Spitzer Rachel F, Caccia Nicolette, Kives Sari, Allen Lisa M
Department of Pediatrics, Division of Endocrinology, Section of Gynecology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Fertil Steril. 2008 Nov;90(5):2016.e17-20. doi: 10.1016/j.fertnstert.2008.01.045. Epub 2008 Mar 6.
To report a case of complete obstructing uterine septum repaired in a minimally invasive manner by operative hysteroscopy under laparoscopic guidance. A complete obstructing uterine septum is a rare congenital abnormality. To date, management of such abnormalities has traditionally been by metroplasty.
Case report and review of the literature.
Pediatric and adolescent gynecology service at a tertiary care hospital.
PATIENT(S): A 16-year-old nulligravid presented with severe, persistent dysmenorrhea and a history of significant endometriosis. Imaging initially suggested a functional, noncommunicating uterine horn, but magnetic resonance imaging review confirmed a complete obstructing septate uterus.
INTERVENTION(S): The patient was managed by menstrual suppression until the time of surgery. The septum was resected by operative hysteroscopy under laparoscopic guidance. The procedure was without complication.
MAIN OUTCOME MEASURE(S): The patient recovered well and resumed spontaneous menses without dysmenorrhea.
RESULT(S): A second-look hysteroscopy 4 months later confirmed patency of the previously obstructed side and allowed the opportunity to complete the resection of the septum.
CONCLUSION(S): Operative hysteroscopy is an effective and safe minimally invasive technique to manage the rare complete obstructing uterine septum. Hysteroscopy is less invasive than traditional metroplasty and is associated with easier recovery. Additionally, there is no uterine scar and thus less implication for future fertility. Further series of such procedures are required to offer greater experience and proof of safety of this approach.
报告1例在腹腔镜引导下经宫腔镜手术以微创方式修复完全性梗阻性子宫纵隔的病例。完全性梗阻性子宫纵隔是一种罕见的先天性异常。迄今为止，此类异常的传统治疗方法是子宫成形术。
病例报告及文献复习。
一家三级医疗中心的儿科及青少年妇科门诊。
一名16岁未孕女性，有严重、持续性痛经及显著的子宫内膜异位症病史。最初的影像学检查提示功能性、非交通性子宫角，但磁共振成像复查确诊为完全性梗阻性纵隔子宫。
患者在手术前采用药物抑制月经。在腹腔镜引导下经宫腔镜切除纵隔。手术无并发症。
患者恢复良好，恢复自然月经且无痛经。
4个月后复查宫腔镜证实先前梗阻侧通畅，并有机会完成纵隔切除。
宫腔镜手术是治疗罕见的完全性梗阻性子宫纵隔的一种有效且安全的微创技术。宫腔镜手术比传统子宫成形术创伤小，恢复更容易。此外，不会形成子宫瘢痕，因此对未来生育影响较小。需要进一步开展此类手术系列研究，以积累更多经验并证明该方法的安全性。
