Zhang H, Qu H, Ning G, Cheng B, Jia F, Li X, Chen X
Department of Radiology, West China Second University Hospital, Sichuan University, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, China.
Department of Radiology, West China Second University Hospital, Sichuan University, Sichuan, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, China.
Clin Radiol. 2017 Jul;72(7):612.e7-612.e15. doi: 10.1016/j.crad.2017.02.002. Epub 2017 Mar 7.
To outline the anatomical variations of obstructive reproductive tract anomalies (ORTA) using magnetic resonance imaging (MRI) and its role in preoperative evaluation.
MRI and treatment of 21 paediatric patients with ORTA were reviewed and analysed. MRI findings were correlated with ultrasound and surgical findings.
Patients presented in two distinct ways: primary amenorrhoea with cyclic pelvic pain, or progressive dysmenorrhoea. MRI showed haematocolpos, haematocervix, haematometra, and/or haematosalpinx; it also provided detailed information regarding uterine morphology, ipsilateral kidney absence, and endometriosis. Diagnosis at MRI of the obstruction sites correlated completely (100%) with the surgical diagnosis. Obstruction occurred at different levels of the genital tract, and surgical treatment was given based on the obstruction sites. One patient underwent excision of the hymen tissue for imperforate hymen. Four cases of lower vaginal atresia were treated with vaginoplasty. Three patients with typical Herlyn-Werner-Wunderlich (HWW) syndrome underwent resection of the vaginal septum, and one patient with concurrent post-partum placenta increta was treated accordingly; one patient with atypical HWW syndrome had the left uterus resected. There were 11 cases of cervical agenesis or cervicovaginal dysgenesis, eight of which were complicated with uterine anomalies, and in all cases the uterus was removed. Among the 10 obstructive cervical anomalies, there were three cases of cervical agenesis and seven cases of cervical dysgenesis, including five obliterated cervical os (cervical obstruction), one cervical fibrous cord, and one cervical fragmentation.
ORTA can occur from the hymen to the lower segment of the uterus and requires surgical intervention. The preoperative evaluation is vital to guide proper surgery. MRI, with its imaging advantages, is the imaging technique of choice to assess the obstructed sites and complicated anomalies of ORTA.
利用磁共振成像（MRI）概述梗阻性生殖道畸形（ORTA）的解剖变异及其在术前评估中的作用。
回顾并分析21例患有ORTA的儿科患者的MRI及治疗情况。将MRI结果与超声及手术结果进行对比。
患者以两种不同方式就诊：原发性闭经伴周期性盆腔疼痛，或进行性痛经。MRI显示阴道积血、宫颈积血、子宫积血和/或输卵管积血；还提供了有关子宫形态、同侧肾缺如和子宫内膜异位症的详细信息。MRI对梗阻部位的诊断与手术诊断完全相符（100%）。梗阻发生在生殖道的不同水平，并根据梗阻部位进行手术治疗。1例患者因处女膜闭锁接受处女膜组织切除术。4例低位阴道闭锁患者接受阴道成形术治疗。3例典型的赫林 - 韦纳 - 温德利希（HWW）综合征患者接受阴道纵隔切除术，1例并发产后胎盘植入的患者也相应接受治疗；1例非典型HWW综合征患者切除左侧子宫。有11例宫颈闭锁或宫颈阴道发育不全，其中8例合并子宫畸形，所有病例均切除子宫。在10例梗阻性宫颈畸形中，有3例宫颈闭锁，7例宫颈发育不全，包括5例宫颈口闭锁（宫颈梗阻）、1例宫颈纤维索和1例宫颈碎裂。
ORTA可发生于处女膜至子宫下段，需要手术干预。术前评估对于指导恰当的手术至关重要。MRI凭借其成像优势，是评估ORTA梗阻部位及复杂畸形的首选成像技术。
