残角子宫35例临床分析  

Clinical data analysis of 35 patients with rudimentary horn of uterus

作　　者：杨真[1] 徐晓旭 杨岑[3] 史宏晖[3] 于昕[3] 樊庆泊[3] 

机构地区：[1]大连市中心医院,大连116033 [2]北京市通州区妇幼保健院,北京100010 [3]中国医学科学院北京协和医院妇产科,北京100730

出　　处：《生殖医学杂志》2015年第4期272-276,共5页Journal of Reproductive Medicine

摘　　要：目的提高对残角子宫临床特点、诊断及处理的认识。方法对2004年1月至2014年1月北京协和医院收治的35例经手术确诊的残角子宫患者的临床资料进行回顾性分析。结果 (1)35例患者中IIa型3例(8.6%),IIb型22例(62.9%),IIc型8例(22.9%),无IId型,分型不详2例(5.7%);临床表现为痛经者24例(68.5%),不孕者6例(17.1%),12例合并子宫内膜异位症(34.3%),12例合并泌尿生殖系统畸形(34.3%)。(2)所有患者术前均行超声检查,提示为残角子宫12例,双子宫5例,畸形子宫3例,未见异常15例;其中13例患者术前同时行核磁共振检查,提示为残角子宫5例,双子宫4例,纵隔子宫1例,畸形子宫1例,未见异常2例,与超声诊断基本符合,超声及核磁共振与手术诊断符合率均为38.5%(5/13)(P>0.05);7例术前行子宫输卵管造影,双侧输卵管未显影1例,单侧未显影4例,双侧正常2例。(3)非妊娠时诊断者23例,妊娠时诊断者12例(其中4例为残角子宫妊娠)。(4)手术切除残角子宫共25例,其中腹腔镜16例,开腹9例。结论残角子宫的诊断和分型是治疗的依据,超声及核磁共振检查有助于残角子宫的诊断,子宫输卵管碘油造影有助于判断其分型,宫腹腔镜联合手术诊治残角子宫具有良好效果。Objective： To improve the awareness of the clinical feature, diagnosis and treatment of rudimentary uterine horn. Methods. The clinical data of 35 patients with rudimentary uterine horn confirmed by surgery from January 2004 to January 2014 were analyzed retrospectively. Results： Among 35 patients with rudimentary uterine horn,3 patients belonged to type IIa（8.6%）,22 type Iib（62, 9%） ,8 type Iic（22.9%） ,none type IId,and 2 unknown type（5.7%）. Twenty-four patients （68.6%） presented dysmenorrhea and 6 （17.1%） sterility; 12 （34.3%） patients combined with endometriosis and 12（34.3 %） with genito-urinary system abnormality. All patients underwent ultrasound examination before surgery. The results of ultrasound examination showed 12 patients with rudimentary horn of uterus, 5 with double uterus, 3 with uterine malformation,and 15 with normal uterus. Thirteen patients also underwent magnetic resonance imaging（MRI）. The MRI results showed 5 patients with rudimentary horn of uterus,4 with double uterus, 1 with uterine mediastinum, 1 with uterine malformation and 2 with normal uterus. The results were consistent with that of ultrasound diagnosis. Both of the coincidence rates between ultrasound ~ MRI diagnosis and surgery were 38.5%（5/13）. Seven patients underwent hysterosalpingography. The results showed that bilateral fallopian tubes were not visualized in 1 patient;unilateral fallopian tube was absent in 4 patients; and bilateral fallopian tubes were normal in 2 patients. Twenty-three patients were not pregnant,and 12 patients were pregnant including 4 patients with pregnancy in rudimentary uterine horn at the time of diagnosis. Twenty-five patients underwent surgical resection of rudimentary uterine horn. Among them, 16 patients were operated by laparoscope and 9 patients by laparotomy. Conclusions： Diagnosis and classification of rudimentary uterine horn is the basis of treatment. Ultrasonography and magnetic resonance imaging can be used in the diagnosis. Hysterosal

关 键 词：残角子宫 子宫畸形 妊娠 腹腔镜 诊断 

分 类 号：R4[医药卫生—临床医学]