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无阴道有子宫的单纯阴道闭锁 子宫切除不应该 A simple vaginal atresia without a vagina should not be removed by hysterectomy in 2008-9-21

  • 来源:cfl
  • 作者:cfl
  • 更新日期:2019-07-19 21:29
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黄女士,25岁。14岁开始周期性下腹痛,逐渐加重,处于噩梦之中。 Mrs. Wong, 25 years old. At the age of 14, he began periodic abdominal pain, gradually aggravated, and was in a nightmare. Departure. 2000年10月(18岁),仍然无月经来潮,腹痛已经无

黄女士,25岁。14岁开始周期性下腹痛,逐渐加重,处于噩梦之中。 ­Mrs. Wong, 25 years old. At the age of 14, he began periodic abdominal pain, gradually aggravated, and was in a nightmare. Departure.

2000年10月(18岁),仍然无月经来潮,腹痛已经无法忍受,周期性变成持续性,止痛药失效,湖南湘雅医院诊断:先天无阴道,宫腔闭锁,右侧囊肿,左侧输卵管阻塞,宫腔积血,并行开腹行人工阴道成型手术和巧克力囊肿剥除术,术后每月行经1次,月经量多,但仍有痛经,半年后阴道逐渐闭锁,再次出现闭经,痛经越来越重。

­In October 2000(18 years old), there was still no menstrual cramps, abdominal pain was unbearable, periodicity became persistent, painkillers failed, Hunan Xiangya Hospital diagnosed: congenital absence of vagina, atresia, right cyst, left fallopian tube obstruction, uterine blood accumulation, Parallel open abdominal surgery for artificial vaginal formation and chocolate cyst stripping, after the surgery once a month, the amount of menstruation, but there are still cramps, half a year later the vagina gradually locked, once again appear amenorrhoea, dysmenorrhea more and more heavy. Departure.

2004年江西萍乡妇幼保健院为其做了子宫切除术,术后痛经消逝,阴道闭锁仍在,另一场噩梦开始。 ­

In 2004, the Pingxiang Women's and Children's Health Hospital in Jiangxi Province performed a hysterectomy. After surgery, dysmenorrhea disappeared, vaginal atresia was still present, and another nightmare began. Departure.

2008年结婚,性生活障碍,夫妇苦不堪言,痛不欲生。 ­Married in 2008, sex disorders, couples suffering, pain. Departure.

患者有末日之感,大夫有冤枉之词。世间公道谁人予以评说。 ­The patient has a sense of doom, and the doctor has a word. Justice in the world is judged by everyone. Departure.

阴道闭锁的安太疗法: ­Antai therapy for vaginal atresia:

宫腹腔镜联合下人工子宫脱垂阴道成型术 ­Uteral laparoscopy combined with artificial uterine prolapse vaginal molding

腹腔镜监护下沿处女膜缘打入人工隧道,直达宫颈处,探针于宫颈中心部位加压刺入(有落空感)随即有暗红色血流出,彻底引流积血,探宫腔长度,4-8号扩宫器依次扩张宫颈管,经宫颈管向宫腔内置入双腔造影管,置入水囊7ml,宫腔内注入美兰液,腹腔镜下见输卵管伞端美兰液流出。将宫颈下拉与处女膜缘的阴道粘膜环形缝合一周,形成子宫脱垂状。 ­

Under laparoscopic monitoring, enter the artificial tunnel along the edge of the hymen, directly to the cervix, and the probe presses into the central part of the cervix(there is a feeling of frustration) and then there is a dark red blood flow, completely draining blood, exploring the length of the cavity, 4-8. The palace expansion device expands the cervix in turn, After the cervical tube is inserted into the uterine cavity, a double-cavity radiography tube is inserted into the water sac 7ml, and the Meilan liquid is injected into the uterine cavity. Under the laparoscope, the Meilan liquid flows out of the fallopian tube. The cervix is pulled down and the vaginal mucosa of the hymen margin is closed in a circular suture for one week to form a uterine prolapse. Departure.

术后月经畅通,痛经消逝,阴道随着子宫的复位逐渐上提,阴道粘膜逐渐被拉长,阴道逐渐加深。子宫完全复位之时,就是阴道成型之日。这一过程自然完成要经过3-5年,如果有性生活就会大大加速。 ­

­

After the operation, menstrual flow, dysmenorrhea disappeared, the vagina gradually increased with the reduction of the uterus, the vaginal mucosa was gradually elongated, the vagina gradually deepened. When the uterus is completely reset, it is the day when the vagina is formed. This process takes three to five years to complete naturally, and if there is sex, it will greatly accelerate. Departure.

评论:单纯阴道闭锁畸形及其罕见,阴道闭锁是指有子宫而无阴道罕见的畸形,由于经血不能排除而通过输卵管反流入盆腔,每月周而复始,如不及时引流往往会形成严重的盆腔子宫内膜异位症或子宫腺肌症。要与先天无子宫无阴道的“双无”和处女膜闭锁相鉴别,治疗原则是阴道成型和引流经血。但是绝不允许切除子宫(阴道有病,子宫尚好),子宫切除就把阴道闭锁,变成了“双无”患者,使畸形进一步加深,相当于“患者左眼瞎,去治疗医生把右眼也给 捅 瞎 了。 ­

Departure.

Comment: simple vaginal atresia and its rare, vaginal atresia refers to the uterus and no vaginal rare deformity, because menstrual blood can not be ruled out through the fallopian tube back into the pelvic cavity, repeated every month, if not timely drainage often will form serious pelvic endometriosis or adenomyosis. To identify the "double absence" and hymen atresia with no uterus and no vagina, the treatment principle is vaginal formation and drainage of menstrual blood. However, the uterus must not be removed(the vagina is sick and the uterus is good). The hysterectomy turns the vagina into a "double zero" patient, further deepening the deformity, which is equivalent to "the patient's left eye is blind. Go to therapy. The doctor blinded his right eye, too. Departure.

医生见到这样的患者,如果不具备阴道成型的技术和能力,可以先行经血引流(B超引导下把铁管打入宫腔,再放上引流管,长期保留,和膀胱造漏和之长造漏一样),起到阻止痛经和导流月经作用,这符合“急则治其标”的原则。如果连造漏的技术也不具备,就应该让患者转院,这正是:留得青山在,自有后来人”。切除子宫是万万不可取的。 ­

When the doctor sees such a patient, if he does not have the technology and ability to form a vagina, he can first drain blood(under the guidance of B ultrasound, the iron tube is inserted into the uterine cavity, and the drainage tube is put again, which is retained for a long time, and the bladder leaks and the length of the leak. The same), Play a role in preventing menstrual cramps and menstruating menstruation, which is in line with the principle of "urgent treatment of its target". If even the leak technology is not available, the patient should be transferred to hospital. This is exactly: Stay in Castle Peak and have their own future. " A hysterectomy is absolutely impossible. Departure.

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