阴道斜隔综合征80例临床分析  

Clinical analysis of 80 patients with oblique vaginal septum syndrome

作　　者：张明乐[1] 周莹 许晓彤 田彦鹏 张琳[1] 赵嘉炜 周静文 郑义礼 黄向华[1] Zhang Mingle;Zhou Ying;Xu Xiaotong;Tian Yanpeng;Zhang Lin;Zhao Jiawei;Zhou Jingwen;Zheng Yili;Huang Xianghua(Department of Obstetrics and Gynecology,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Obstetrics and Gynecology,Qianjiang Central Hospital of Hubei Province,Qianjiang 433100,China;Department of Obstetrics and Gynecology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]河北医科大学第二医院妇产科,石家庄050000 [2]湖北省潜江市中心医院妇产科,潜江433100 [3]郑州大学第一附属医院妇产科,郑州450052

出　　处：《中华妇产科杂志》2024年第5期353-359,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金(81671407);河北省创新能力提升计划(20577705D)。

摘　　要：目的探讨阴道斜隔综合征患者的临床特征和诊疗方案。方法回顾性分析2005年7月至2023年7月于河北医科大学第二医院就诊的80例阴道斜隔综合征患者的临床资料。阴道斜隔综合征根据我国2021年专家共识的分型方法分为4型;分析总结患者的临床表现、合并泌尿系统发育异常、诊疗方式及治疗结局。结果80例阴道斜隔综合征患者的分型为:Ⅰ型35例(44%,35/80),Ⅱ型33例(41%,33/80),Ⅲ型2例(3%,2/80),Ⅳ型10例(13%,10/80)。80例患者的就诊原因主要为周期性下腹痛(70%,56/80)、阴道淋漓流血(20%,16/80)、排尿排便困难(15%,12/80)、阴道流脓(10%,8/80)。患者合并泌尿系统发育异常的发生率为88%(70/80),其中以阴道斜隔侧的肾缺如最为常见(81%,65/80);6%(5/80)合并其他泌尿系统发育异常,也有13%(10/80)的患者双侧肾脏正常。80例患者中74例接受了阴道斜隔切开或切除术。10例Ⅳ型患者中,有5例接受了子宫颈闭锁侧的子宫切除术,未处理斜隔;4例患者接受了宫腹腔镜联合子宫颈成形+阴道斜隔切开或切除术;1例患者因家属要求抑制月经而延迟手术治疗。2例患者在腹腔镜下切除了异位开口的输尿管及发育不良的肾脏。11例合并卵巢子宫内膜异位囊肿、输卵管积液或积脓的患者同时接受了相应的腹腔镜手术。结论Ⅰ型、Ⅳ型阴道斜隔综合征患者的主要症状为下腹痛,Ⅱ型、Ⅲ型患者的主要症状为阴道淋漓流血、流液。磁共振成像(MRI)检查对评估复杂的阴道斜隔综合征具有优势,术前建议行MRI检查,以除外其他轴向的生殖道发育异常以及复杂的泌尿系统发育异常。若存在漏尿、阴道流脓或复杂畸形时,需要术前完善检查,多学科讨论,制定合理的手术方案;首次处理关系患者预后,应高度重视。Objective To investigate the clinical features,diagnosis and treatment of oblique vaginal septum syndrome(OVSS).Methods The clinical data of 80 patients with OVSS admitted to The Second Hospital of Hebei Medical University from July 2005 to July 2023 were retrospectively analyzed.According to the classification system of OVSS proposed by Female Genital Anomalies Study Group,Chinese Obstetricians and Gynecologists Association in 2021,the patients were divided into four groups.The clinical manifestations,accompanied urinary system abnormalities,diagnosis and treatment methods and treatment outcomes were observed.Results According to the above classification system,among the 80 patients with OVSS,35 patients(44%,35/80)were categorized as typeⅠ,33 patients(41%,33/80)were categorized as typeⅡ,2 patients(3%,2/80)were categorized as typeⅢand 10 patients(13%,10/80)were categorized as typeⅣ.The main onset symptom of patients was periodic abdominal pain(70%,56/80),vaginal bleeding(20%,16/80),dysuria or fecal impaction(15%,12/80),vaginal mucopurulent discharge(10%,8/80).The morbidity of combined urinary system abnormalities was 88%(70/80),and the most common urinary system abnormality was ipsilateral renal agenesis(81%,65/80).Bilateral kidneys were normal in 13%(10/80)patients,and 6%(5/80)were combined with other urinary system abnormalities.A total of 74 patients underwent vaginal oblique septectomy or septum excision.Five of the 10 patients with typeⅣunderwent hysterectomy on the cervical atresia side,4 patients received hysteroscopy combined with cervicoplasty+oblique septotomy or septum excision,and one patient selected delayed menstruation.Two patients underwent laparoscopic resection of the dysplasia kidney and ectopic ureter which opening to the vagina.Eleven patients with endometriosis cyst,hydrosalpinx or empyema underwent laparoscopic surgery.Conclusions The main symptom of typeⅠandⅣpatients is abdominal pain,while the main symptom of typeⅡandⅢpatients is bleeding.Magnetic resonance imaging(MRI)h

关 键 词：畸形 多发性 先天畸形 子宫 阴道 泌尿生殖系统畸形 阴道斜隔综合征 

分 类 号：R711.1[医药卫生—妇产科学]