女性生殖道畸形的诊治——常见外阴阴道畸形的种类及诊治

生殖器畸形多为先天发育缺陷及发育异常所致。现就常见的外阴阴道畸形及诊治简述如下。     

常见子宫畸形的种类及诊治

女性生殖道畸形中,子宫发育畸形较为常见。现就子宫畸形的组织学发生、常见类型、诊断及治疗简述如下。1子宫畸形的发生和类型子宫的形成要经过两侧副中肾管的发育、合并、腔化、中隔的融合吸收等一系列复杂的步骤。在胚胎发育的过程中,若受到某些内在或外来因素的干扰,副中肾管停止发育或其融合发生障碍,则可导致子宫发育异常,形成不同类型的子宫畸形。有几种子宫畸形的分类方法,归纳起来主要有解剖学分类和功能性分类法,较常用的是解剖学分类。常见子宫畸形类型有:(1)先天性无子宫及子宫发育不全:①先天性无子宫:两侧副中肾管未到中线前即…     

影像学检查在女性生殖道畸形诊断中的应用价值

影像学检查在女性生殖道畸形的诊断中占有重要的地位,各种影像检查技术有不同的应用价值和指征。其中超声检查不但易行、价廉,且无辐射性损伤,是目前女性生殖系统疾病首选的检查方法[1]。女性生殖道畸形常常合并泌尿系统畸形,且有时2种或2种以上畸形并存。临床上根据所考虑的畸形部位和各种影像学检查的特点来进行选择。1处女膜闭锁超声检查可明确诊断,表现为阴道、宫颈管、宫腔、输卵管扩张积血,内为多个液性暗区,暗区与暗区之间互相沟通。实时超声下可见积液在子宫与阴道间流动。有输卵管扩张时,直肠子宫陷凹内可见液性暗区。时间长或合并…     

生殖道畸形致宫颈积血2例

宫颈积血临床罕见，是因宫颈发育异常造成。我院曾收治宫颈积血患者2例。为探讨宫颈积血的临床特点和治疗方法，对这2例宫颈积血患者诊治情况做一回顾分析，现将结果报道如下。     

女性外生殖器畸形的诊治

女性外生殖器畸形与雄激素作用异常有关。病因中主要是先天性的性发育异常和后天分泌雄激素的肿瘤。治疗的关键在于明确病因,方法包括病因的手术治疗、药物治疗及外阴整形手术。     

畸形子宫产妇妊娠结局的临床分析

目的:通过比较各类畸形子宫与正常子宫产妇孕期情况及母儿结局,为畸形子宫妇女的孕前咨询、孕期管理、产程监护及分娩方式的选择提供参考.方法:回顾分析于昆明医科大学第一附属医院产科分娩的102例畸形子宫患者的临床资料.结果:102例畸形子宫患者中,16.7％为孕前诊断,14.7％为产后诊断.孕期行泌尿系统B超者占11.8％,...     

子宫损伤的原因及诊治

子宫损伤是严重的妇产科并发症,发生率约017%~510%。随着城乡妇幼卫生三级保健网的建立和逐步完善,子宫损伤的发病率已明显降低,但并非罕见。子宫损伤若处理不当,可直接危害妇女的生命,应引起足够的重视,争取做到及时发现,及时处理。1　子宫损伤的常见原因1.1　妊娠期子宫破裂1.1.1　子宫畸形与瘢痕子宫　一般发生在妊娠早、中期。畸形子宫以残角子宫和单角子宫妊娠引起子宫破裂多见,因为残角子宫肌层组织发育较差,妊娠后子宫增大,肌层变薄,绒毛向蜕膜下生长而植入肌层,使肌层更薄弱,最后导致子宫损伤、破裂。瘢痕子宫妊娠由于曾行手术…     

完全中隔子宫畸形21例临床分析

苗勒管发育异常在女性中的发生率约1％～3％，其中以中隔子宫最为多见，而完全中隔子宫畸形并不多见。1995年至2006年，我院收治了21例完全中隔子宫畸形患者，现对其临床资料分析报道如下。[第一段]     

宫腔镜结合腹腔镜诊治先天性子宫畸形的价值

目的:探讨宫腔镜结合腹腔镜诊治先天性子宫畸形的价值。方法:回顾性分析41例合并不孕或不育的经宫腹腔镜联合诊治的先天性子宫畸形病例。结果:29例为纵隔子宫,5例双子宫,4例单角子宫,2例鞍状子宫,1例双角子宫。手术同时解除导致不孕或不育的因素如盆腔粘连、多囊卵巢综合征、子宫内膜异位症及矫正子宫畸形等。而B超、HSG、宫腔镜均有一定的误诊率。结论:宫腹腔镜联合手术可作为子宫畸形合并不孕或不育妇女的最理想的诊治手段。     

阴道三维立体超声在子宫畸形及子宫其它异常诊断中的应用价值

目的 探讨阴道三维立体超声对子宫畸形及子宫其它异常的诊断价值。方法 对168例不孕妇女行子宫碘油造影（HSG）、阴道二维超声和阴道三维立体超声检查,并对其结果进行比较。结果 阴道三维立体超声对子宫畸形的检出率与对子宫碘油造影十分接近,由于可以同时观察子宫肌层,在鉴别诊断方面更有优势。阴道二维超声对子宫畸形的检出率较低。结论 在对子宫畸形以及子宫其它异常诊断中,阴道三维立体超声可以成为重要的诊断方法之一。     

磁共振成像与彩色三维多普勒超声在子宫发育畸形诊断中的价值

目的探讨磁共振成像（MRI）与彩色三维多普勒超声在子宫发育畸形诊断中的价值。方法回顾性分析2011年1月至2013年5月经手术确诊的子宫发育畸形患者98例的临床资料,其中65例术前经彩色三维多普勒超声诊断,33例经MRI诊断,24例同时行二维彩超和MRI检查,分析其诊断子宫发育畸形的准确度。结果 98例患者中,纵隔子宫39例,单角子宫17例,双角子宫16例,双子宫11例,无子宫9例,复杂畸形6例。三维彩超和MRI诊断子宫畸形的准确度分别为89.2%（58/65）和93.9%（31/33）,两者比较,差异无统计学意义（P〉0.05）。2例罗伯特子宫患者中,三维彩超和MRI术前均未明确诊断;4例子宫畸形合并阴道畸形患者中,仅1例术前确诊。24例患者二维彩超和MRI诊断的准确度分别为54.2%（13/24）和91.7%（22/24）,两者比较,差异有统计学意义（P〈0.05）。结论经阴道/直肠三维彩超和MRI对纵隔子宫、单角子宫、双角子宫、双子宫及无子宫或幼稚子宫的诊断率较高,三维彩超可作为子宫畸形的首选无创检查方法。但对于复杂的子宫畸形,二者的诊断准确度较低。     

Role of pelvic endoscopy in diagnosing congenital uterine malformations]

The role of pelvic endoscopy in diagnosing uterine abnormalities, considering material of 1170 patients, is presented in this paper. It has been documented that pelviscopy together with hysterosalpingography play basic role in determining type of uterine abnormality. In 20 cases pelvic endoscopy enabled verification of the primary diagnosis set by hysterosalpingography. Pelvic endoscopy is a method by choice in the diagnostics of the Rokitansky-Küster-Hauser syndrome.     

Transvaginal ultrasound for diagnosis of uterine malformations

Uterine malformations were detected in 8 of 300 patients (3%) referred for transvaginal ultrasound scan (TVS) for different indications. Six of them had a partially septate uterus and two had a uterus didelphys. As uterine malformations can be associated with both sterility and reproductive failure, we suggest that the study of uterine morphology and structure could be a part of routine TVS examination.     

Transvaginal ultrasound for diagnosis of uterine malformations

Summary. Uterine malformations were detected in 8 of 300 patients (3%) referred for transvaginal ultrasound scan (TVS) for different indications. Six of them had a partially septate uterus and two had a uterus didelphys. As uterine malformations can be associated with both sterility and reproductive failure, we suggest that the study of uterine morphology and structure could be a part of routine TVS examination.     

The value of prenatal sonography in the diagnosis of congenital malformations

Three hundred and forty-one prenatal ultrasound tests performed in 79 cases who presented congenital malformations at birth were studied retrospectively. A correct prenatal diagnosis was only made in 24 cases (30.3%), whereas there were 50 false negative (63.3%) and 5 dubious cases (6.3%). The percentage of false negative was greater in the group of cases examined in peripheral centres (56%) in comparison to those examined in our institute (35%).     

Surgical treatment of uterine malformations]

Clinical data of 29 patients with uterine malformation treated at the Fertility Unit, Service and Department of Obstetrics and Gynecology, Dr. G. Grant B. Clinical Hospital, Concepción Chile from January 1978 to May 1990 are presented. Uterine septa (19 cases, 65.5%) were the most common uterine malformation found. Less frequent were: uterus bicornuous 7 cases (24.1%) and uterus didelphis 3 cases (10.4%). The high frequency (92.8%) of pregnancy wastage is detached. Surgical treatment was practiced in 24 patients. Thirteen Tompkins and 5 Jones techniques were performed in 18 uterine septa. Five Strassman techniques and one extirpation of a rudimentary not communicated horn were practised in the 6 cases with uterus bicornuous. In patients with adequate follow-up, the overall term birth rate after metroplasty is 84.6% compared with only 2.4% before surgical treatment. This study concludes that in despite of the lack of hysteroscopy as a new method of uterine septa treatment our patient's infertility was benefited with surgical treatment of uterine anomalies.     

The significance of hysteroscopic treatment of congenital uterine malformations

Hysteroscopic surgery replaced abdominal metroplasty and is today the treatment of choice for congenital uterine malformations. This is not just because of its reproductive results, which are comparable to those achieved with the abdominal approach, but mainly because of several post-operative benefits (reduced morbidity, convalescence and costs, and no scar tissue on the abdominal and uterine walls), improved reproductive performance (no reduction in uterine volume, shorter interval to conception after operation) and the mode of delivery (avoiding Caesarean section). Decisions on when and how to treat uterine septa, in relation to the type of malformation, are discussed. In particular, indications for treatment have been broadened to include not only the septate uterus associated with adverse reproductive outcome, but also patients before any potential obstetric accidents, especially in those with declining fecundity (>35 years), with reproductive problems (unexplained infertility) and before assisted reproductive techniques, as well as in women with no actual desire of pregnancy. Two types of hysteroscopic treatment are available: resectoscopic and office hysteroscopic surgery. The indications for resectoscopic surgery are broad-based septa and complete septa with single or double cervix. The resectoscope allows an excellent continuous flow system, providing continuous washing of the uterine cavity and a clear view, removing bubbles and debris during the procedure. However, an exact measurement of fluid balance must be performed to avoid excessive fluid intravasation. Laparoscopic or sonographic monitoring is mandatory. Treatment of limited-based small septa whose apex is easily visible can be achieved with an outpatient approach using office mini-hysteroscopic surgery and the vaginoscopic technique. The intra-operative check of the fundus is performed by ultrasonography. No preparation of the endometrium is required, except for large, broad-based septa, and hormonal therapy and intrauterine devices are not utilized post-operatively. The post-operative follow-up consists of a hysteroscopic check performed 1-3 months after surgery.