先天性宫颈闭锁29例分析

目的:探讨先天性宫颈闭锁的矫治方法。方法:回顾性分析1984年3月至2009年3月25年间我院收治的先天性宫颈闭锁患者29例的临床资料。结果:按宫颈闭锁的解剖学特征将此畸形分为4型:Ⅰ型19例,子宫体下为壁厚5～6mm、平均直径7.7cm×6.1cm的积血囊腔;Ⅱ型5例,子宫体下为短实性组织,无骶主韧带固定;Ⅲ型2例,子宫体下为长实性宫颈组织;Ⅳ型3例,子宫体下为壁厚约1.5cm的盲状宫颈管腔。根据宫颈闭锁畸形特征制定宫颈闭锁的分型诊断标准,Ⅰ型为宫颈不全闭锁型:子宫组织学内口闭锁,其以上的子宫解剖学内口和子宫峡部发育正常,宫颈管缺如;Ⅱ型为无宫颈或子宫峡部闭锁型:子宫组织学内口以上子宫管腔闭锁,闭锁段以下宫颈缺如,多数伴有子宫体发育不良;Ⅲ型为宫颈完全闭锁型:子宫解剖学内口以下峡部和颈管全部闭锁,闭锁宫颈长度、直径和形状不同,多数伴有子宫体发育不良;Ⅳ型为子宫峡部缺失型:子宫体下端直接与呈盲端的宫颈管腔相连,子宫峡部缺如。结论:先天性宫颈闭锁分型诊断标准对宫颈闭锁的诊治具有重要的临床价值。

Analysis on 29 cases of congenital cervical atresia

Objective:To explore the diorthosis of congenital cervical atresia.Method:A retrospective study was conducted on clinical data of 29 cases with congenital cervial atresia received and treated by Clinical Medical Institute with Anhui Medical University,between Mar.1984 and Mar.2009.Result:Congenital cervical atresia was divided into four types based on its anatomical characteristics:19 cases with type Ⅰ,characterized by uterine body connecting hematocele cyst cavities with a wall thickness of 5~6mm and an average diameter of 7.7cm×6.1cm,5 cases with typeⅡ,characterized by uterine body connecting a short solid tissue.2 cases with typeⅢ,characterized by uterine body connecting a long solid cervix tissue.3 cases with type Ⅳ,characterized by uterine body connecting a blind cervical cavity with a wall thickness of approximate 1.5cm.Diagnostic criterion for cervical atresia was developed based on characteristics of each type of cervical atresia.TypeⅠ was incomplete cervical atresia,in which histological internal os was blocked,while uterine anatomic internal os and uterine isthmus was normal.Cervical duct was absent.TypeⅡ was absence of vagina and atresia of uterine isthmus,in which canalis up histological internal os was blocked,cervical duct was absent,with most cases complicated with dysplasia of uterus body;TypeⅢ was complete blockage of cervix,in which uterine isthmus and cervical duct below uterine anatomic internal os were completely blocked.Lengths,diameters and shapes of the blocked cervix were varied,and most cases were complicated with dysplasia of uterus body.TypeⅣ was absence of uterine isthmus,in which lower end of uterine body connected directly with blind end of cervical duct,anatomic internal os of uterine was not distinct,and isthmus uteri was absent.Conclusion:Diagnostic criterion for categorization of congenital cervical atresia is of significant clinical value for its diagnosis and treatment.