147例小儿妇科疾病的临床分析

A clinical analysis of gynecological diseases in 147 children

目的分析因妇科疾病住院治疗的儿童病例的临床特点。方法回顾性分析妇科住院治疗的147例患儿的临床资料。结果147例小儿妇科疾病住院病例中以卵巢肿瘤最多(36.1%,53/147)、其次为生殖道发育异常或畸形(19.7%,29/147)、青春期功能失调性子宫出血(12.2%,18/147)、外伤性外阴阴道损伤(10.2%,15/147)、阴道异物(5.4%,8/147)。卵巢肿瘤患儿主要表现为腹痛和腹盆腔包块,生殖道畸形主要表现为进行性加重的腹痛,而青春期功血则以月经不调或不规则阴道流血或阴道大量流血为主要表现。对卵巢肿瘤、生殖道畸形或发育异常均进行了相应的手术治疗,青春期功血的治疗主要根据临床表现和子宫内膜厚度采用不同方案的性激素止血。8例阴道异物均采用宫腔镜阴道检查,在不损伤处女膜的情况下成功取出阴道异物。1例输卵管妊娠进行了腹腔镜输卵管妊娠病灶清除术,1例葡萄胎患儿清宫术后确诊为侵袭性葡萄胎行化疗。结论小儿妇科疾病发病率居前3位的依次是卵巢肿瘤、生殖道发育异常或畸形、青春期功能失调性子宫出血;常见症状为腹痛、腹盆腔包块、阴道不规则流血;诊治过程要充分考虑到儿童的生理和生殖特点,充分发挥腹腔镜、宫腔镜、B超等诊疗器械的优势。

ObjectiveTo study the clinical features of gynecological diseases in hospitalized children.Methods A retrospective analysis was performed for the clinical data of 147 children with gynecological diseases who were hospitalized and treated in the department of gynecology.ResultsAmong the 147 children, ovarian tumors were most common （53 cases, 36.1%）, followed by reproductive tract dysplasia or malformation （29 cases, 19.7%）, adolescent dysfunctional uterine bleeding （18 cases, 12.2%）, traumatic injury in the vulva/vagina （15 cases, 10.2%）, and vaginal foreign body （8 cases, 5.4%）. The main symptoms of ovarian tumors includedabdominal pain and abdominal or pelvic mass. Progressive abdominal pain was a main symptom in children with reproductive tract dysplasia or malformation. The children with adolescent dysfunctional uterine bleeding manifested as irregular or a lot of vaginal bleeding. The children with ovarian tumors and reproductive tract malformation or dysplasia were given surgical treatment, and those with adolescent dysfunctional uterine bleeding were given different sex hormones based on their clinical manifestations and endometrial thickness. Eight children with vaginal foreign body underwent hysteroscopy for vaginal examination, and the foreign body was successfully removed without the damage of the hymen. One patient with tubal pregnancy underwent laparoscopic tubal pregnancy debridement. One patient with hydatid mole was diagnosed with invasive hydatid mole after complete curettage of uterine cavity and then received chemotherapy.ConclusionsThe top three gynecological diseases in children are ovarian tumors, reproductive tract dysplasia or malformation, and adolescent dysfunctional uterine bleeding. Common chief complaints of the patients include abdominal pain, abdominal masses, and irregular vaginal bleeding. Diagnosis and treatment should fully consider the physiological and reproductive features of children and give full play to the advantages of laparoscopy, hysteroscopy, and ultrasound.