮肤代阴道粘膜。将皮肤代阴道上缘与子宫开口对接缝合,术后放置Folley's导尿管作为支架。另4例(4/5)子宫饱满、双卵巢宫内膜囊肿、盆腔粘连的病例,先在子宫前壁做一小切口,打开宫腔,探查宫腔无异常,吸净宫腔内经血后,自宫腔向宫颈下极方向,在闭锁的宫颈中央钻孔,直至子宫下极,形成宫颈通道,取游离腹膜代宫颈粘膜组织,同时行双卵巢囊肿剥出术。同时另一组医生分离尿道及直肠间腔隙,人工造穴,宫颈和人工阴道贯通后,经阴道在宫腔内放置支架及Folley's导尿管。, http://www.100md.com(陈 鸣,刘建华,康 俭,阮正一,鲁丽丽)
[关键词]先天性宫颈闭锁;整形术,卵巢宫内膜囊肿;子宫畸形
[中国分类号]R713[文献标识码]A[文章编号]1008-6455(2010)05-0652-03
Clinical study of diagnosis and treatment of congenital cervix atresia
, http://www.100md.com
CHEN Ming,LIU Jian-hua,KANG Jian,RUAN Zheng-yi,LU Li-li
(Department of Obstetrics and Gynecology, Affiliated Ninth People's Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200011,China)
Abstract:ObjectiveTo investigate the preoperative evaluation, the choice of operative procedures and surgical effects in the treatment of congenital cervical atresia.MethodsThe data of diagnosis and treatment in 12 cases of congenital cervical atresia, from 2005 to 2008, were retrospectively studied, in order to approach the appropriate treatment for the congenital cervical atresia.ResultsThe ages of the cases ranged from 13 to 19 years. All cases suffered from vaginal atresia at once. Among them 4 cases had uterine malformation and 4 ovarian chocolate cyst. 5 cases underwent cervical plastic and vaginal reconstructive procedures, 4 vaginal reconstruction and hysterectomy, and 3 vaginal reconstruction and endometrium removal.ConclusionsCongenital cervical atresia should be diagnosed as early as possible. A careful evaluation of the cases must be made before the operations according to the endometrial developing conditions, for the choice of individual plastic surgical procedures to get higher success rate and more probable recovery of reproductive function. The postoperative management and follow-up are also imperative for the surgical success.
, 百拇医药
Key words:congenital cervical atresia; plastic surgery;ovarian chocolate cyst; uterine malformation
先天性宫颈闭锁是女性生殖器官在形成、分化过程中,由于某些因素的影响,正常管道腔化受阻所致,如果同时伴有副中肾衍生物发育不全或融合障碍,可致无子宫、无阴道、始基子宫或双子宫、鞍状子宫等发育异常,临床较罕见。目前的诊断主要根据Buttram的分类标准:部分或完全性宫颈闭锁合并先天性闭锁阴道或有阴道,子宫内膜有功能[1]。主要临床表现为原发性闭经和周期性下腹痛。及时的诊断及选择合适的治疗方法对预后影响较大。先天性宫颈闭锁合并先天性阴道闭锁,要求保留生育功能的患者,处理尤为棘手。我院自2005年～2008年共收治12例先天性宫颈闭锁合并先天性阴道闭锁患者,现将临床资料进行总结和分析。
1一般资料
, http://www.100md.com 笔者收集的12例先天性宫颈闭锁患者均合并先天性阴道闭锁,年龄13～19岁,平均年龄15.42±2.19岁,染色体检查为46xx。8例患者(8/12)在入院前有不同程度周期性下腹痛的症状,无月经血流出。12例患者的尿道下方均有一浅凹,无阴道。通过腹部超声、CT或磁共振检查,发现12例患者均有子宫,5例患者子宫饱满,有宫腔积液,另外7例有宫腔少量积液;4例合并卵巢宫内膜囊肿,4例合并子宫畸形。这12例病例符合Buttram的诊断标准,在青春期无月经来潮或伴有急性或慢性下腹痛。通过肛查、B超检查、CT、MRI诊断为先天性宫颈闭锁及合并的其他畸形,如子宫畸形。笔者发现5例宫腔积液较多的患者,年龄较轻,周期性下腹痛发作的时间较早,疼痛持续时间3～4天,提示子宫内膜的发育及功能良好,术中发现有功能的子宫内膜面积正常。而另外7例患者青春期周期性下腹痛发作的时间较晚,在17岁左右才诊断宫颈闭锁的患者,最迟19岁。下腹痛症状轻微或不明显,在术前检查时发现宫腔少量积液,术中证实子宫内膜菲薄,宫腔面积小,宫颈发育差。
2手术方法与结果
, 百拇医药
选择合适的治疗方案,关键是判断子宫内膜的发育情况及功能。通过询问病史,如下腹痛发生的年龄、症状的轻重,及影像学检查,可以在术前明确子宫内膜的情况。笔者根据Buttram的分类标准,将12例患者分为两类。
2.1 一类为子宫内膜功能正常的5例患者,笔者选择宫颈整形及阴道成形术,同时对其中的4例行卵巢宫内膜囊肿剥除术。1例(1/5)先在阴道浅凹处做一弧形切口,分离尿道及直肠间腔隙、人工造穴,探及子宫下极后钻孔,直至见暗红色经血流出。取大腿外侧皮肤代阴道粘膜。将皮肤代阴道上缘与子宫开口对接缝合,术后放置Folley's导尿管作为支架。另4例(4/5)子宫饱满、双卵巢宫内膜囊肿、盆腔粘连的病例,先在子宫前壁做一小切口,打开宫腔,探查宫腔无异常,吸净宫腔内经血后,自宫腔向宫颈下极方向,在闭锁的宫颈中央钻孔,直至子宫下极,形成宫颈通道,取游离腹膜代宫颈粘膜组织,同时行双卵巢囊肿剥出术。同时另一组医生分离尿道及直肠间腔隙,人工造穴,宫颈和人工阴道贯通后,经阴道在宫腔内放置支架及Folley's导尿管。, http://www.100md.com(陈 鸣,刘建华,康 俭,阮正一,鲁丽丽)