腹腔镜治疗宫颈发育不全：罕见病例报告

IF 3.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-10-22 DOI:10.1016/j.jmig.2025.09.109

J Dubuisson , V Crofts

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引用次数: 0

摘要

研究目的介绍腹腔镜下成功治疗一例罕见的先天性梗阻性苗勒管异常，确定为部分阴道发育不全和宫颈发育不全。设计描述进行直接腹腔镜子宫阴道吻合术以恢复生殖道连续性的手术步骤，随访2年。在全麻下进行临床检查和腹腔镜检查。患者或参与者：一名13岁女孩被转介治疗周期性骨盆疼痛。尽管还没到初潮，她却表现出第二性征。磁共振成像显示子宫，有大血块，尺寸为6.4 × 5.2cm。然而，影像学检查不能确切地证实阴道近端和宫颈的存在。由于激素和镇痛治疗无法缓解剧烈疼痛，患者最终接受了微创手术。干预措施外生殖器正常。一个2厘米的阴道死囊被确定为阴道上三分之二的缺失。我们可以轻轻地手动扩张它，以达到肿胀的集合。腹腔镜检查显示子宫内膜异位症腹膜病变，整个腹腔广泛沉积黄素。子宫肿大并峡部扩张（血肿）。测量和主要结果患者术后立即得到缓解。两个月后，择期阴道镜检查发现一个3cm长的阴道，在吻合口处有一个可渗透的开口。宫腔镜显示宫颈内管仍然扩张，有粘液。通过宫颈内膜可见部分隔子宫。5个月复查宫腔镜无狭窄，随访2年后月经周期正常。结论保守治疗宫颈发育不全是有效的，腹腔镜子宫阴道直接吻合可获得长期成功。

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Laparoscopic Management of Cervical Agenesis: A Rare Case Report

Study Objective

To present the successful laparoscopic management of a rare case of congenital obstructive Mullerian anomaly, identified as partial vaginal aplasia and cervical agenesis.

Design

Description of the surgical steps involved in performing a direct laparoscopic utero-vaginal anastomosis to restore the continuity of the genital tract, with a 2-year follow-up.

Setting

Clinical examination and laparoscopy were performed under general anesthesia.

Patients or Participants

A 13-year-old girl was referred for management of cyclic pelvic pain. Despite not having reached menarche, she exhibited secondary sexual characteristics.

Magnetic resonance imaging revealed the presence of a uterus with a large hematometra measuring 6.4 × 5.2cm. However, imaging could not conclusively confirm the presence of a proximal vagina and a cervix.

Due to the failure of hormonal and analgesic therapy to alleviate severe pain, the patient final underwent a mini-invasive surgical procedure.

Interventions

The external genitalia appeared normal. A 2cm vaginal cul-de-sac was identified with the absence of the upper two-thirds of the vagina. We were able to gently manually dilated it in order to reach the bulging collection.

Laparoscopy revealed endometriotic peritoneal lesions with widespread deposits of siderin throughout the abdominal cavity. An enlarged uterus with a hugely dilated isthmic portion (hematometra) was confirmed.

Measurements and Primary Results

The patient experienced immediate relief post-operatively. Two months later, an elective vaginoscopy revealed a 3cm long vagina with a permeable opening at the level of the anastomosis. Hysteroscopy indicated an endocervical canal, still dilated, with the presence of mucus. Passage through the endocervix allowed visualisation of a uterus presenting a partial septum. Repeated hysteroscopy at 5 months showed no stenosis and patient reported normal menstrual cycles after 2-year follow-up.

Conclusion

Cervical agenesis can be effectively managed conservatively, with long-term success achievable using a direct laparoscopic utero-vaginal anastomosis.

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来源期刊

Journal of minimally invasive gynecology 医学-妇产科学

CiteScore

5.00

自引率

7.30%

发文量

272

审稿时长

37 days

期刊介绍： The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.