宫颈环扎术治疗完全性纵隔子宫并双宫颈双阴道一例并文献复习

doi:10.12280/gjfckx.20211105

摘要/Abstract

摘要：

先天性子宫畸形合并宫颈功能不全发病率可高达30%。纵隔子宫作为一种先天性子宫畸形,育龄妇女患病率约为0.2%~2.3%;具有较高的不孕、流产和早产风险。报告1例完全性纵隔子宫并双宫颈双阴道患者,妊娠前宫腔镜下行子宫纵隔切除术,孕14周经阴道行双侧宫颈预防性环扎术,孕23⁺⁶周宫口开大,保守治疗,孕30⁺¹周早产临产拆线,最终自然分娩并抱婴回家的临床处置经过,并回顾总结近年国内外纵隔子宫合并妊娠的诊治进展。

关键词: 妊娠, 苗勒管, 宫颈功能不全, 环扎术,宫颈, 产前保健, 病例报告, 苗勒管发育不全, 纵隔子宫

Abstract:

The incidence of congenital uterine malformation combined with uterine cervical incompetence can be as high as 30%. Septate uterus is one of congenital uterine anomalies with a prevalence of 0.2%~2.3% in women of childbearing age. It has a high risk of infertility, miscarriage and premature birth. Now we report a case of complete septate uterus with double cervix and double vagina. Hysteroscopic hysterectomy was performed before pregnancy, and bilateral cervical cerclage was performed via vagina at 14 weeks of gestation. At 23⁺⁶ weeks of gestation, the cervix was dilated and conservative treatment was performed, and the suture was removed at 30⁺¹ weeks of gestation when was about to give birth, and the patient gave birth naturally and brought the baby home. The current research of the diagnosis and treatment for septate uterus in pregnancy at home and abroad in recent years is reviewed.

Key words: Pregnancy, Mullerian ducts, Uterine cervical incompetence, Cerclage, cervical, Prenatal care, Case reports, Hypomelia mullerian duct anomalies, Septate uterus

徐崇彬, 李映桃, 周梦阳, 肖晓梅, 温景锋, 黄颖敏, 王艳. 宫颈环扎术治疗完全性纵隔子宫并双宫颈双阴道一例并文献复习[J]. 国际妇产科学杂志, 2022, 49(4): 443-448.

XU Chong-bin, LI Ying-tao, ZHOU Meng-yang, XIAO Xiao-mei, WEN Jing-feng, HUANG Ying-min, WANG Yan. Cervical Cerclage for Complete Septate Uterus with Double Cervix and Double Vagina: A Case Report and Literature Review[J]. Journal of International Obstetrics and Gynecology, 2022, 49(4): 443-448.

图/表 7

图1 环扎术前后、不同孕周双侧宫颈肉眼变化图注：1-1 为孕14周环扎术前宫颈图;1-2 为环扎术后孕15+2周宫颈图,箭头指示分别为环扎缝线（左侧双层环扎,右侧单层环扎）;1-3 为环扎术后孕23+6周羊膜囊突出宫颈图,箭头指示为羊膜囊突出;1-4 为孕30+1周早产临产拆线后宫颈图,箭头指示为羊膜囊突出。其中A代表左侧宫颈,B代表右侧宫颈。

图2 宫颈环扎术前、后左侧宫颈管二维超声对比图注：A 2020年7月29日宫颈环扎术前,B 2020年8月3日宫颈环扎术后;红色箭头所示为宫颈长度,白色箭头所示为环扎线距宫颈外口长度,黄色箭头所示为环扎线强回声。

图3 2020年9月22日双侧宫颈管变化超声对比图注：A 行单线宫颈环扎术的左侧宫颈管,B 行双线宫颈环扎的右侧宫颈管;红色箭头所示为羊膜囊突入宫颈管,白色箭头所示为剩余宫颈管长度,黄色箭头所示为环扎线强回声。

表1 宫颈长度变化表降钙素原（ng/mL）

时间（孕周）	宫颈剩余长度（左/右,mm）	宫颈形态（左/右）	宫颈内口宽度（左/右,mm）	宫颈内口深度（左/右,mm）
2020年9月22日（21⁺²周）	14/5	U/U	12/12	27/32
2020年9月28日（22⁺¹周）	12/5	U/U	13/10	27/31
2020年10月15日（24⁺⁴周）	10/0	U/全程扩张	23/-	25/-
2020年10月25日（26周）	15/0	Y/全程扩张	10/-	33/-
2020年11月3日（27⁺²周）	9/0	Y/全程扩张	20/-	28/-

图4 感染指标变化趋势图

表2 阴道分泌物及用药情况

图5 产后阴道纵隔及双宫颈图

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