Department of Pediatric Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
Department of Reproductive Medicine and Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India.
Int Urogynecol J. 2024 Sep;35(9):1807-1816. doi: 10.1007/s00192-024-05878-1. Epub 2024 Jul 25.
Congenital cervicovaginal agenesis in the presence of a functional endometrium is a rare Müllerian anomaly. The management ranges from hysterectomy historically to various reconstructive procedures more recently. We report our experience with utero-colo-vaginoplasty in the management of this anomaly and its long-term follow-up.
The case records of all the patients with vaginal or cervicovaginal agenesis in our hospital from January 2002 to December 2019 were reviewed retrospectively. The patients were then called for an outpatient visit and examined in detail. The anatomical variations, surgical procedures and outcomes were recorded and analysed.
Sixteen patients aged 14 to 26 years were included during the study period. They presented with cyclical painful cryptomenorrhea. Magnetic resonance imaging (MRI) confirmed cervicovaginal or distal vaginal agenesis. All the patients underwent utero-colo-vaginoplasty. Intraoperative rectal injury led to post-operative faecal leak from the perineal wound in one patient in the post-operative period. Restoration of painless menstrual flow was possible in all 16 cases. Long-term complications were seen in 4 patients. These were stenosis of the perineal neovaginal orifice in 2 patients, obstruction at colo-uterine anastomosis in 1 patient and mucosal prolapse at the neovagina in 1 patient. Three of these patients needed secondary surgical procedures. Five were sexually active and reported consummation of penetrative intercourse. None of them had conceived.
In our experience, utero-colo-vaginoplasty allows for regular painless menstruation and coitus with minimal long-term complications. The sole disadvantage is the failure to conceive.
先天性宫颈阴道发育不全伴功能性子宫内膜是一种罕见的 Müllerian 异常。其管理范围从历史上的子宫切除术到最近的各种重建手术。我们报告了我们在这种异常的管理中使用子宫结肠阴道成形术的经验及其长期随访结果。
回顾性分析了 2002 年 1 月至 2019 年 12 月我院所有阴道或宫颈阴道发育不全患者的病历。然后对患者进行门诊随访并进行详细检查。记录和分析了解剖变异、手术过程和结果。
研究期间共纳入 16 例 14 至 26 岁的患者。她们表现为周期性疼痛性隐经。磁共振成像（MRI）证实宫颈阴道或阴道远端发育不全。所有患者均行子宫结肠阴道成形术。1 例患者术后出现直肠损伤，导致会阴伤口粪便漏出。16 例患者均恢复无痛月经来潮。4 例患者出现长期并发症。其中 2 例患者会阴新阴道口狭窄，1 例患者结肠子宫吻合口梗阻，1 例患者新阴道黏膜脱垂。其中 3 例患者需要二次手术。5 例患者有性生活，报告完成了插入式性交。她们均未怀孕。
根据我们的经验，子宫结肠阴道成形术可使月经规律、无痛且可进行性交，长期并发症较少。唯一的缺点是无法怀孕。
