An atresia cervix removal, lower uterine segment substitute for cervix and uterovaginal anastomosis: a case report and literature review

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• 作者：Haojie He ; Hongyan Guo ; Jinsong Han ; Yu Wu…
• 关键词：Cervical agenesis ; Cervical dysgenesis ; Congenital cervical atresia ; Reconstructive surgical procedure
• 刊名：Archives of Gynecology and Obstetrics
• 出版年：2015
• 出版时间：January 2015
• 年：2015
• 卷：291
• 期：1
• 页码：93-97
• 全文大小：758 KB
• 参考文献：1. (1988) The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril 49:944-55
  2. Rock JA, Carpenter SE, Wheeless CR, Jones HWJ (1995) The clinical management of maldevelopment of the uterine cervix. J Pelv Surg 1:129-33
  3. Fujimoto VY, Miller JH, Klein NA, Soules MR (1997) Congenital cervical atresia: report of seven cases and review of the literature. Am J Obstet Gynecol 177:1419-425 CrossRef
  4. Deffarges JV, Haddad B, Musset R, Paniel BJ (2001) Utero-vaginalanastomosis in women with uterine cervix atresia: long-term follow-up and reproductive performance. A study of 18 cases. Hum Reprod 16:1722-725 CrossRef
  5. Grimbizis GF, Gordts S, Di Spiezio Sardo A et al (2013) The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod 28:2032-044 CrossRef
  6. Hovsepian DM, Hovsepian DM, Anthony A, Ratts VS (1999) A combined surgical and radiologic technique for creating a functional neoendocervical canal in a case of partial congenital cervical atresia. Fertil Steril 71:158-62 CrossRef
  7. Roberts CP, Rock JA (2011) Surgical methods in the treatment of congenital anomalies of the uterine cervix. Curr Opin Obstet Gynecol 23:251-57 CrossRef
  8. Li M, Zhang Z (2013) Laparoscopically assisted biomaterial graft for reconstruction in congenital atresia of vagina and cervix. Fertil Steril 100:1784-787 CrossRef
  9. Wang YT, He HJ, Liang HM et al (2013) Rearrangement after failure of primary surgery for congenital cervical atresia complicated with vaginal aplasia: report of five cases. Chin J Min Inv Surg 13:145-48
  10. Jacob HJ, Griffin TW (1989) Surgical reconstruction of the congenitally atretic cervic: two cases. Obstet Gynecol Surv 44:556-59 CrossRef
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Gynecology
  Obstetrics and Perinatology
  Endocrinology
  Human Genetics
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-0711

文摘

Purpose The management of cervical dysgenesis is still a big challenge, mostly due to the complexity of the malformation and the difficulty to conserve the patient’s fertility during the surgery. The objective of this article is to report a new successful approach for treating cervical dysgenesis as well as conserving patients-fertility. Materials and methods We presented a case of a 22-year-old girl with vaginal agenesis and cervical dysgenesis, who after an initial failure at reconstructive surgery was successfully treated by removing a cord-like cervix and a central muscular cylinder of her lower uterine segment and lining the channel with peritoneum as the reconstructed cervix. Results The patient has had normal menstruation without dysmenorrhea for one and a half years since the surgery. Conclusions Several steps should be followed in managing patients with congenital cervical atresia: (1) a sufficient imaging evaluation before operation is necessary; (2) a falling-off-proof cervical catheter such as a mushroom catheter (also referred to as pezzers self-retaining catheter), and a proper vaginoplasty are key to a successful cervical canalization; (3) smooth grafted tissues such as peritoneum can be used to line the cervical canal to avoid adhesions.