应用宫腔镜诊治幼女和少女妇科疾病

The Use of a Hysteroscope in Diagnosing and Establishing Therapeutic Management of Pediatric and Adolescent Patients with Gynecological Problems

幼女和少女妇科疾病的诊治在以往是一个比较棘手的问题。由于其生理和解剖特点,加上受到传统观念的影响,在必须进行经阴道检查和手术时,处女膜就成为了妇科医生诊断和治疗的障碍。近年来妇科内镜技术的发展使宫腔镜成为诊治幼女和少女妇科疾病的重要手段。宫腔镜进入时无需使用拉钩过度牵拉阴道,可在不损伤处女膜的前提下通过尚未发育成熟的相对狭窄的阴道,帮助确立诊断并可进行治疗,因而可替代大部分传统的需用阴道窥器的经阴道检查和手术,其全程均在可视下操作所以更加安全。近年来,应用宫腔镜在不损伤处女膜的情况下诊治幼女和少女的妇科疾病已经成为一种趋势,但大多数相关报道还仅局限于个案报道和含有少量病例的临床研究。对评估应用宫腔镜进行阴道内镜和(或)宫腔镜检查或手术来诊治幼女和少女妇科疾病的可行性和有效性进行综述。

The diagnosis and treatment of gynecological problems in pediatric and adolescent patients were challenging in the past. Due to its physiological and anatomical characteristics, a vaginal approach for the assessment of gynecological problems in these patients has always been a problem. Furthermore, when vaginal examination is needed, virginity might be a significant obstacle for the gynecologist in diagnosing and establishing the management. Recent advance in gynecological endoscopic procedure has made hysteroscopy a promising option in assessing gynecological disorders in these patients. Hysteroscope is a useful substitute for vaginoscopy and/or hysteroscopy in the exploration of the immature genital tract. It is a safe procedure because it can always be performed under visual control. The scope of the hysteroscope is advanced into the vagina without a speculum or tenaculum, so it can facilitate diagnosis and treatment of gynecological disorders in pediatric and adolescent patients with intact hymens, limited vaginal access, narrow vaginas. Recent studies have used a hysteroscope for vaginoscopy and hysteroscopy to diagnose and establish therapeutic management of pediatric and adolescent patients with gynecological problems without injury of the hymen in recent years, but most of these studies are limited in case report and small scale clinical research. This article evaluated the effectiveness and feasibility of the use of a hysteroscope for vaginoscopy and hysteroscopy in diagnosing and establishing therapeutic management of pediatric and adolescent patients with gynecological problems.