Clinical Features Analysis Of 35 Cases With Rudimentary Horn Of Uterus

Objective: The clinical features,diagnosis and treatment,pathology and prognosis of the rudimentary horn uterus were analyzed and discussed in order to provide further guidance for clinical diagnosis and treatment and to reduce misdiagnosis and mistreatment.Methods: By retrospectively analyzing the clinical features of 35 cases of rudimentary horn uterus admitted to XX Obstetrics And Gynecology Hospital from January 2003 to April 2017,the clinical features of the patients were collected and analyzed,including the patient's age,preoperative clinical manifestations,fertility history,auxiliary examination and its coincidence with the surgical diagnosis,pathological features and surgical methods and other informations,and by telephone,home visits and other clinical follow-up of clinical symptoms and fertility situation and other information.Results:1.Classification and clinical symptom characteristics: Among the 35 patients with rudimentary horn uterus,one patient belonged to type IIa(2.9%),16 type IIb(45.7%),and 18 type IIc(18.4%).Type IIa patients with symptoms of dysmenorrhea after cesarean section and progressive aggravation.Among the patients with type IIb,the main symptoms were dysmenorrhea,12 cases with dysmenorrhea,accounting for75%(12/16)in all IIb patients,5 patients(31.3%)with EMS,and 7 patients(43.8%)combined with pregnancy in rudimentary horn.Most Type IIc patients were asymptomatic,11(61.1%)were found accidentally during cesarean section,5(27.8%)had history of infertility or spontaneous abortion,and 4(22.2%)had dysmenorrhea.There were 7 cases of pregnancy in rudimentary horn,all of which were type IIb.The clinical features were as follows: 2 cases of varying degrees of abdominal pain,1 case of abortion failure in other hospital,4 cases of early pregnancy ultrasound examination revealed rudimentary horn pregnancy.There were 14 cases of pregnancy complicated with rudimentary horn uterus,of which 10 cases(71.4%)had abnormal fetal position,5cases(35.7%)had premature delivery,6 cases(42.9%)had premature rupture of membranes,2.Diagnostic value of Auxiliary examination: All 35 patients were examined by ultrasound before operation.12 cases were diagnosed as rudimentary horn uterus by ultrasound.The coincidence rate with postoperative diagnosis was 34.3%(12/35).The coincidence rates of preoperative two-dimensional ultrasound,three-dimensional ultrasound,MRI and postoperative diagnosis were 23.3%,100% and 100%respectively,.4 cases of during pregnancy were diagnosed as rudimentary horn uterus,Coincidence rate with postoperative diagnosis were 19%,and are in early pregnancy.Hysterosalpingography(HSG)and hysteroscopy for the diagnosis and classification of rudimentary horn uterus has some value,but compared with hysteroscopy,but compared with hysteroscopy,Hysterosalpingography can not improve the diagnostic rate of rudimentary horn uterus.Hysteroscopy has more advantages in observing the shape of uterine cavity and whether the uterine cavity is connected or not.3.Treatment and prognosis: Of the 14 patients diagnosed at nonpregnancy,9 of them received removal of rudimentary,including 2 cases of laparotomy,7 cases of laparoscopy and 5 cases of non-resection.At the same time,3 cases were treated with the removal of ovarian endometrioid cyst,while ipsilateral tubal resection in 5 cases.Among 21 cases diagnosed during pregnancy,9 patients received removal of rudimentary,There were 12 cases without resection,of which 1 case(type IIc)underwent tubal ligation at the same time and There were 7 cases(IIb type)of pregnancy in rudimentary horn,all of them underwent laparoscopic resection of rudimentary horn uterus and ipsilateral salpingium.In 17 cases with dysmenorrhea before operation,10 cases received removal of rudimentary,all of which disappeared after operation,of which 3 cases were lost to follow-up and 4 cases were not changed(all of them were untreated),and all the patients recovered well after operation,and no complications occurred.As of May 2017,Of the 18 patients who had fertility requirements after resection of rudimentary horn uterus,5 were pregnant after operation,all of whom were naturally conceived.of which 1 had rupture of the uterus at 39 weeks of gestation,and 2 had full-term pregnancy After vaginal delivery,Cesarean section due to abnormal fetal position in 2 cases of term pregnancy.Conclusion:1.The treatment of his age more common in adolescence and childbearing age.There was no significant difference between type IIb and type IIc.2.Type IIa can cause dysmenorrhea.Among the patients with type IIb,the main symptoms were dysmenorrhea,can also combined with EMS and pregnancy in rudimentary horn.Type IIc most of asymptomatic,often found by chance,the unilateral uterine pregnancy prone to premature birth,malformations and premature rupture of membranes and other complications.3.Ultrasonography is the first choice for diagnosis of rudimentary horn uterus,especially three-dimensional ultrasound.Magnetic resonance imaging(MRI)has unique advantages in the diagnosis of uterine malformation.Hysterosalpingography(HSG)is superior to hysteroscope in the diagnosis and typing of rudimentary horn uterus.4.Type IIa,type IIb rudimentary horn uterus,but once diagnosed,the rudimentary horn uterus and the affected salpingotomy should be performed as soon as possible.Type IIc rudimentary horn uterus,generally no clinical symptoms,may not make any treatment.In case of accidental discovery,it is still open to question whether ligation and resection of the affected fallopian tube.Pregnancy in rudimentary horn,excision of rudimentary horn uterus and ipsilateral fallopian tube should be performed immediately.