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执业医师妇产科第二十四章 女性生殖器官发育异常

2018-08-29 31页 doc 145KB 18阅读

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执业医师妇产科第二十四章 女性生殖器官发育异常执业医师妇产科第二十四章 女性生殖器官发育异常 第二十四章女性生殖器官发育异常 女性生殖器官在形成、分化过程中,由于某些内源性因素(生殖细胞染色体不分离,嵌合 体,核型异常等)或外源性因素(使用性激素药物)的影响,原始性腺的分化、发育、内生殖器 始基的融合、管道腔化和发育以及外生殖器的衍变可发生改变,导致各种发育异常。常见的生殖 器官发育异常有:?正常管道形成受阻所致异常,包括医`学教育网搜集整理处女膜闭锁、阴道横隔、阴道纵隔、阴道 闭锁和宫颈闭锁;?副中肾衍生物发育不全所致异常,包括无子宫、无阴道、始基子宫、子宫...
执业医师妇产科第二十四章 女性生殖器官发育异常
执业医师妇产科第二十四章 女性生殖器官发育异常 第二十四章女性生殖器官发育异常 女性生殖器官在形成、分化过程中,由于某些内源性因素(生殖细胞染色体不分离,嵌合 体,核型异常等)或外源性因素(使用性激素药物)的影响,原始性腺的分化、发育、内生殖器 始基的融合、管道腔化和发育以及外生殖器的衍变可发生改变,导致各种发育异常。常见的生殖 器官发育异常有:?正常管道形成受阻所致异常,包括医`学教育网搜集整理处女膜闭锁、阴道横隔、阴道纵隔、阴道 闭锁和宫颈闭锁;?副中肾衍生物发育不全所致异常,包括无子宫、无阴道、始基子宫、子宫发 育不良、单角子宫和输卵管发育异常;?副中肾管衍生物融合障碍所致异常,包括双子宫、双角 子宫、鞍状子宫和纵隔子宫等发育异常。 由于女性生殖器官与泌尿器官在起源上相同,故泌尿器官的发育可以影响生殖器官的发育, 约10,泌尿器官发育异常的新生儿伴有生殖器官异常。因此,在诊断生殖器官异常的同时,要 考虑是否伴有泌尿器官的异常。 第一节外生殖器发育异常 女性外生殖器发育异常中较常见的有处女膜闭锁和外生殖器男性化。 )处女膜闭锁(imperforate hymen) (一 处女膜闭锁又称无孔处女膜。系发育过程中,阴道末端的泌尿生殖窦组织未腔化所致。由于 无孑L处女膜使阴道和外界隔绝,故阴道分泌物或月经初潮的经血排出受阻,积聚在阴道内。有时 经血可经输卵管倒流至腹腔。若不及时切开,反复多次的月经来潮使积血增多,发展为子宫腔积 血,输卵管可因积血粘连而伞端闭锁。 【临床表现】绝大多数患者至青春期发生周期性下腹坠痛,呈进行性加剧。严重者可引起 肛门或阴道部胀痛和尿频等症状。检查可见处女膜膨出,表面呈紫蓝色;肛诊可扪及阴道膨 隆,凸向直肠;并可扪及盆腔肿块,用手指按压肿块可见处女膜向外膨隆更明显。偶有幼女 因大量粘液潴留在阴道内,导致处女膜向外凸出而确诊。盆腔B型超声检查可见子宫和阴道 内有积液。 【治疗】先用粗针穿刺处女膜膨隆部,抽出积血后再进行“x”形切开,排出积血,常规检 查宫颈是否正常,切除多余的处女膜瓣,修剪处女膜,再用可吸收缝线缝合切口边缘,使开口成 圆形。术后给予抗感染药物。 ( (二)外生殖器男性化 外生殖器男性化系外生殖器分化发育过程中受到大量雄激素影响所致。常见于真两性畸for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 形、 先天性肾上腺皮质增生或母体在妊娠早期接受具有雄激素作用的药物治疗。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 368 妇产科学 1(真两性畸形(true hermaphroditism) 染色体核形多为46,XX,46,XX,46,XY嵌合体。 46,XY少见。患者体内同时存在睾丸和卵巢两种性腺组织。较多见的是性腺内含有卵巢与睾丸 组织,又称卵睾(ovotestis);也可能是一侧卵巢,另一侧为睾丸。真两性畸形患者外生殖器的 形态很不一致,多数为阴蒂肥大或阴茎偏小。 2(先天性肾上腺皮质增生(congenital adrenal hyperplasia,CAH) 为常染色体隐性遗传性 疾病。系胎儿肾上腺皮质合成皮质酮或皮质醇的酶(如21一羟化酶,11 p_羟化酶与3p羟类固醇脱 氢酶)缺乏,不能将l7Q一羟孕酮羟化为皮质醇或不能将孕酮转化为皮质酮,因此其前质积聚, 并向雄激素转化,产生大量雄激素。 3(外在因素 影响生殖器官的药物主要为激素类药物。雄激素与合成孕激素有雄激素作 用,对泌尿生殖窦最敏感,可使女性外生殖器男性化。妊娠早期服用雄激素类药物,可发生 女性胎儿阴道下段发育不全,阴蒂肥大及阴唇融合等发育异常;妊娠晚期服用雄激素可致阴 蒂肥大。 【临床表现】 阴蒂肥大,有时显著增大似男性阴茎。严重者伴有阴唇融合,两侧大阴唇肥厚 有皱,并有不同程度的融合,类似阴囊。 【诊断】 1(病史和体征询问患者母亲在妊娠早期是否曾接受具有雄激素作用的药物治疗,家族中 有无类似畸形患者。检查时应了解阴蒂大小,尿道口与阴道口的位置,有无阴道和子宫。同时检 查腹股沟与大阴唇,了解有无异位睾丸。 2(实验室检查疑真两性畸形或先天性肾上腺皮质增生时,应检查染色体核型。前者染色 体核型多样,后者则为46,XX,血雄激素呈高值,并伴有血清l7a一羟孕酮值升高和尿17酮及l7 羟含量增加。 3(性腺活检必要时可通过性腺活检,确诊是否为真两性畸形。 【治疗】行肥大阴蒂部分切除,使保留的阴蒂接近正常女性阴蒂大小。同时手术矫正外阴部 其他畸形。 1(真两性畸形取决于外生殖器的功能状态,将不必要的性腺切除,保留与外生殖器相适 应的性腺,并以此性别养育。 2(先天性肾上腺皮质增生 先给予肾上腺皮质激素治疗,减少血清睾酮含量至接近正常水 平,再作阴蒂整形术和其他畸形的相应矫正手术。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 第二节阴道发育异常 阴道发育异常可分为3类:先天性无阴道,副中肾管尾端融合异常和阴道腔化障碍。临床上 可见以下几种异常。 (一)先天性无阴道(congenital absence of vagina) 先天性无阴道系双侧副中肾管发育不全或双侧副中肾管尾端发育不良所致。目前所知,先天 性无阴道既非单基因异常的结果,也非致癌物质所致。发生率为l,4000,1,5000,先天性无阴 道几乎均合并无子宫或仅有始基子宫,卵巢功能多为正常。 【临床表现】 原发性闭经及性生活困难。极少数子宫发育正常的患者因经血倒流,可有周期 性腹痛。检查可见患者体格、第二性征以及外阴发育正常,但无阴道口,或仅在前庭后部见一浅 凹。偶见短浅阴道盲端。常伴子宫发育不良(无子宫或始基子宫)。45,,50,患者伴有泌尿道 异常,10,伴有脊椎异常。此病须与处女膜闭锁和雄激素不敏感综合征相鉴别。肛诊时,处女膜 闭锁可扪及阴道内肿块,向直肠膨隆,子宫正常或增大,B型超声检查有助于鉴别诊断。雄激素 不敏感综合征为X连锁隐陛遗传病,染色体核型为46,XY。而先天性无阴道为46,XX,血清睾 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 第二十四章女性生殖器官发育异常 369 酮为女性水平。 【治疗】 1(模具顶压法用木质或塑料阴道模具压迫阴道凹陷,使其扩张并延伸到接近正常阴道的 长度。适用于无子宫且阴道凹陷组织松弛者。 2(阴道成型术方法多种,各有利弊。常见术式有:羊膜阴道成型术、盆腔腹膜阴道成型 术、乙状结肠代阴道术、皮瓣阴道成型术和外阴阴道成型术等方法。若有正常子宫,应使阴道与 宫颈连通。 (二)阴道闭锁(atresia of vagina) 阴道闭锁为泌尿生殖窦未参与形成阴道下段所致。闭锁位于阴道下段,长度约,3era,其 上多为正常阴道。 【临床表现】 绝大多数患者至青春期发生周期性下腹坠痛,呈进行性加剧。严重者可引起肛 门或阴道部胀痛和尿频等症状。症状与处女膜闭锁相似,无阴道开口,但闭锁处粘膜表面色泽正 常,亦不向外隆起。肛诊可扪及凸向直肠包块,位置较处女膜闭锁高。 【治疗】应尽早手术切除。先用粗针穿刺阴道粘膜,抽出积血后切开闭锁段阴道,排出积 血,常规检查宫颈是否正常,切除多余闭锁的纤维结缔组织,利用已游离的阴道粘膜覆盖创面, 术后定期扩张阴道以防挛缩。 (三)阴道纵隔(10ngitudinal vaginal septum) 阴道纵隔为双侧副中肾管会合后,尾端纵隔未消失或部分消失所致。分为完全纵隔和不全 纵隔。 【临床表现】 阴道完全纵隔者无症状,性生活和阴道分娩无影响。不全纵隔者可有性生活困 难或不适,分娩时胎先露下降可能受阻。阴道检查可见阴道被一纵形粘膜壁分为两条纵形通道, 粘膜壁上端近宫颈,完全纵隔下端达阴道口,不全纵隔未达阴道口。阴道完全纵隔常合并双 子宫。 【治疗】 阴道纵隔影响性生活或阴道分娩时,应将纵隔切除,创面缝合以防粘连。若阴道分 娩时发现阴道纵隔,可当先露下降压迫纵隔时先切断纵隔的中部,待胎儿娩出后再切除纵隔。 (四)阴道斜隔 病因尚不明确。可能是副中肾管向下延伸未到泌尿生殖窦形成一盲端所致。阴道斜隔常伴有 同侧泌尿系发育异常,多为双宫体、双宫颈及斜隔侧的肾缺如。 阴道斜隔分为三个类型(图24—1): 工型为无孔斜隔隔后的子宫与外界及另侧子宫完全隔离,宫腔积血聚积在隔后腔。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet ?型为有孔斜隔隔上有一数毫米的d,:fL,隔后子宫与另侧子宫隔绝,经血通过小孑L滴出, 引流不畅。 ?型为无孔斜隔合并宫颈瘘管在两侧宫颈间或隔后腔与对侧宫颈之间有小瘘管,有隔一侧 子宫经血可通过另一侧宫颈排出,引流亦不通畅。 【临床表现】发病年龄较轻,月经周期正常,三型均有痛经,I型较重,平时一侧下腹痛。 ?型月经间期阴道少量褐色分泌物或陈旧血淋漓不净,脓性分泌物有臭味。?型经期延长有少量 血,也可有脓性分泌物。妇科检查一侧穹隆或阴道壁可触及囊性肿物。工型肿物较硬,官腔积血 时触及增大子宫。?、?型囊性肿物张力较小,压迫时有陈旧血流出。 【诊断】月经周期正常,有痛经及一侧下腹痛;月经周期中有流血、流脓或经期延长。妇科 检查一侧穹隆或阴道壁有囊肿,增大子宫及附件肿物。局部消毒后在囊肿下部穿刺,抽出陈旧 血,即可诊断。B型超声检查可见一侧宫腔积血,阴道旁囊肿,同侧肾缺如。子宫碘油造影检查 可显示?型者宫颈间的瘘管。有孔斜隔注入碘油,可了解隔后腔情况。必要时应做泌尿系造影 检查。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 【治疗】 由囊壁小孑L或穿刺定位,上下剪开斜隔,暴露宫颈。沿斜隔附着处,作菱形切除, 边缘电凝止血或油纱卷压迫24,48小时,一般不放医`学教育网搜集整理置阴道模型。 (五)阴道横隔(transverse vaginal septum) 阴道横隔为两侧副中肾管会合后的尾端与尿生殖窦相接处未贯通或部分贯通所致。横隔可位 于阴道内任何部位,但以上、中段交界处为多见,其厚度约为lcm。阴道横隔无孑L称完全性横 隔;隔上有dqL称不全性横隔。位于阴道上端的横隔多为不全性横隔;阴道下部的横隔多为完全 性横隔。(图24—2) for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 【临床表现】 不全性横隔位于上部者多无症状, 位置偏低者可影响性生活。阴道分娩时影响胎先露部 下降。完全性横隔有原发性闭经伴周期性腹痛,并呈 进行性加剧。妇科检查见阴道较短或仅见盲端,横隔 中部可见dqL。肛诊时可扪及宫颈及宫体。完全性横 隔由于经血潴留,可在相当于横隔上方部位触及块物。 【治疗】切除横隔,缝合止血。可先用粗针穿刺 定位,抽出积血后再行切开术。术后放置阴道模型, 定期更换,直到上皮愈合。切除横隔后,也可将横隔 上方的阴道粘膜部分分离拉向下方,覆盖横隔的创面, 与隔下方的阴道粘膜缝合。分娩时,若横隔薄者可于 胎先露部下降压迫横隔时切开横隔,胎儿娩出后再切 除横隔;横隔厚者应行剖宫产术。横隔切除术后要注 意创面的愈合和横隔残端挛缩。 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 第三节宫颈及子宫发育异常 一、先天性宫颈闭锁(congenital atresia of the cervix) 临床上罕见。若患者子宫内膜有功能时,青春期后可因宫腔积血而出现周期性腹痛,经血还 可经输卵管逆流入腹腔,引起盆腔子宫内膜异位症。治疗可手术穿通宫颈,建立人工子宫阴道通 道或行子宫切除术。 二、子宫发育异常 “、J口力。用7I q】 子宫发育异常多因形成子宫段副中肾管发育及融合异常所致。副中肾管发育异常分类见图 24—3。 (一)子宫未发育或发育不良 1(先天性无子宫(congenital absence of the uterus):因双侧副中肾管形成子宫段未融合, 退化所致。常合并无阴道。卵巢发育正常。 2(始基子宫(primordial uterus):系双侧副中肾管融合后不久即停止发育,子宫极小,仅 长1,3cm。多数无宫腔或为一实体肌性子宫。偶见始基子宫有宫腔和内膜。卵巢发育可正常。 3(幼稚子宫(infantile uterus):双侧副中肾管融合形成子宫后发育停止所致。卵巢发育 正常。 【临床表现】 先天性无子宫或实体性的始基子宫无症状。常因青春期后无月经就诊,检查才 发现。具有宫腔和内膜的始基子宫若宫腔闭锁或无阴道者可因月经血潴留或经血倒流出现周期性 腹痛。幼稚子宫月经稀少、或初潮延迟,常伴痛经。检查可见子宫体小,宫颈相对较长,宫体与 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 宫颈之比为1:l或2:3。子宫可呈极度前屈或后屈。 【治疗】 先天性无子宫、实体性始基子宫可不予处理。始基子宫有周期性腹痛或官腔积血者 需手术切除。幼稚子宫主张雌激素加孕激素序贯周期治疗。 (二)单角子宫与残角子宫 1(单角子宫(unieornous uterus):仅一侧副中肾管正常发育形成单角子宫,同侧卵巢功能 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 正常。另侧副中肾管完全未发育或未形成管道,未发育侧卵巢、输卵管和肾脏亦往往同时缺如。 2(残角子宫(rudimentary horn of the uterus):系一侧副中。肾管发育,另一侧副中肾管中下 段发育缺陷,形成残角子宫。有正常输卵管和卵巢,但常伴有同侧泌尿器官发育畸形。约65, 单角子宫合并残角子宫。根据残角子宫与单角子宫解剖上的关系,分为三种类型:工型残角子宫 有官腔,并与单角子宫腔相通;Il型残角子宫有官腔,但与单角子宫腔不相通;?型为实体残角医`学教育网搜集整理 子宫,仅以纤维带相连单角子宫。 【临床表现】 单角子宫无症状。残角子宫若内膜有功能,但其宫腔与单角官腔不相通者,往 往因月经血倒流或官腔积血出现痛经,也可发生子宫内膜异位症。检查可见单角子宫偏小、梭 形、偏离中线。伴有残角子宫者可在子宫一侧扪及较子宫小的硬块,易误诊卵巢肿瘤。若残角子 宫腔积血时可扪及肿块,有触痛。子宫输卵管碘油造影、B型超声检查磁共振显像有助于正确 诊断。 【治疗】单角子宫不予处理。孕期加强监护,及时发现并发症予以处理。非孕期残角子宫确 诊后应切除。早、中期妊娠诊断明确,及时切除妊娠的残角子宫,避免子宫破裂。晚期妊娠行剖 宫产后,需警惕胎盘粘连或胎盘植入,造成产后大出血。切除残角子宫时将同侧输卵管切除,避 免输卵管妊娠的发生,圆韧带应固定于发育侧同侧宫角部位。 (三)双子宫(didelphic uterus) 双子宫为两侧副中肾管未融合,各自发育形成两个子宫医`学教育网搜集整理和两个宫颈。两个宫颈可分开或相 连;宫颈之间也可有交通管。也可为一侧子宫颈发育不良、缺如,常有一小通道与对侧阴道相 通。双子宫可伴有阴道纵隔或斜隔。 【临床表现】患者多无自觉症状。伴有阴道纵隔可有性生活不适。伴阴道无孔斜隔时可出现 痛经;伴有孑L斜隔者于月经来潮后有阴道少量流血,呈陈旧性且淋漓不尽,或少量褐色分泌物。 检查可扪及子宫呈分叉状。宫腔探查或子宫输卵管碘油造影可见两个官腔。伴阴道纵隔或斜隔 时,检查可见相应的异常。 【治疗】一般不予处理。当有反复流产,应除外染色体、黄体功能以及免疫等因素后行矫形 手术。伴阴道不全纵隔或斜隔应作隔切除术。 (四)双角子宫(bicornuate uterus) for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 双角子宫是双侧中肾管融合不良所致。分2类:?完全双角子宫(从宫颈内口处分开); ?不全双角子宫(宫颈内口以上处分开)。 【临床表现】 一般无症状。有时双角子宫月经量较多并伴有程度不等的痛经。检查可扪及宫 底部有凹陷。8型超声检查、磁共振显像和子宫输卵管碘油造影有助于诊断。 【治疗】双角子宫一般不予处理。若双角子宫出现反复流产时,应行子宫整形术。 (五)纵隔子宫(septate uterus) 纵隔子宫为双侧副中肾管融合后,纵隔吸收受阻所致。分2类:?完全纵隔子宫(纵隔由宫 底至宫颈内口之下);?不全纵隔(纵隔终止于宫颈内口之上)。 【临床表现】一般无症状。纵隔子宫可致不孕。纵隔子宫流产率26,,94,,妊娠结局最 差。检查可见完全纵隔者宫颈外口有一隔膜。8型超声检查、磁共振显像和子宫输卵管碘油造影 可以辅助诊断,官腔镜和腹腔镜联合检查可以明确诊断。 【治疗】纵隔子宫影响生育时,宫底楔形切除纵隔是传统治疗方法。上世纪80年代后采用 在腹腔镜监视下,通过宫腔镜切除纵隔是主要治疗纵隔子宫的手术方法。手术简单、安全、微 创,妊娠结局良好。 (六)弓形子宫(arcuate uterus) 弓形子宫为宫底部发育不良,中间凹陷,宫壁略向官腔突出。 【临床表现】一般无症状。检查可扪及宫底部有凹陷;凹陷浅者可能为弓形子宫。8型超 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 第二十四章女性生殖器官发育异常 373 声、磁共振显像和子宫输卵管碘油造影有助于诊断。 【治疗】 弓形子宫一般不予处理。若出现反复流产时,应行子宫整形术。 (七)己烯雌酚所致的子宫发育异常 妊娠2月内服用己烯雌酚(diethylstilbestrol,DES)可导致副中肾管的发育缺陷,女性胎 儿可发生子宫发育不良,如狭小T型官腔、子宫狭窄带、子宫下段增宽以及宫壁不规则。其中 T型官腔常见(42,,62,)。T型宫腔也可见于母亲未服用者DES,称DES样子宫。 【临床表现】一般无症状,常在子宫输卵管碘油造影检查时发现。由于DES可致宫颈功能 不全,故早产率增加。妇科检查无异常。诊断依靠子宫输卵管碘油造影。 【治疗】 一般不予处理。宫颈功能不全者可在妊娠l4,16周行宫颈环扎术。 第四节输卵管发育异常 输卵管发育异常罕见,是副中肾管头端发育受阻,常与子宫发育异常同时存在。几乎均在因 其他病因手术时偶然发现。 1(输卵管缺失或痕迹输卵管痕迹(rudimentary fallopian tube)或单侧输卵管缺失为同侧 常伴有该侧输尿管和肾脏的发育异常。未见单独双侧输卵管缺失,多副中肾管未发育所致。 伴发 其它内脏严重畸形,胎儿不能存活。 2(输卵管发育不全是较常见的生殖器官发育异常。输卵管细长弯曲,肌肉不同程度的发 育不全,无管腔或部分管腔通畅造成不孕,有憩室或副口是异位妊娠的原因之一。 3(副输卵管单侧或双侧输卵管之上附有一稍小但有伞端的输卵管。有的与输卵管之间有 交通,有的不通。 4(单侧或双侧有二条发育正常的输卵管,均与宫腔相通。 【治疗】若不影响妊娠,无需处理。 第五节卵巢发育异常 卵巢发育异常因原始生殖细胞迁移受阻或性腺形成移位异常所致。有以下几种情况: 1(卵巢未发育或发育不良单侧或双侧卵巢未发育极罕见。单侧或双侧发育不良卵巢外观 色白,细长索状,又称条索状卵巢(streak ovary)。发育不良卵巢切面仅见纤维组织,无卵泡。 临床表现为原发性闭经或初潮延迟、月经稀少和第二性征发育不良。常伴内生殖器或泌尿器官异 常。多见于特纳综合征患者(Turner’s syndrome)。B型超声检查、腹腔镜检查有助于诊断,必 要时行活体组织检查和染色体核型检查。 2(异位卵巢卵巢形成后仍停留在原生殖嵴部位,未下降至盆腔内。卵巢发育正常者无 for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet 症状。 ’ 3(副卵巢(Supernumerary ovary) 罕见。一般远离正常卵巢部位,可出现在腹膜后。无症 状,多在因其他疾病手术时发现。 【治疗】 若条索状卵巢患者染色体核型为XY,卵巢发生恶变的频率较高,确诊后应予 切除。 (朱兰) for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet for computer software engineering GB/T50314-2000 of electrical installations code for construction and acceptance of GBJ232- 92 intelligent building weak design construction figure set GJBT-471 2. system description this times engineering weak design including: hours a Kok information facilities system integrated wiring system (containing room network, communications part) wired TV system information guide and the released system hours II Kok public security system fire automatically alarm system (containing public broadcast part) security technology prevention system security monitoring system out entrance control system car library management system hours three Kok building equipment monitoring system hours four Kok information application system queued station ICU visitation system operation the system monitoring and training system call intercom system hours, five hours Kok Kok intelligent integrated system of information system (1) cabling systems (including computer room network, communication component) computer network systems and voice communications systems Center of information on medical floor computer room located in the engine room. Voice communication system using a local telecommunications operator providing voice service, configuration-independent integrated services digital program-controlled switchboards. Operators providing communications ... If any compatibility requirements, by way of increased access to the Communications Board within the chassis to meet
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