儿童处女膜闭锁的临床特征及诊疗策略  

Clinical features and management strategies of imperorate hymen in children

作　　者：张振乾 陈可欣 严向明[1] 周云[1] 张婷[1] 付明翠[1] 曹戌[1] Zhang Zhenqian;Chen Kexin;Yan Xiangming;Zhou Yun;Zhang Ting;Fu Mingcui;Cao Xu(Department of Urology,Children's Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属儿童医院泌尿外科,苏州215000

出　　处：《临床小儿外科杂志》2022年第3期278-282,共5页Journal of Clinical Pediatric Surgery

基　　金：江苏省自然科学基金面上项目(BK20191176);苏州市临床重点病种诊疗技术专项项目(LCZX201908)。

摘　　要：目的 探讨儿童处女膜闭锁的临床特征及诊疗策略。方法 回顾性收集苏州大学附属儿童医院泌尿外科2012年2月至2020年10月收治的24例处女膜闭锁患儿临床资料,评估内容包括病史、体征、辅助检查结果、手术方法、术中情况以及术后随访情况等。结果 24例中,青春期前发现处女膜闭锁7例(29%),青春期时出现临床症状而就诊17例(71%)。最常见的临床表现为下腹部疼痛不适(16/17);多数患儿有泌尿系统症状,包括尿潴留及排尿困难(7/17)、尿频(2/17);少数患儿伴有发热(2/17)、腹胀(1/17)、恶心(1/17)、排便困难(1/17)等。在有症状患儿中,7例(41.2%)曾被误诊。24例均行处女膜“+”字切开术,术后随访无一例出现明显并发症。结论 处女膜闭锁的诊断需通过仔细的体格检查,超声检查可为明确诊断提供依据。手术的最佳时机是青春期开始后至月经初潮之前。处于青春期且伴有症状的患儿一经确诊,应尽快手术。处女膜“+”字切开术作为标准手术方式,安全有效。Objective To explore the clinical features and treatment of imperforate hymen(IH) in children.Methods A retrospective analysis was performed for 24 children of imperforate hymen from February 2012 to October 2020.The medical history,physical signs,auxiliary examination results,surgical methods,intraoperative conditions,and postoperative follow-up conditions were evaluated.Results There were 7 children(29%) diagnosed with IH before puberty,and 17(71%) were treated with symptoms during puberty.The main clinical manifestations included abdominal pain and discomfort(16/17,94.1%).Most of the pediatric patients had urinary symptoms such as retention of urine and impaired urination(7/17,41.2%) and frequent urination(2/17,11.8%).Some had fever(2/17,11.8%),bloating(1/17,5.9%),nausea(1/17,5.9%),and difficulty defecating(1/17,5.9%).7(41.2%) of the children with symptoms had been misdiagnosed.All 24 children underwent hymenotomy with a cruciate incision,with no obvious postoperative complications during follow-up.Conclusion The diagnosis of IH requires careful physical examination,in which ultrasound examination can be helpful in making correct diagnosis.The best timing for surgery is during puberty,but before the menarche.Symptomatic adolescent should receive surgery as soon as possible after diagnosis.The hymen cruciate incision is safe and effective as a standard surgical procedure.

关 键 词：处女膜/畸形 处女膜/外科学 

分 类 号：R711.1[医药卫生—妇产科学]