腹腔镜下积液引流治疗新生儿及小婴儿子宫阴道积液

Feasibility of laparoscopic effusion drainage for hydrometrocolpos in neonates and younger infants

目的探讨腹腔镜下积液引流治疗新生儿、小婴儿子宫阴道积液的可行性。方法回顾分析2011年1月至2013年12月行腹腔镜治疗的4例子宫阴道积液患儿的临床资料及其随访情况。年龄2d至4个月，平均38d。合并尿生殖窦畸形2例，合并泄殖腔畸形1例，合并Muckusick-Kaufman综合征1例；伴发单侧肾积水2例，伴发双侧肾积水及球形结肠1例。4例患儿均行腹部、盆腔彩色超声检查，腹部CT检查和生殖道造影检查，2例行膀胱镜检查。4例均行腹腔镜探查、子宫阴道积液引流，其中1例同时行肠造瘘术。结果4例子宫阴道积液患儿术后排便排尿困难、腹胀、腹部包块、阴道外口囊肿等症状全部消失，随访6个月～3年，均未复发。结论子宫阴道积液是临床少见疾病，通常是泄殖腔畸形或泌尿生殖窦畸形的一种表现，或某些综合征的症状之一；女性患儿泌尿生殖系统的疾病可多种畸形同时发生，临床诊断处理时应有所兼顾；腹腔镜下积液引流治疗新生儿、小婴儿子宫阴道积液临床可行。详细的体格检查以及彩色超声、MRI、CT、造影、术中内镜检查均有助于正确诊断。全面、正确认识该病以及个体化的治疗策略对疾病预后有重要意义。

Objective To explore the feasibility of laparoscopic effusion drainage for hydrometrocolpos in neonates and younger infants. Methods Retrospective analyses were conducted for the clinical data and follow-up information of 4 children of hydrometrocolpos undergoing laparoscope between January 2011 and December 2013. Their average age was 38 days （range, 2 days to 4 months）. And the concurrent conditions included urogenital sinus malformation （n = 2）, eloacal malformation （n = 1）, Muckusick-Kaufman syndrome （n = 1）, congenital double uterine （n = 1 ） and vaginal inclined diaphragin and effusion, simple hymen atresia （n = 1）, unilateral hydronephrosis （n = 2）, bilateral renal seeper ＆ pouch colon （n = 1 ）. All received abdominal ＆ pelvic ultrasonography, abdominal computed tomography and genital tract imaging （ n = 5 ）, cystoseopy （ n = 3 ） and laparoseopic exploration （n = 4）. Uterine-vaginal fluid drainage was performed. And an incision of longitudinal vaginal septum was performed with fluid drainage. Among 4 cases undergoing laparoscopic fluid drainage, one underwent colostomy. Results Postoperatively the symptoms of dysuria, difficult defecation, abdominal distension, abdominal mass and vaginal mouth cyst disappeared. There was no recurrence during a follow-up period of 6 months to 3 years. Conclusions Uterus vaginal fluid is a manifestation of cloacal or urogenital sinus malformation. Female genitourinary diseases in children may present multiple malformations at the same time so that clinical diagnosis and treatment should be balanced. Laparoscopic effusion drainage is feasible for hydrometrocolpos in neonates and younger infants. Thorough physical and ultrasonic examinations, imaging studies and intraoperative endoscopy may aid the diagnosis. Comprehensive and correct understanding of disease and individualized treatment are of important significance for disease prognosis.