Zhang Zhenqian,Chen Kexin,Yan Xiangming,et al.Clinical features and management strategies of imperorate hymen in children[J].Journal of Clinical Pediatric Surgery,,21():278-282.[doi:10.3760/cma.j.cn101785-202101069-014]
Clinical features and management strategies of imperorate hymen in children
- Abstract:
- Objective To explore the clinical features and treatment of imperforate hymen (IH) in children.Methods A retrospective analysis was performed for 24 children of imperforate hymen from February 2012 to October 2020.The medical history, physical signs, auxiliary examination results, surgical methods, intraoperative conditions, and postoperative follow-up conditions were evaluated.Results There were 7 children (29%) diagnosed with IH before puberty, and 17 (71%) were treated with symptoms during puberty.The main clinical manifestations included abdominal pain and discomfort (16/17, 94.1%).Most of the pediatric patients had urinary symptoms such as retention of urine and impaired urination (7/17, 41.2%) and frequent urination (2/17, 11.8%).Some had fever (2/17, 11.8%), bloating (1/17, 5.9%), nausea (1/17, 5.9%), and difficulty defecating (1/17, 5.9%). 7 (41.2%) of the children with symptoms had been misdiagnosed.All 24 children underwent hymenotomy with a cruciate incision, with no obvious postoperative complications during follow-up.Conclusion The diagnosis of IH requires careful physical examination, in which ultrasound examination can be helpful in making correct diagnosis.The best timing for surgery is during puberty, but before the menarche.Symptomatic adolescent should receive surgery as soon as possible after diagnosis.The hymen cruciate incision is safe and effective as a standard surgical procedure.
References:
[1] 苏朋俊, 张树成, 王练英, 等.新生儿处女膜闭锁误诊原因分析[J].中国当代儿科杂, 2007, 9(1):67-68.DOI:10.3969/j.issn.1008-8830.2007.01.017.Su PJ, Zhang SC, Wang LY, et al.Analysis of the causes of misdiagnosis of neonatal imperforate hymen[J].Chin J Contemp Pediatr, 2007, 9(1):67-68.DOI:10.3969/j.issn.1008-8830.2007.01.017.
[2] Sloane W, Berger C, Anne-Marie E, et al.Diagnosis and management of hymenal variants:ACOG committee opinion summary, number 780[J].Obstet Gynecol, 2019, 133(6):1292-1293.DOI:10.1097/AOG.0000000000003283.
[3] Dahal GR, Phuyal S, Agrawal P.Symptomatic Imperforate Hymen in Early Infancy:A Case Report[J].JNMA J Nepal Med Assoc, 2020, 58(226):433-435.DOI:10.31729/jnma.4922.
[4] 王欣, 段华.先天性处女膜闭锁16例临床分析并文献复习[J].北京医学, 2017, 39(4):407-408.DOI:10.15932/j.0253-9713.2017.04.024.Wang X, Duan H.Clinical analysis and literature review of 16 cases of congenital imperforate hymen[J].Beijing Med J, 2017, 39(4):407-408.DOI:10.15932/j.0253-9713.2017.04.024.
[5] Posner JC, Spandorfer PR.Early detection of imperforate hymen prevents morbidity from delays in diagnosis[J].Pediatrics, 2005, 115(4):1008-1012.DOI:10.1542/peds.2004-0183.
[6] Shaw LM, Jones WA, Brereton RJ.Imperforate hymen and vaginal atresia and their associated anomalies[J].J R Soc Med, 1983, 76(7):560-566.DOI:10.1177/014107688307600707.
[7] Lee KH, Hong JS, Jung HJ, et al.Imperforate Hymen:A Comprehensive Systematic Review[J].J Clin Med, 2019, 8(1):1-14.DOI:10.3390/jcm8010056.
[8] 林基通, 刘晓帆, 肖婷婷, 等.围产期处女膜闭锁一例[J].中华小儿外科杂志, 2021, 42(1):72-75.DOI:10.3760/cma.j.cn.421158-20190910-00534.Lin JT, Liu XF, Xiao TT, et al.Perinatal hymen atresia:one case report[J].Chin J Pediatr Surg, 2012, 42(1):72-75.DOI:10.3760/cma.j.cn.421158-20190910-00534.
[9] Miller RJ, Breech LL.Surgical correction of vaginal anomalies[J].Clin Obstet Gynecol, 2008, 51(2):223-236.DOI:10.1097/GRF.0b013e31816d2181.
[10] Yamazaki H, Chida Y, Hirano Y, et al.Transabdominal ultrasound aids in the diagnosis of hematocolpometra due to imperforate hymen in an 11-year-old female:a case report[J].Choonpa Igaku, 2019, 46(2):197-200.DOI:10.3179/jjmu.JJMU.A.130.
[11] Yadav G, Agrawal N, Binit S, et al.Transverse vaginal septum presenting as secondary amenorrhoea:a rare clinical presentation[J].BMJ Case Reports, 2020, 13(8):1228-1229.DOI:10.1136/bcr-2020-235374.
[12] 朱丽, 孙莉颖, 沈秋香, 等.幼女阴道斜隔综合征2例并文献复习[J].临床小儿外科杂志, 2020, 19(9):858-860.DOI:10.3969/j.issn.1671-6353.2020.09.020.Zhu L, Sun LY, Shen QX, et al.Oblique vaginal septum syndrome in young children:a report of two cases and literature review[J].J Clin Ped Sur, 2020, 19(9):858-860.DOI:10.3969/j.issn.1671-6353.2020.09.020.
[13] Frega A, Verrone A, Schimberni M, et al.Feasibility of office CO2 laser surgery in patients affected by benign pathologies and congenital malformations of female lower genital tract[J].Eur Rev Med Pharmacol Sci, 2015, 19(14):2528-2536.
[14] Bonello K, Tlili Y, Zeid OB, et al.Haematocolpos due to imperforate hymen disguised as constipation[J].J Paediatr Child Health, 2021, 57(5):715-717.DOI:10.1111/jpc.14931.
[15] 朱兰, 王姝, 郎景和.女性生殖器官畸形诊治的中国专家共识[J].中华妇产科杂志, 2015, 50(10):729-733.DOI:10.3760/cma.j.issn.0529-567x.2015.10.002.Zhu L, Wang S, Lang JH.Chinese expert consensus on diagnosis and treatment of female genital malformations[J].Chin J Obstet Gynecol, 2015, 50(10):729-733.DOI:10.3760/cma.j.issn.0529-567x.2015.10.002.
Memo
收稿日期:2021-01-23。
基金项目:江苏省自然科学基金面上项目(BK20191176);苏州市临床重点病种诊疗技术专项项目(LCZX201908)
通讯作者:曹戌,Email:cao_xu1982@163.com