女性生殖道畸形患者发生泌尿系统畸形的临床特点分析

Clinical analysis of anomalies of female reproductive system associated with urinary system

目的 探讨生殖道畸形患者发生泌尿系统畸形的临床特点、诊断和治疗。方法对我院近4年来收治的生殖道畸形患者的临床资料进行回顾性分析。结果289例生殖道畸形患者,年龄在13—47岁,平均年龄(23.4±2.8)岁。根据生殖道畸形发生的情况分为对称性畸形及不对称性畸形两类。其中对称性生殖道畸形213例,包括子宫完全或不完全纵隔135例,处女膜或阴道闭锁20例,先天性无子宫无阴道58例。对称性生殖道畸形中只有1例合并同侧肾脏缺如,发生率为0.50％(1/213),占总生殖道畸形的0.35％(1/289)。不对称性生殖道畸形76例,包括阴道斜隔综合征59例,其中伴同侧肾脏缺如43例,盆腔异位单肾畸形2例,双侧马蹄肾1例,左侧马蹄肾伴右侧肾代偿性增大1例,双侧各有1对肾盂、肾盏,输尿管中下段合并1例;残角子宫13例及单角子宫4例,均合并同侧肾脏缺如。不对称性生殖道畸形合并泌尿系统畸形发生率为85.53％(65/76),占总生殖道畸形的22.49％(65/289)。结论生殖道畸形尤其是不对称性生殖道畸形合并肾脏畸形并非少见,但其临床表现也各有差异。患者就诊时已为成人期,且多以生殖系统异常症状就诊,因此及早发现生殖系统畸形有重要的临床意义。

Objective To determine the association of anomalies of female reproductive system with that of urinary system. Methods Two hundred and eighty-nine cases, including 59 with congenital vaginal inclined septum syndrome, 135 with septate uterus, 4 with unicornuate uterus, 13 with rudimentary horn of uterus, 58 with congenital absence of the uterus and vagina, 14 with imperforated hymen, and 6 with atresia of vagina, treated during the past 4 years, were analysed retrospectively. Results Anomalies of urinary system were more frequently found in patients with anisomerous anomalies of reproductive system(85. 53% , 65/76 cases). In 59 cases of congenital vaginal inclined septum syndrome, 43 had ipsilateral renal agenesis, 2 had one single pelvic kidney, 1 had bilateral horseshoe kidneys, 1 had left-side horseshoe kidney, 1 had one pair of renal pelvis and renal calices with ureters incorporated at middle and inferior segments on both sides. Ipsilateral renal agenesis was also seen in patients with rudimentary horn of uterus(14/14 cases) and unicornuate uterus(4/4 cases). However, there was no urinary system malformation seen in septate uterus patients (0/135 cases), imperforated hymen (0/16) and atresia of vagina (0/4 cases). Only 1 case of congenital absence of the uterus and vagina associated with ipsilateral renal agenesis. Conclusion Anomalies of reproductive ducts associated with renal malformations, especially anisomerous anomalies of reproductive system are not unusual. Early recognition and diagnosis is very important to prevention and treatment of such diseases.