Pozzati F, Mirandola M, Topozouva G, Parodi L, Carla Testa A, Scambia G, Catena U
Facts Views Vis Obgyn. 2023 Jun;15(2):167-170. doi: 10.52054/FVVO.15.2.077.
A complete uterine septum, double cervix and vaginal septum is a complex and rare congenital genital tract anomaly. The diagnosis is often challenging and based on the combination of different diagnostic techniques and multiple treatment steps.
To propose a combined one-stop diagnosis and an ultrasound-guided endoscopic treatment of complete uterine septum, double cervix, and longitudinal vaginal septum anomaly.
Stepwise demonstration with narrated video footage of an integrated approach management of a complete uterine septum, double cervix and vaginal longitudinal septum treated by expert operators combining minimally invasive hysteroscopy and ultrasound. The patient was 30 years old and was referred to our clinic because of dyspareunia, infertility and the suspicion of a genital malformation.
A one-stop complete evaluation of uterine cavity, external profile, cervix, and vagina was made through 2D, and 3D ultrasound combined with hysteroscopic assessment and a U2bC2V1 malformation (according to ESHRE/ESGE classification) was diagnosed. The procedure consisted in a totally endoscopic removal of the vaginal longitudinal septum and the complete uterine septum, starting the uterine septum incision from the isthmic level, and sparing the two cervices, under transabdominal ultrasound guidance. The ambulatory procedure was performed in the Digital Hysteroscopic Clinic (DHC) CLASS Hysteroscopy in Fondazione Policlinico Gemelli IRCCS of Rome - Italy, under general anaesthesia (laryngeal mask).
Surgical time of procedure was 37 minutes; no complications occurred; patient was discharged three hours after the procedure; the hysteroscopic office control after 40 days showed a normal vagina and a normal uterine cavity with two normal cervices.
An integrated ultrasound and hysteroscopic approach allows an accurate one-stop diagnosis and a totally endoscopic treatment option for complex congenital malformations using an ambulatory model of care with optimal surgical results.
完全性子宫纵隔、双宫颈和阴道纵隔是一种复杂且罕见的先天性生殖道畸形。诊断往往具有挑战性，需结合不同诊断技术及多个治疗步骤。
提出一种针对完全性子宫纵隔、双宫颈和阴道纵膈畸形的一站式联合诊断及超声引导下的内镜治疗方法。
由专家操作，结合微创宫腔镜检查和超声，对一名患有完全性子宫纵隔、双宫颈和阴道纵膈的患者进行综合治疗，并通过带旁白的视频片段逐步展示治疗过程。该患者30岁，因性交困难、不孕及怀疑生殖器畸形转诊至我院。
通过二维和三维超声结合宫腔镜评估，对子宫腔、外形、宫颈和阴道进行了一站式全面评估，诊断为U2bC2V1畸形（根据ESHRE/ESGE分类）。手术过程包括在经腹超声引导下，完全经内镜切除阴道纵膈和完全性子宫纵隔，从峡部水平开始切开子宫纵隔，保留两个宫颈。该门诊手术在意大利罗马圣心天主教大学综合医院IRCCS的数字宫腔镜诊所（DHC）H级宫腔镜室进行，采用全身麻醉（喉罩）。
手术时间为37分钟；未发生并发症；患者术后3小时出院；术后40天的宫腔镜门诊检查显示阴道正常、子宫腔正常，有两个正常宫颈。
超声与宫腔镜联合应用，能够通过门诊护理模式对复杂先天性畸形进行准确的一站式诊断和完全经内镜治疗，手术效果理想。
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