青少年梗阻性阴道发育畸形的MR影像表现

MRI in the evaluation of obstructive vaginal anomalies in children

目的探讨青少年梗阻性阴道发育畸形(OVA)的MRI影像表现特点,分析MRI在该发育畸形术前诊断中的作用。方法回顾性分析18例OVA患者的MRI影像表现,并将MRI诊断结果与术前超声及术中发现进行对比分析。结果本研究纳入的OVA患者MRI表现包括梗阻的直接和间接征象、伴发的其他生殖道或生殖道外畸形及相关并发症等。MRI对阴道发育畸形的诊断与手术发现完全吻合;超声正确诊断4例(22.22%),阴性诊断6例(33.33%),不确定诊断8例(44.44%)。青少年OVA主要分为阴道下段闭锁、先天性无阴道及阴道斜隔综合征3种,手术方式各异。4例阴道下段闭锁行阴道下段成形术;10例先天性无阴道,由于患者均合并宫体和/或宫颈畸形,行子宫切除术;4例阴道斜隔综合征行阴道斜隔切除术,其中1例并发盆腔脓肿,行盆腔脓肿引流术,1例并发产后胎盘植入行相应治疗。结论 MRI能准确评估青少年OVA的梗阻位置、阴道畸形类型及相关合并症、并发症。

Objective To assess the anatomic variations and MRI appearance of the obstructive vaginal anomalies（OVA） in children.Methods MRI of 18 children with OVA was correlated with ultrasound and surgical findings.Results MRI showed hematocolpos,hematocervix,hematometra,and/or hematosalpinx in addition to vaginal morphology and other associated anomalies.The MRI diagnosis of OVA correlated with the surgical findings in all children.The lower vaginal atresia（4） was treated with vaginoplasty.Vaginal agenesis（10） was associated with uterine and/or cervical anomalies necessitating hysterectomy.The remaining4 children with Herlyn-Werner-Wunderlich syndrome had vaginal septum resection（4） as well as drainage of pelvic abscess（1） and treatment for postpartum placenta increta（1）.Conclusion MRI is the imaging modality of choice to assess OVA and associated anomalies in children.