宫腹腔镜联合诊治阴道斜隔综合征8例分析

Study on the significance of combination of hysteroscopy and laparoscopy in diagnosis and treatment of oblique vaginal septum syndrome: a report of 8 cases

目的探讨宫腹腔镜联合诊治阴道斜隔综合征的临床价值。方法对2009年1月至2011年12月对宫腹腔镜联合治疗阴道斜隔综合征8例患者进行回顾分析。结果 8例患者平均年龄为22岁,已婚3例,未婚5例,其中1例有原发性闭经,7例有月经不规律,6例有周期性腹痛。所有患者中有3例术前超声提示可疑有阴道斜隔,但未明确诊断,所有患者均通过宫腔镜联合检查确诊并同时行宫腔镜下阴道斜隔切除术,其中7例为右侧斜隔,1例为左侧斜隔,1例合并子宫中隔,术中行子宫中隔切除术。4例患者在腹腔镜、B超联合监护下行宫腔镜阴道斜隔切除,3例单纯采用腹腔镜监护下完成手术。术后恢复良好,症状均缓解,3例无性生活患者处女膜完整无裂伤,随访至今无复发,5例患者术后因避孕而均未曾妊娠。结论宫腹腔镜联合诊治阴道斜隔综合征可以同期确诊并治疗,具有创伤小、避免处女膜损伤、并发症少、复发率低的特点。

Objective To explore the clinical significance of hysteroscopy combined with laparoscopy in treatment of patients with oblique vaginal septum syndrome. Methods The clinical data of 8 patients with oblique vaginal septum syndrome during January 2009 to December 2011 treated with combined laparoscopy and hysteroscopy were retrospectively analyzed. Results Among these 8 patients, their mean age was 22 years old, married in 3 cases and unmarried in 5 cases. One of these 8 patients had primary amenorrhea, 7 cases with irregular menstruation, and 6 ca- ses with periodic abdominal pain. Among them, 3 patients were suspected of oblique vaginal septum by preoperative ultrasonography, but their diaguosis was not certain, all patients including 7 cases of right oblique septum, 1 case of left oblique septum and 1 case associated with uterine septum were diagnosed by oblique vaginal resection under hysteroscopy combined with hysteroscopy, and they were treated by excision of septum. Downward oblique vaginal septum resection had been performed in 4 cases with hysteroscopy under the monitoring of laparascopy and B ultrasound, operation had been performed in 3 cases with laparoscopic monitoring operation. All these 3 patients got good postoperative recovery, their symptoms were relieved with intact hymen, and no recurrence occurred up to now, and 5 patients had no pregnancy due to contraception. Conclusion Oblique vaginal septum syndrome can be earlier diagnosed and treated under laparoscopy combined with hysteroscopy, this kind of procedure has the advantages of less trauma, fewer complications, avoiding the damage of hymen and low rate of recurrence.