Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Curr Opin Obstet Gynecol. 2011 Aug;23(4):251-7. doi: 10.1097/GCO.0b013e3283478839.
Cervical agenesis is an extremely rare congenital anomaly of the female reproductive tract. There are many anatomical forms that constitute this type of cervical abnormality and the literature is replete with attempts to surgically restore a patent outflow tract and preserve fertility in these patients. There are no carefully designed cohort or randomized trials to support a best surgical practice; past reports are descriptive only.
Of late, there has been renewed interest in the surgical treatment of cervical dysgenesis with techniques both through laparotomy with hysterotomy and more recently, minimally invasive approaches, which have attempted to restore a patent outflow tract without perineal dissection or graft harvesting in an attempt to avoid uterovaginal scarring if further surgery is necessary. To maintain consistency in the field of surgical reconstruction of the female reproductive tract, there has been a call for streamlined classifications of the anatomical abnormalities observed to better compare patient findings and the outcome of their surgical reconstruction in the literature.
The authors discuss the embryological development of this rare reproductive tract abnormality and have proposed a systematic surgical strategy for each anatomic finding. Ultimately, counseling patients on the best surgical approach requires a discussion on the potential postoperative complications, the degree of cervical abnormality, and the patient's desired treatment outcome. Whether the patient desires definitive treatment with a hysterectomy to avoid the risk of further surgery or, when anatomically appropriate, she wants to pursue a patent outflow tract and the possibility of future childbearing, evidence-based medicine must become the source for surgical strategies.
宫颈发育不全是女性生殖道一种罕见的先天性畸形。有许多解剖结构构成了这种类型的宫颈异常，文献中充斥着试图通过手术恢复通畅的流出道并保留这些患者生育能力的尝试。没有精心设计的队列或随机试验来支持最佳的手术实践；过去的报告仅具有描述性。
最近，人们对宫颈发育不良的手术治疗重新产生了兴趣，采用了经剖腹手术和经阴道子宫切开术的技术，最近还采用了微创方法，试图在不进行会阴切开术或移植物采集的情况下恢复通畅的流出道，以避免进一步手术时出现子宫阴道瘢痕。为了保持女性生殖道重建领域的一致性，人们呼吁对观察到的解剖异常进行简化分类，以便更好地比较患者的发现和文献中他们手术重建的结果。
作者讨论了这种罕见生殖道异常的胚胎发育，并为每种解剖发现提出了一种系统的手术策略。最终，讨论患者的最佳手术方法需要考虑潜在的术后并发症、宫颈异常程度以及患者的治疗期望。无论患者是希望通过子宫切除术进行确定性治疗以避免进一步手术的风险，还是在解剖上合适时希望追求通畅的流出道和未来生育的可能性，循证医学都必须成为手术策略的来源。
