青春期非产后子宫内翻一例并文献复习

Non-Puerperal Uterine Inversion in Adolescent: A Case Report and Literature Review

子宫内翻指宫底陷入宫腔内,宫底内膜突向阴道方向,多见于产后第三产程,而非产后子宫内翻少见。报告1例青春期患者发生子宫内翻的诊治过程,患者术前出现阴道大量出血伴阴道流液,给予纠正贫血、抗感染等对症治疗后,完善相关检查时提示子宫内翻或子宫畸形,术中证实为子宫内翻。遂先行子宫复位术,术中考虑子宫恶性肿瘤可能性大,建议送冰冻病理后决定手术范围,家属拒绝,要求直接行子宫切除术,遂行腹腔镜下子宫次全切除术+双侧输卵管切除术,术后病理检查为子宫恶性间叶组织肿瘤。通过复习国内外30余年关于非产后子宫内翻的相关文献,总结诊治经验,提高对该疾病的认识,避免误诊。

Uterine inversion refers to the plunging of the uterine fundus into the uterine cavity and the protrusion of the endometrium towards the vagina,which is mostly seen in the third postpartum stage,while non-puerperal uterine inversion is rare in clinical practice.We report the diagnosis and treatment of an adolescent patient with non-puerperal uterine inversion.The patient had massive vaginal bleeding with vaginal drainage before surgery,and after symptomatic treatment such as correction of anemia and anti-infection,the patient improved the relevant examination to indicate uterine inversion or uterine malformation,which was confirmed to be uterine inversion during operation.We had performed uterine reset surgery first.Considering the possibility of uterine malignancy during the surgery,it was suggested to send it to frozen pathology to decide the scope of operation.The family refused and requested direct hysterectomy.Therefore,we performed laparoscopic subtotal hysterectomy+bilateral salpingectomy.The postoperative pathological examination confirmed malignant mesenchymal tumor of the uterus.By reviewing the relevant literature on non-puerperal uterine inversion in the past 30 years at home and abroad,we summarize the diagnostic and treatment experience,improve clinicians′understanding of the disease,avoid misdiagnosis and guide the clinic.