子 宫 畸 形—发 育 异 常Zigong distortion-development of different types.转载2008-07-06

【概述】【 Overview】

先天性子宫发育异常是生殖器官畸形中最常见的一种，临床意义亦比较大。两侧副中肾管在演化过程中，受到某种因素的影响和干扰，可在演化的不同阶段停止发育而形成各种发育异常的子宫。安太医院在实践中创造了许多专利性新技术，在矫正子宫畸形方面，成绩卓著，并且对一些多发畸形实行签约治疗。

Congenital abnormal uterine development is the most common type of genital malformations, and its clinical significance is also relatively large. In the course of evolution, both sides of the secondary renal duct are affected and interfered by certain factors, and they can stop development at different stages of evolution and form various abnormal uterus. An tai hospital in practice has created a number of patented new technologies, in the correction of uterine malformations, outstanding achievements, and some of the multiple malformations to implement contract treatment, invalid refund.

【诊断】【 Diagnosis】

如患者有原发性闭经、痛经、不孕、宫外孕、习惯性流产、每次妊娠胎位均不正或难产等病史，应首先想到子宫畸形的可能，进一步详细询问病史及进行妇科检查。动态数字化子宫输卵管造影、扩宫试验、腔内四维彩超和电子立体宫腹腔镜检查，可以明确诊断。生殖器官畸形常合并泌尿系统畸形或下消化道畸形，必要时可作静脉肾盂造影或钡灌肠检查。当发现泌尿道或下消化道畸形时，亦需详细检查有无生殖器官畸形，包括子宫畸形在内。

If the patient has the history of primary amenorrhea, dysmenorrhea, infertility, ectopic pregnancy, habitual miscarriage, each pregnancy fetal position is not correct or dystocia, should first think about the possibility of uterine malformations, further detailed inquiries about the history and gynecological examination. Dynamic digital hysterectomy, dilation test, four-dimensional color ultrasound and electronic stereoscopic laparoscopy can be clearly diagnosed. Genital malformations are often combined with urinary system malformations or lower gastrointestinal malformations. If necessary, they can be used as venous renal pelvis imaging or barium enema examination. When urethra or lower digestive tract malformations are found, genital malformations, including uterine malformations, must also be examined in detail.

【分类及处理】[Classification and Processing]

(一)先天性无子宫及子宫发育不全：后者指子宫发育停留在胎儿期至青春期前之不同幼稚阶段。

1. Congenital absence of uterus: Both sides of the secondary renal duct extend to the midline and meet. If they do not stop developing before the midline, this is the so-called corner uterus and vagina. If they fail to "coelomatization", there is no uterus formation. Congenital absence of uterus is often combined with congenital absence of vagina, but there can be normal fallopian tubes and ovaries. At the time of anal diagnosis, it is equivalent to the cervix and uterus, and it is not possible to touch the uterus but only to the peritoneal pleats. Performance primary amenorrhea, sexual intercourse disorder.

1.先天性无子宫：两侧副中肾管向中线横行伸延而会合，如未到中线前即停止发育，这就是所谓的墙角子宫和阴道，未能“腔化”，则无子宫形成。先天性无子宫常合并先天性无阴道，但可有正常的输卵管与卵巢。肛诊时在相当于子宫颈、子宫体部位，触不到子宫而只扪到腹膜褶。表现原发闭经，性交障碍。

(1) Congenital infertility and uterine insufficiency: the latter refers to the different childish stages of uterine development from the fetal stage to adolescence.

诊断：依靠电子阴道镜，腔内四维彩超，染色体分析和电化学发光法内分泌检测就可确诊。

Diagnosis: diagnosis can be made by using electronic colposcopy, four-dimensional color ultrasound, chromosome analysis and electrochemical luminescence.

安太专利：腹腔镜下墙角阴道复位术：腹腔镜监护下，打通会阴隧道，将附着于盆底的阴道组织，拉入隧道内并且固定，术后放入棉制支撑物3个月左右。腹部无瘢痕，阴道可达到以假乱真效果。住院14天，术后即可性交。只要保密，男方是无法发现的，费用大约4.5万元。

Antai patent: laparoscopic corner vaginal reduction surgery: laparoscopic monitoring, open up the perineum tunnel, will attach to the pelvic floor of the vaginal tissue, pull into the tunnel and fixed, put into the cotton support for about 3 months after surgery. There is no scar on the abdomen, and the vagina can achieve true effects. In hospital for 14 days, sexual intercourse can be performed after surgery. As long as it is confidential, the man can not find it. The cost is about 45,000 yuan.

2.始基子宫：如两侧副中肾管向中线横行延伸会合后不久即停止发育，则这种子宫很小，多无宫腔或虽有宫腔而无内膜生长，因此亦无月经来潮，有阴道。

2. Foundation uterus: If the two sides of the secondary renal canal stop developing shortly after the extension of the midline, then the uterus is very small, there is no cavity or although there is a cavity and no endometrium grows, so there is no menstruation. Tide, there is a vagina.

诊断：依靠电子阴道镜，腔内四维彩超，染色体分析和电化学发光法内分泌检测就可确诊。

Diagnosis: diagnosis can be made by using electronic colposcopy, four-dimensional color ultrasound, chromosome analysis and electrochemical luminescence.

安太专利：宫腔成型和内膜移植术：宫腔镜和腹腔镜联合从宫颈口打出子宫腔，术后放入带有生物防粘膜的特制支撑物1个月，逐渐加大支撑物，直至宫腔能够容纳5ml液体，然后进行子宫内膜移植。腹部无瘢痕，术后可以正常来月经和妊娠。每次住院14天，一般一年内完成。费用大约10万元。

Antai patent: uterine cavity molding and endometrial transplantation: hysteroscopy and laparoscopy combined with uterine cavity from the cervix, post-operative placement of a special support with biological anti-mucous membranes for 1 month, gradually increase the support until the uterine cavity can accommodate 5ml liquid, and then intrauterine membrane transplantation. There is no scar on the abdomen, and menstruation and pregnancy can be normal after surgery. Each hospitalization is 14 days, which is generally completed within one year. The cost is about 100,000 yuan.

3.幼稚子宫：妊娠晚期或胎儿出生后到青春期以前的任何时期，子宫停止发育，可出现各种不同程度的子宫发育不全。这类子宫的宫颈相对较长，多呈锥形，外口小;子宫体比正常小，常呈极度前屈或后屈。前屈者往往子宫前壁发育不全，后屈者则往往子宫后壁发育不全。幼稚子宫可造成痛经、月经过少、闭经或不孕。

3. Infant uterus: At any time between late pregnancy or after the birth of the fetus and puberty, the uterus stops developing and various degrees of uterine insufficiency can occur. The cervix of this type of uterus is relatively long, mostly conical, and the outer mouth is small; The uterus is smaller than normal and often shows extreme forward or backward bending. The anterior flexor is often incomplete in the anterior wall of the uterus, and the posterior flexor is often incomplete in the posterior wall of the uterus. The infantile uterus can cause dysmenorrhea, menarche, amenorrhea, or infertility.

诊断：依靠动态数字化子宫输卵管造影，腔内四维彩超，染色体分析和电化学发光法内分泌检测就可确诊。

Diagnosis: rely on dynamic digital hysterectomy, intrauterine four-dimensional color ultrasound, chromosome analysis and electrochemical luminescence method endocrine detection can be diagnosed.

安太专利：宫腔扩大术：宫腔镜和腹腔镜联合进行宫腔扩大术，术后带有生物防粘膜的特制支撑物1个月，再次手术，直至宫腔能够容纳5ml液体，腹部无瘢痕，术后可以正常来月经和妊娠。每次住院14天，一般一年内完成。费用大约5万元。

Antai patent: uterine enlargement: hysteroscopy and laparoscopy combined with uterine enlargement, post-operative with biological anti-mucosa special support for 1 month, surgery again, until the uterine cavity can accommodate 5ml liquid, abdominal scar, postoperative period can be normal menstruation and pregnancy. Each hospitalization is 14 days, which is generally completed within one year. The cost is about 50,000 yuan.

(二)两侧副中肾管会合受阻：这种类型最为常见，亦具有重要的临床意义。由于其会合受阻的时期及程度不同，可有如下表现：

(2) The conjunction of the two sides of the secondary renal duct is blocked: this type is the most common and also has important clinical significance. Due to the different periods and degrees of obstruction, the following can be seen:

1.单角子宫：一侧副中肾管发育完好，形成一发育较好的单角子宫伴有一发育正常输卵管。对侧副中肾管发育完全停止，多形成残角子宫。单角子宫的功能可能正常。如妊娠，则妊娠及分娩经过可正常，但亦可能引起流产或难产。

1. Single corner uterus: One side of the secondary renal duct is well developed, forming a well-developed single corner uterus accompanied by a normal fallopian tube. The development of the secondary renal duct in the opposite side completely stopped, and a residual horn uterus was formed. The function of the single corner uterus may be normal. In the case of pregnancy, pregnancy and childbirth can be normal, but it may also cause miscarriage or dystocia.

诊断：动态数字化子宫输卵管造影，腔内四维彩超，染色体分析和电化学发光法内分泌检测就可确诊。

Diagnosis: dynamic digital hysterectomy, four-dimensional color ultrasound in the cavity, chromosome analysis and electrochemical luminescence method endocrine detection can be diagnosed.

安太专利：子宫融合术:如果有残角子宫存，宫腔镜和腹腔镜联合，即将残角子宫破开，不在单角子宫上，术后放带有生物防粘膜的特制支撑物1个月，造影发现宫腔正常即成。腹部无瘢痕，术后可以正常来月经和妊娠。每次住院14天。费用大约5万元。

Antai patent: uterine fusion surgery: If there is a residual cervix uterus, hysteroscopy and laparoscopy combined, the cervix uterus will be broken, not on the single cervix uterus, and special support with biological anti-mucous membrane will be placed for 1 month after surgery. The imaging found that the uterine cavity is normal. There is no scar on the abdomen, and menstruation and pregnancy can be normal after surgery. 14 days each time. The cost is about 50,000 yuan.

宫腔扩大术：如果无残角子宫存在，或不足以破开融合，就只能做宫腔扩大术。每次住院14天，一般一年内完成。费用大约5万元。

Enlargement: If there is no ankylosing uterus, or if it is not enough to break the fusion, it can only be performed. Each hospitalization is 14 days, which is generally completed within one year. The cost is about 50,000 yuan.

2.残角子宫：一侧副中肾管发育正常，另一侧在发育过程中发生停滞等异常情况，而形成不同程度的残角子宫，多数仅通过纤维条束与对侧的单角子宫联接。由于内膜多半无功能，常无症状出现。如有功能，则在青春期后出现周期性下腹疼痛等经血潴留症状。有些与对侧子宫有一狭窄腔道相通，这种情况下可发生残角子宫妊娠，其症状一如输卵管间质部妊娠，常在妊娠3～4个月破裂，发生严重内出血。

2. Disabled horn uterus: One side of the secondary renal duct develops normally, and the other side staggers during development, resulting in different degrees of residual horn uterus, most of which are only connected to the opposite side of the single corner uterus through fiber strips. Due to the fact that the inner membrane is mostly inactive, there are often no symptoms. If there is any function, there are symptoms of menstrual blood retention such as periodic lower abdominal pain after puberty. Some have a narrow cavity with the opposite side of the uterus. In this case, residual cervix uterus pregnancy can occur. The symptoms are like tubal interstitial pregnancy. They often rupture in pregnancy for 3 to 4 months and severe internal bleeding occurs.

诊断治疗同单角子宫。尽量不要切除残角子宫，更不要开腹手术。

Diagnosis and treatment of uniangular uterus. Try not to remove the residual horn uterus, and do not open abdominal surgery.

3.盲角子宫：两侧副中肾管发育均较好，形成盲角子宫。青春期后月经来潮，有周期性下腹痛，且日渐严重，长期不被发现。经血潴留，可造成子宫积血、输卵管积血，甚至经血可经输卵管伞端开口流入腹腔。可在下腹部触及日益增大的肿块。有的盲角子宫本身并发阴道闭锁或阴道发育不全。表现为原发闭经，周期下腹痛，逐渐加重。

3. Blind corner uterus: Both sides of the secondary renal duct development is good, forming blind corner uterus. Menstruation after puberty, periodic abdominal pain, and increasingly serious, long-term undetected. Blood retention can cause uterine accumulation of blood, tubal accumulation of blood, and even menstrual blood can flow into the abdominal cavity through the end of the fallopian tube. Can touch a growing mass in the lower abdomen. Some blind horns of the uterus itself with vaginal atresia or vaginal hypoplasia. The expression is primary amenorrhea, periodic abdominal pain, gradually aggravated.

安太专利：子宫下拉复位阴道牵引术+宫颈成型术：腹腔镜下，打通阴道隐窝与子宫颈间的隧道，将子宫颈强行拉下缝合在前庭创缘上，宫颈造口引流宫内积血，放置造影管，术后随着子宫上提复位，阴道逐渐就会被拉出来，这样不用放模具，也不会粘连，阴道经过5-6年就可到到正常长度，表面上皮化完全。住院14天，费用5万。注意此术越早越好，晚了子宫就会患上严重的腺肌症和严重的盆腔粘连，即使手术也难保留生育能力。

Antai patent: subuterine pull reduction vaginal traction + cervix molding: laparoscopic, open the tunnel between the vagina and the cervix, forcibly pull the cervix down and sew it on the vestibular edge, cervix mouth drainage intrauterine accumulation of blood, placement of contrast tubes, After surgery, with the recovery of the uterus, the vagina will gradually be pulled out, so that there is no need to put the mold, nor will it stick, the vagina can reach the normal length after 5-6 years, and the surface is completely dermal. 14 days in hospital at a cost of 50,000. Note that the earlier this procedure is performed, the better, the later the uterus will suffer from severe adenomyosis and severe pelvic adhesion, even if the operation is difficult to retain fertility.

4.双子宫及重复子宫(对称型)：这两种畸形极相似。前者系由于副中肾管发育后完全没有会合，各具一套输卵管、子宫、宫颈及阴道，这种情况比较少见。后者亦称双角双颈型双子宫，系副中肾管完全会合，但中隔未吸收。两者区别仅在于，前者两子宫间之间隙较后者宽大。双子宫可有或可无阴道纵隔。

4. Double uterus and repeated uterus(symmetric type): The two deformities are very similar. The former is due to the fact that there is no conjunction after the development of the secondary renal duct. Each has a set of fallopian tubes, uterus, cervix, and vagina. This situation is relatively rare. The latter, also known as the double-horned double-necked double uterus, is a secondary renal duct that fully merges, but the septum is not absorbed. The difference between the two is only that the gap between the two uterus is wider than the latter. The double uterus may or may not have vaginal mediastinal.

诊断：依靠电子阴道镜，动态数字化子宫输卵管造影，腔内四维彩超，染色体分析和电化学发光法内分泌检测就可确诊。

Diagnosis: rely on electronic colposcopy, dynamic digital hysterectomy, four-dimensional color ultrasound in the cavity, chromosome analysis and electrochemical luminescence method endocrine detection can be diagnosed.

安太专利：宫融合术：如果子宫小，就把两个分开的子宫，从一侧作一总行切口，达到粘膜，将左右两侧切口面对缝一起。术后宫腔放带有生物防粘膜的特制支撑物1个月，用造影检测效果。腹部无瘢痕，术后可以正常来月经和妊娠。每次住院7天。费用大约5万元。

An tai patent: palace fusion surgery: if the uterus is small, two separate uterus, make a head line incision from one side, reach the mucous membrane, the left and right sides of the incision face the seam together. After the operation, a special support with biological anti-mucous membrane was placed in the uterine cavity for 1 month. There is no scar on the abdomen, and menstruation and pregnancy can be normal after surgery. Seven days at a time. The cost is about 50,000 yuan.

5.双角子宫：两侧副中肾管尾端已大部会合，末端中隔已吸收，故有一个宫颈及一个阴道;但相当于子宫底部会合不全，导致子宫两侧各有一角突出，称双角子宫。如此类畸形程度更轻，表现宫底向内凹陷，根据不同程度，形成所谓马鞍形子宫、心形子宫、弓形子宫，如妊娠可引起流产或胎位异常。

5. Two-horned uterus: Most of the two sides of the secondary renal duct end have been merged, the end of the septum has been absorbed, so there is a cervix and a vagina; However, it is equivalent to incomplete union at the bottom of the uterus, resulting in a prominent corner on each side of the uterus, called the double-horned uterus. If the degree of such deformities is lighter, it shows a depression in the bottom of the palace. According to different degrees, the so-called saddle-shaped uterus, heart-shaped uterus, and bow-shaped uterus are formed. For example, pregnancy can cause miscarriage or abnormal fetal position.

诊断：依靠动态数字化子宫输卵管造影，腔内四维彩超，染色体分析就可确诊。

Diagnosis: rely on dynamic digital hysterectomy, the cavity four-dimensional color super, chromosome analysis can be diagnosed.

安太专利：较深大畸形，行腹腔镜下子宫融合术，把两个分开的子宫角，从一侧宫角至对侧宫角作一横切口，对半切开肌壁，将左右两侧切口面对缝一起。术后放入支撑物即成。

Antai patent: deeper large deformity, laparoscopic uterine Fusion, two separate uterine horns, from one side of the uterine angle to the opposite side of the uterine angle to make a horizontal incision, cut the muscle wall half, the left and right sides of the incision face the seam together. After surgery, put support into it.

较浅的畸形，按纵隔处理即可。

Shallow deformities can be treated by mediastinal treatment.

6.纵隔子宫：两侧副中肾管会合后，纵隔未被吸收，将宫体分为两半，但子宫外形横宽纵短。有时纵隔不完全，表现各异，有的只是宫腔下宫角深邃而已，导致两个分开的子宫—宫颈间有小通道，故称相通子宫。常伴有阴道纵隔，通道常位于子宫峡部。有时一侧阴道部分闭锁，潴留的经血可通过峡部通道向对侧通畅阴道缓慢流出，因而病人可因经常有陈旧性血性分泌物自阴道流出而就诊。主要表现为不孕，习惯性流产，反复发生宫外孕，胎位不正或前置胎盘等。

6. Intermedial uterus: After the two sides of the secondary renal tube meet, the mediastinal is not absorbed and the palace is divided into two halves, but the uterine shape is wide and short. Sometimes the mediastinal septum is not complete and the performance is different. Some are only deep in the lower palace corner of the palace, resulting in two separate uterus-there is a small channel between the cervix, so it is called the same uterus. Often accompanied by the vaginal mediastinal, the channel is often located in the uterus. Sometimes one side of the vagina is partially locked, and the remaining menstrual blood can slowly flow out of the vagina through the channel of the isthmus to the opposite side, so the patient can see the patient because of the frequent outflow of old bloody secretions from the vagina. The main manifestations are infertility, habitual miscarriage, recurrent ectopic pregnancy, fetal position or placenta.

安太专利：宫腔镜下纵隔冷刀分离术：在腹腔镜监护下，通过宫腔镜用冷刀子分开后放入带有生物防粘膜的特制支撑物，根据情况可能要多次手术。是目前治疗子宫纵隔的首选方法。避免电切，因为纵隔不是多长了组织，其实质是中隔吸收不全，如果切除就会形成宫腔狭小的““斗鸡眼”致使经量少、闭经或不孕;再者就是预防术后粘连，实践证明，用雌激素做人工周只能使粘连加重，有害无益。只有放带生物防粘膜的支撑物才是唯一选择。可签约住院7天，费用3万。

An tai patent: hysteroscopic submediastinal cold knife separation: under laparoscopic surveillance, through the hysteroscopy with a cold knife separated into a special support with biological anti-mucous membrane, depending on the circumstances may require multiple operations. It is currently the first choice for the treatment of uterine mediastinal. Avoid electrocutting, because the mediastinal septum is not much longer than the tissue, its essence is that the septum absorption is incomplete, and if removed, it will form a narrow "fighting chicken eye" in the uterine cavity, resulting in less meridians, amenorrhea, or infertility; The second is to prevent adhesion after surgery, practice has proved that using estrogen to do artificial weeks can only make adhesion aggravated, harmful and useless. The only choice is to release support with biological anti-mucous membranes. Antai signed up for treatment and promised to stick together again. Hospital for 7 days at a cost of 30,000.

(三)副中肾管会合后管道未贯通：副中肾管会合后形成子宫的部分，其一部或全部未贯通而形成实质性子宫，亦无内膜，这种子宫除较小外，外观似正常子宫，但无月经。

(3) After the secondary renal duct Union, the pipeline is not through: After the secondary renal duct merges, the uterus is formed. One or all of the secondary renal ducts are not connected to form a substantial uterus, and there is no inner membrane. In addition to the smaller uterus, the appearance resembles that of a normal uterus., but no menstruation.

诊断：依靠腔内四维彩超和阴道镜就可确诊。

Diagnosis: The diagnosis can be made by relying on the four-dimensional color ultrasound and colposcopy in the cavity.

安太治疗：宫腔镜腹腔镜联合下宫腔成型后子宫内膜移植，需要2-4次手术，每次住院14天，总费用约10万。

Antai treatment: hysteroscopic laparoscopy combined with endometrial transplantation after lower uterine cavity formation requires 2-4 operations, each hospitalization for 14 days, with a total cost of approximately 100,000.

(四)先天性子宫异位：子宫或双子宫之一可象卵巢，输卵管一样，移位于腹股沟疝内。子宫亦可停留在胚胎时期的较高位置而不降入盆腔。

(4) Congenital hysteresis: One of the uterus or double uterus can move in the inguinal hernia like an ovary, fallopian tube. The uterus can also stay at a higher position in the embryonic period without falling into the pelvic cavity.

诊断：依靠腔内四维彩超和腹腔镜确诊。Diagnosis: The diagnosis depends on the four-dimensional color ultrasound and laparoscopy.

安太专利：腹腔镜下子宫复位固定，一般需要住院5天，费用1-2万。

Antai patent: Laparoscopic uterus reset fixed, generally needs to be hospitalized for 5 days, the cost is 1-2 thousand.

(五)宫口松弛或机能不全，是宫颈口松弛，怀孕到中期，在胎儿重力作用下突然开发，而发生晚期反复自然流产或早产。

(5) Lax or incomplete function of the uterine mouth is the relaxation of the cervical mouth, pregnancy to the middle stage, sudden development under the action of fetal gravity, and late repeated spontaneous miscarriage or premature birth.

诊断：依靠动态数字化子宫输卵管造影，腔内四维彩超，扩宫试验就可确诊。

Diagnosis: rely on dynamic digital hysterectomy, the cavity four-dimensional color super, the expansion of the test can be diagnosed.

安太治疗：宫颈埋箍术。 非孕状态下，宫颈内口浆膜下埋上一个 生物“钢箍”，狙击流产，住院5天，费用3万。

Antai treatment: cervical banding. In the non-pregnant state, a biological "steel hoop" is buried under the serous membrane of the cervix, sniper miscarriage, contract treatment, and post-operative miscarriage. He was hospitalized for 5 days at a cost of 30,000.

【注意事项】[Notes]

1. 子宫畸形是罕少见病，年轻和基层医生(省级一下)多经验不足。

1. Uterine deformities are rare diseases, and young and grassroots doctors(at the provincial level) are more experienced.

2. 宫腹腔镜技术最好的矫形的最好工具，开腹手术已经淘汰，因为开腹视野差，容易形成次生性伤害，如瘢痕和副损伤。

2. The best tool for the best orthopaedic surgery of the laparoscopic technique, open abdominal surgery has been eliminated because of the poor open abdominal field of vision, easy to form secondary injuries, such as scars and side injuries.

3. 一般手术机会只有一次，后悔不及。如果首次矫形失败往往很难挽救，如先天无阴道患者被切除墙角阴道组织，就无法再实施墙角阴道复位术了;有些还造成严重的次生性伤害，如肠穿孔和严重的瘢痕，给再次手术带来极大困难。

3. The usual surgery is only once, and I regret it. If the first orthosis failure is often difficult to save, such as congenital non-vaginal patients were removed from the vaginal tissue in the corner, it is no longer possible to perform vaginal reduction in the corner; Some also cause serious secondary injuries, such as intestinal perforations and severe scarring, which poses great difficulties for reoperation.

4. 有效多贵都便宜，无效多便宜都贵，千万不能图便宜而手术，断送一生幸福。

4. Effective and expensive are cheap, invalid and cheap are expensive, must not be cheap and surgery, life happiness.