| Purpose:To investigate the clinical characteristics, diagnosis and treatment of(oblique vaginal septum syndrome,OVSS),resulting in significance changes of patients with pregnancy before and after surgery.Methods: Analysis of the 60 cases of patients with OVSS from January 2005 to December 2014 in the hospital. All patients were divided into 4 groups according to the type of OVSS. Then, they were treatment and postoperative diagnosis.. The type I group of patients has imperforate oblique vaginal septum, type II group has perforate oblique vaginal septum, type III group has imperforate oblique vaginal septum and cervical fistula, and type IV group has imperforate oblique vaginal septum and ipsilateral cervical atresia. After diagnosis of these four groups have been treated,clinical characteristics and the outcome of pregnancy were investigated.Results: 1. The ages of patients age was ranged from 10 to 46 years old, and the average age was 22.86±7.76 years, which of them have been menarche. The median of attack time for all patients is about 5 years away from the menarche, and median of treatment time in my hospital is away from the attack time about 2 years. 2. The patients of OVSS contained 13 cases of type I, 28 cases of type II, 16 cases of type III, and 3cases of type IV.The average age at diagnosis was 14.91±4.65 year old,25.31±6.44 year old,26.38±7.2 year old,15.67±5.03 year old, respectively. The median of attack time away from menarche is about 0.5 years, 7 years, 6.5 years, and 0 years respectively.The median duration of treatment in my hospital away from menarche is about 0.8 years,2 years, 3 years, and1 year.3. The main reasons for treatment are: 45%(27/60)dysmenorrhea, 16.7%(10/60)infertility, 15% menostaxis(9/60), 11.7%(7/60)pretherapy gestation complications, 6.7%(4/60) malformation, and 5%(3/60)pus discharge from the vagina. 4. Major clinical characteristics included: vaginal wallpackage block, dysmenorrhea, infertility, menstrual extension, and vaginal discharge pus. The percentage of themis 76.67%(46 / 60), 75%(45 / 60), 38.3%(23/60), 35%(21/ 60), 18.3%(6 / 60), and6.67%(4/60) of type II patients with no obvious symptoms respectively.5.The type of uterine contained: 45 cases(75%) in uterus didelphys, 13cases(21.7%) in the complete uterus septum and duplicated cervix, 2 cases(3.3%) in uterus bicornis. Thus, the treatment of the left oblique septum is 28 cases(46.67%), and the right oblique septum is 32 cases(53.33%).59 cases of oblique septum kidneys disappeared, 1 case of renal dysplasia. 6. The situation of diagnosis is including : 49 cases were treated with vaginal septum resection, 6 cases were treated by hysterectomy,and 5 cases were follow-up. 7. 57 patients were complete follow-up, and 3 cases were lost, which is one of typeⅡ, typeⅢ, and typeⅣ. The follow-up time ranged from one year to 10 years. 8. After treatment, 95.2%(40/42)of patients with dysmenorrhea were relief or disappeared. 85.7%(18/21) of of patients with menstruation were extened.100% of patients with vaginal discharge pus and the vaginal wall mass were relief or disappeared. 9. Misdiagnosis :There are 27 patients have been misdiagnosis in the outside of my hospitalmisdiagnosis rate was 45.0%(27/60). 1, 1, and 1 case were misdiagnosis for acute appendicitis, primary dysmenorrhea, and imperforate hymen,respectively. 4, 5, and 6 cases were misdiagnosis for pelvic tumor or with ruptured,vaginitis, and ovulation obstructive abnormal uterine bleeding, respectively. 1, 1, 2 and1 cases were misdiagnosis for simple uterus didelphys, uterus septum, rudimentary horn of uterus, and the development of kidney malformation, respectively.10. The condition of the pregnancy :The patients of type I and IV are in young age when they were in diagnosis. They were not calculated in pregnancy study. 30.3% of type II and III patients withpregnancybefore the surgery surge, while after the pregnancy rate was up to 78.3% after surgery.The rate of spontaneous abortion from 57.7% before the surgery was decreased to 16.7%. These data has statistical significance(P<0.01).Conclusion: 1. The major of clinical characteristics for OVSS was vaginal wall package block, dysmenorrhea, infertility, menstrual extension, vaginal discharge pus. 2.The incidence of OVSS is rare, and some of OVSS has no clinical characteristics,resulting in misdiagnosis. The misdiagnosis patients often are considered with pelvicabscess, menstrual cramps, ovulation obstructive abnormal uterine bleeding, and colpitis.. 3. The patients of OVSS treated by oblique vaginal septum surgery has small cut, and can quickly recovery. After the recovery, the patients has their obliquely across the side of the uterus, and the fertility would be improved. 5. Low pregnancy rate and high abortion rate of patients with OVSS have significantly improved by oblique vaginal septum surgery. 6.To promote the acknowledges of of OVSS is great important for early diagnosis, early treatment, and fertility. |
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