Section of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
Curr Opin Obstet Gynecol. 2010 Oct;22(5):381-7. doi: 10.1097/GCO.0b013e32833e4a4a.
Müllerian anomalies include a fascinating constellation of congenital malformations. There is significant diversity in anatomic variants and their respective long-term sexual and reproductive outcomes. We review the current controversies in classification and management of vaginal, uterine, and fallopian tube anomalies.
Comparative trials of preoperative magnetic resonance imaging (MRI) and laparoscopic intraoperative evaluation have demonstrated a moderately well correlated prediction of anatomic description. Three-dimensional ultrasound technology appears to be equivalent to MRI in detecting uterine anomalies; however MRI is a consistently superior method of evaluating the vaginal and cervical anatomy. Despite advances in both modalities, care at an experienced center is most highly associated with an accurate preoperative diagnosis and a decrease in the number of inappropriate surgical procedures.Large case series continue to be the main vehicle by which treatment and surgical management of these unique anomalies are described and recommended. Case reports continue to provide information on novel approaches to improve operative techniques. In the absence of prospective studies, these series provide the only emerging information on the long-term sexual and reproductive function of women with vaginal and uterine anomalies.
Recent developments in three-dimensional ultrasonography and MRI improve our ability to accurately describe and diagnose female reproductive tract anomalies. With the description of new complex malformations, which do not fall into the recognized American Society of Reproductive Medicine, formerly American Fertility Society (AFS) classification system, questions arise regarding embryologic development upon which this classification system is based and support attempts to devise a new, comprehensive classification. Advances in surgical correction have expanded the options for the reconstructive surgeon when approaching a patient with an anomaly of the reproductive tract.
苗勒管畸形包括一系列迷人的先天性畸形。解剖变异及其各自的长期性生殖结局存在显著差异。我们综述了阴道、子宫和输卵管畸形分类和管理方面的当前争议。
术前磁共振成像（MRI）和腹腔镜术中评估的比较试验表明，对解剖描述的预测具有中等程度的相关性。三维超声技术似乎与 MRI 一样能够检测子宫畸形；然而，MRI 是评估阴道和宫颈解剖结构的始终更好的方法。尽管这两种方法都取得了进展，但在有经验的中心进行治疗与护理与准确的术前诊断和减少不适当的手术程序数量高度相关。大型病例系列仍然是描述和推荐这些独特畸形的治疗和手术管理的主要手段。病例报告继续提供有关改进手术技术的新方法的信息。在缺乏前瞻性研究的情况下，这些系列提供了关于阴道和子宫畸形女性长期性生殖功能的唯一新信息。
三维超声和 MRI 的最新发展提高了我们准确描述和诊断女性生殖道畸形的能力。随着不符合公认的美国生殖医学学会（以前称为美国生殖内分泌学会，AFS）分类系统的新型复杂畸形的描述，关于基于该分类系统的胚胎发生提出了疑问，并支持尝试设计新的、全面的分类。外科矫正的进步扩大了重建外科医生在处理生殖道畸形患者时的选择范围。
