Ⅱ型阴道闭锁一例并文献复习

doi:10.12280/gjfckx.20200830

摘要/Abstract

摘要：

先天性阴道闭锁（congenital atresia of vagina）是由泌尿生殖窦及苗勒管末端发育异常而未形成贯通的阴道所致,发病率较低。阴道完全闭锁也称为Ⅱ型阴道闭锁,多合并宫颈的发育不良,子宫体发育不良或子宫畸形,在临床上更为罕见。本文对2018年10月吉林大学第二医院妇产科收治后又转诊至北京协和医院的1例Ⅱ型阴道闭锁病例进行临床分析并复习相关文献,总结目前国内外诊断、分型和治疗的进展,以期医生能更好地认识这种生殖道畸形,患者得到个体化治疗,实现更佳预后。

关键词: 阴道闭锁, 诊断, 分型, 治疗, 病例报告

Abstract:

The congenital atresia of vagina is caused by abnormal development of the urogenital sinuses and the ends of the Mullerian tubes and does not form a normalvagina, which is less common. Complete vaginal atresia, also known as type II vaginal atresia, is associated with dysplasia of the cervix, dysplasia of the uterine body, or uterine deformity, and is more rare clinically. In this paper, one case of type II vaginal atresia who was admitted to the Second Hospital of Jilin University and then transferred to Peking Union Medical College Hospital in October 2018 was clinically analyzed, we also reviewed related literature and summarized the progress of the diagnosis, classification and treatment at home and abroad, in the hope of a doctor to better understand the genital tract malformation, patients to receive individualized treatment and achieve a better prognosis.

Key words: Gynatresia, Diagnosis, Classification, Therapy, Case reports

张国伟, 付美琦, 姜颖显, 郑玉, 向梅. Ⅱ型阴道闭锁一例并文献复习[J]. 国际妇产科学杂志, 2021, 48(3): 318-321.

ZHANG Guo-wei, FU Mei-qi, JIANG Ying-xian, ZHENG Yu, XIANG Mei. Type Ⅱ Vaginal Atresia: A Case Report and Literature Review[J]. Journal of International Obstetrics and Gynecology, 2021, 48(3): 318-321.

图/表 3

参考文献 22

[1]	冷金花, 郎景和, 连利娟, 等. 阴道闭锁16例临床分析[J]. 中华妇产科杂志, 2002,37(4):217-219. doi: 10.3760/j.issn:0529-567X.2002.04.009. doi: 10.3760/j.issn:0529-567X.2002.04.009
[2]	Grimbizis GF, Gordts S, Di Spiezio Sardo A,et al. The ESHRE-ESGE consensus on the classification of female genital tract congenital anomalies[J]. Gynecol Surg, 2013,10(3):199-212. doi: 10.1007/s10397-013-0800-x. doi: 10.1007/s10397-013-0800-x pmid: 23894234
[3]	郎景和. 妇科手术笔记[M]. 北京: 中国科学技术出版社, 2004: 45-49.
[4]	Grimbizis GF, Campo R. Congenital malformations of the female genital tract: the need for a new classification system[J]. Fertil Steril, 2010,94(2):401-407. doi: 10.1016/j.fertnstert.2010.02.030. doi: 10.1016/j.fertnstert.2010.02.030
[5]	Li M, Zhang Z. Laparoscopically assisted biomaterial graft for reconstruction in congenital atresia of vagina and cervix[J]. Fertil Steril, 2013,100(6):1784-1787. doi: 10.1016/j.fertnstert.2013.08. 046. doi: 10.1016/j.fertnstert.2013.08. 046
[6]	Dietrich JE, Millar DM, Quint EH. Obstructive reproductive tract anomalies[J]. J Pediatr Adolesc Gynecol, 2014,27(6):396-402. doi: 10.1016/j.jpag.2014.09.001. doi: 10.1016/j.jpag.2014.09.001
[7]	王曼, 苏铁芬, 马文擎, 等. 阴道发育异常247例临床分析[J]. 现代妇产科进展, 2012,21(11):825-828.
[8]	Drews U. Helper function of the Wolffian ducts and role of androgens in the development of the vagina[J]. Sex Dev, 2007,1(2):100-110. doi: 10.1159/000100031. doi: 10.1159/000100031 pmid: 18391520
[9]	朱兰, 郎景和, 宋磊, 等. 关于阴道斜隔综合征、MRKH综合征和阴道闭锁诊治的中国专家共识[J]. 中华妇产科杂志, 2018,53(1):35-42. doi: 10.3760/cma.j.issn.0529-567x.2018.01.008. doi: 10.3760/cma.j.issn.0529-567x.2018.01.008
[10]	Management of Acute Obstructive Uterovaginal Anomalies: ACOG Committee Opinion, Number 779[J]. Obstet Gynecol, 2019,133(6):e363-363e371. doi: 10.1097/AOG.0000000000003281. doi: 10.1097/AOG.0000000000003281
[11]	Acién P, Acién M. The presentation and management of complex female genital malformations[J]. Hum Reprod Update, 2016,22(1):48-69. doi: 10.1093/humupd/dmv048. doi: 10.1093/humupd/dmv048
[12]	Roberts CP, Rock JA. Surgical methods in the treatment of congenital anomalies of the uterine cervix[J]. Curr Opin Obstet Gynecol, 2011,23(4):251-257. doi: 10.1097/GCO.0b013e3283478839. doi: 10.1097/GCO.0b013e3283478839
[13]	Kamada Y, Sakamoto A, Tabuchi K, et al. Opening the Anterior Vaginal Vault: A Novel Approach to Vaginoplasty with a Modified McIndoe Procedure Using an Artificial Dermis[J]. J Pediatr Adolesc Gynecol, 2015,28(5):e119-122. doi: 10.1016/j.jpag.2014.02.016. doi: 10.1016/j.jpag.2014.02.016
[14]	Zhou Q, Chen X, Luo X, et al. Laparoscopic-assisted uterovaginal anastomosis for uterine cervix atresia with vaginal aplasia using a silicone stent lined with acellular porcine small intestinal submucosa graft inserted using a 16F Foley catheter[J]. J Minim Invasive Gynecol, 2013,20(5):710-713. doi: 10.1016/j.jmig.2013.03.010. doi: 10.1016/j.jmig.2013.03.010
[15]	罗光楠, 潘宏信. 罗湖术式在阴道闭锁治疗中的应用及热点问题探讨[J]. 国际妇产科学杂志, 2017,44(3):245-247.
[16]	Rall K, Schickner MC, Barresi G, et al. Laparoscopically assisted neovaginoplasty in vaginal agenesis: a long-term outcome study in 240 patients[J]. J Pediatr Adolesc Gynecol, 2014,27(6):379-385. doi: 10.1016/j.jpag.2014.02.002. doi: 10.1016/j.jpag.2014.02.002
[17]	Kisku S, Varghese L, Kekre A, et al. Bowel vaginoplasty in children and young women: an institutional experience with 55 patients[J]. Int Urogynecol J, 2015,26(10):1441-1448. doi: 10.1007/s00192-015-2728-3. doi: 10.1007/s00192-015-2728-3
[18]	Zhao XW, Ma JY, Wang YX, et al. Laparoscopic vaginoplasty using a single peritoneal flap: 10 years of experience in the creation of a neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome[J]. Fertil Steril, 2015,104(1):241-247. doi: 10.1016/j.fertnstert.2015.04.014. doi: 10.1016/j.fertnstert.2015.04.014
[19]	Khulpateea BR, Silver DF. A ten year experience of cecal neovagina procedures for the restoration of sexual function on a gynecology oncology service[J]. Gynecol Oncol, 2014,134(1):150-153. doi: 10.1016/j.ygyno.2014.04.058. doi: 10.1016/j.ygyno.2014.04.058
[20]	Li FY, Xu YS, Zhou CD, et al. Long-term outcomes of vaginoplasty with autologous buccal micromucosa[J]. Obstet Gynecol, 2014,123(5):951-956. doi: 10.1097/AOG.0000000000000161. doi: 10.1097/AOG.0000000000000161
[21]	Pan HX, Luo GN. Phenotypic and clinical aspects of Mayer-Rokitansky-Küster-Hauser syndrome in a Chinese population: an analysis of 594 patients[J]. Fertil Steril, 2016,106(5):1190-1194. doi: 10.1016/j.fertnstert.2016.06.007. doi: 10.1016/j.fertnstert.2016.06.007
[22]	ACOG Committee Opinion No. 355: Vaginal agenesis: diagnosis, management, and routine care[J]. Obstet Gynecol, 2006,108(6):1605-1609. doi: 10.1097/00006250-200612000-00059. doi: 10.1097/00006250-200612000-00059