Chang Aimee S, Siegel Cary L, Moley Kelle H, Ratts Valerie S, Odem Randall R
Washington University School of Medicine, St. Louis, Missouri, USA.
Fertil Steril. 2004 Apr;81(4):1133-6. doi: 10.1016/j.fertnstert.2003.08.051.
To describe a unique congenital müllerian anomaly.
Case report.
A university-based reproductive endocrine center.
PATIENT(S): Five reproductive-age, nulligravida patients who underwent clinical, radiologic, and surgical work-up.
INTERVENTION(S): Retrospective review of prior medical records and studies.
MAIN OUTCOME MEASURE(S): Definition of abnormal pelvic anatomy.
RESULT(S): Five patients from a university-based, reproductive endocrine center were found to have cervical duplication with a longitudinal vaginal septum, uterine septum, and a normal fundus. The patients most often presented initially to their primary obstetrician-gynecologists with symptomatic complaints secondary to their vaginal septums. Diagnoses were obtained with physical examinations, ultrasound imaging, hysterosalpingograms, magnetic resonance imaging, and surgical evaluation.
CONCLUSION(S): These findings call into question the classic hypothesis of unidirectional (caudal to cranial) müllerian development and supports an alternative embryologic hypothesis of Müller et al., which states that fusion and resorption begins at the isthmus and proceeds simultaneously in both the cranial and caudad directions. The high number of cases reported here might be due to the increased accessibility and accuracy of such imaging modalities as magnetic resonance imaging. These patients will be followed longitudinally so that it can be determined whether this anomaly affects fertility and so that the optimal treatment plans can be developed.
描述一种独特的先天性苗勒管异常。
病例报告。
一所大学的生殖内分泌中心。
五名育龄期未孕患者，接受了临床、影像学和手术检查。
回顾既往病历和研究。
明确盆腔解剖结构异常。
一所大学的生殖内分泌中心的五名患者被发现存在宫颈重复畸形，伴有纵向阴道纵隔、子宫纵隔和正常子宫底。患者最初多因阴道纵隔出现症状而就诊于其初级妇产科医生。通过体格检查、超声成像、子宫输卵管造影、磁共振成像和手术评估做出诊断。
这些发现对经典的苗勒管单向（尾端至头端）发育假说提出了质疑，并支持了穆勒等人提出的另一种胚胎学假说，即融合和吸收始于峡部，并在头端和尾端方向同时进行。此处报告的病例数量较多可能是由于磁共振成像等成像方式的可及性和准确性提高。这些患者将接受长期随访，以确定这种异常是否影响生育能力，并制定最佳治疗方案。
