6个月以内婴儿子宫阴道积液临床诊治分析

Diagnosis and treatment of hydrometrocolpos in infants less than 6 months

目的 探讨6个月以内婴儿子宫阴道积液的临床诊治.方法 回顾分析我院2011年1月至2014年6月收治的6例子宫阴道积液患儿的临床资料及随访情况.结果 6例患儿年龄2d至6个月,平均年龄57 d.6例中2例患儿合并尿生殖窦畸形,1例合并泄殖腔畸形,1例合并Muckusick-Kaufman综合征,1例合并阴道斜隔综合征,1例单纯处女膜闭锁.3例伴发单侧肾积水,1例伴发双侧肾积水及球形结肠,1例双手双足多（并）指、趾、先心病,1例伴发双子宫、双阴道、阴道斜膈综合征并肾囊性变.6例患儿均行腹部、盆腔彩超检查,5例行腹部CT或MRI检查和生殖道造影检查,3例行膀胱镜检查,4例行腹腔镜探查.6例均行子宫阴道积液引流,其中1例行处女膜切开引流术,1例行阴道斜隔切除积液引流术,4例行腹腔镜下积液引流（1例同时行肠造瘘术）.6例子宫阴道积液患儿术后临床症状消失,随访6个月至3年,均未复发.结论 婴儿子宫阴道积液临床罕见,常是泄殖腔畸形或泌尿生殖窦畸形的一种表现,或某些综合征的表现之一,临床常表现为腹胀、排便排尿困难、盆腔肿物、会阴部异常等,极易误诊、漏诊;详细的体格检查以及彩超、CT/MRI、造影、术中内镜检查等均有助于正确诊断.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 review the diagnosis and treatment of hydrometrocolpos in infants less than 6 months.Methods The clinical data of 6 infants aged 2 to 180 d （mean 57 d） with hydrometrocolpos admitted in our hospital between January 2011 and June 2014 were retrospectively analyzed.Results Among 6 cases,there were 2 case of urogenital sinus malformation,1 case combined with cloacal deformities,1 case combined with Muckusick-Kaufman syndrome,1 case combined with oblique vaginal syndrome and 1 case combined with obliteration of hymen.There were 3 cases with unilateral hydronephrosis,1 case with bilateral renal seeper and pouch colon,1 case with hands and foot polydactyly-syndactylia and congenital heart disease and 1 case combined double uterus,vagina and cystic renal masses.Abdominal and pelvic ultrasonographic examination was performed in all 6 cases,abdominal CT or MRI scans of genital tract were performed in 5 cases.Three cases received cystoscopy,4 cases underwent laparoscopic exploration.All 6 cases underwent uterine vaginal fluid drainage;one patient received hymen incision,one case received incision of longitudinal vaginal septum and fluid drainage;4 cases received fluid drainage under laparoscopy,including one case undergoing colostomy.The clinical symptoms of all six cases disappeared during 6 months to 3 years follow-up,no patient had recurrence.Conclusions Hydrometrocolpos is relatively rare in neonates or young infants.The clinical manifestations are mainly abdominal distension,defecate difficulty and abnormal perineun.Detailed physical examination and ultrasound examination,CT or MRI scan,imaging,endoscopy are helpful for the diagnosis.Comprehensive investigation and individualized treatment strategy are important.