阴道发育异常144例临床分析

摘要

Objective Analyze clinical feature of vaginal heteroplasia and adopting approaches and indications of their surgical remedy.Methods Clinical data were collected from patients with vaginal heteroplasia administered into Beijing Obstetrics and Gynecology Hospital between November 2002 and May 2009.Analyze its component ratio,clinical feature and follow up 87 patients after the surgery.Results There are 6 types of vaginal heteroplasia,of which congenital absence of vagina is the most common,50 cases,accounting for 34.7％.Clinical presentations include:primary amenorrhea(33.3％),abdominal pain(19.5％),irregular vaginal bleeding(8.3％) and dyspareunia (6.9％).There are 113 patients (78.5％) combined with utero heteroplasia,kidney and other system's malformation.Following up the 87 patients after surgical remedy of vaginal heteroplasia,in which there are 40 patients with congenital absence of vagina.Compare two groups with different surgical approaches,which were using self-skin flaps and peritoneal flaps to form vagina.The length of vagina are (7.53 ± 1.02) cmand (7.21 ± 1.35) cm respectively.The number of cases of the patients whose vaginal width is more than 3cm are 19 and 15 respectively.The ratios of satisfactory sexual life are 78.6％ and 69.2％.There is no difference between the two groups.Except for one patient with vaginal atresia and one patient with oblique septum of vagina were operated again,85 patients did not need a second time surgery.And there were 13 pregnancies among them.Conclusion There is a high incidence of utero heteroplasia,kidney and other system's malformation combined with vaginal heteroplasia.We should choose the ripe time and appropriate approach to rectify the heteroplasia,according to the patients＇ demands situation and experiences the surgeons have.%目的 探讨阴道发育异常的临床特点及手术矫治的时机及方式的选择.方法 收集2002年11月至2009年5月首都医科大学附属北京妇产医院144例阴道发育异常患者的临床资料,分析其构成比、临床特征；随访其中87例术后情况.结果 144例阴道发育异常包括6种类型,先天性无阴道最多见,为50例,占34.7％.临床表现主要为原发闭经(33.3％)、腹痛(19.5％)、阴道不规则出血(8.3％)及性交困难(6.9％).有113例(78.5％)患者同时合并子宫发育异常、肾脏畸形及其他系统畸形.随访87例阴道发育异常矫治术后情况,其中先天性无阴道术后患者40例,自体皮片法及腹膜法再造阴道长分别为(7.53 ±1.02)cm及(7.21±1.35)cm；阴道宽≥3 cm者分别为19例和15例,性生活满意率分别为78.6％及69.2％,两组比较差异无统计学意义；除阴道闭锁及阴道斜隔综合征患者各有1例术后再次手术外,85例患者无再次手术,妊娠13次.结论 阴道发育异常合并子宫发育异常、肾脏畸形及其他系统畸形的发生率较高.应根据患者的要求,具体疾病情况,结合术者的经验,个体化选择手术方式,并在合适的时机进行手术矫治.