| Objective : To explore the clinical characteristics,diagnosis and treatment methods of oblique vaginal septum syndrome(OVSS),and to compare the differences between different types of OVSS.Method: A retrospective analysis of clinical data of 55 patients with OVSS in the Second Hospital of Hebei Medical University from July 2005 to June 2019 was divided into four types: type I(non-porous oblique septum type),type II(Perforated oblique septum type),type III(non-perforated oblique septum combined with cervical fistula type),and type IV(non-oblique oblique septum combined with oblique septal cervical atresia type).Compare the incidence characteristics,treatment,and clinical manifestations of different types of OVSS There were also differences in surgical methods and urinary tract malformations.Follow-up of patients with postoperative symptoms improved and pregnancy outcomes.Result:1.Of the 55 OVSS patients,23 were Type I(41.8%),24 were Type II(43.6%),2 were Type III(3.6%),and 6 were Type IV(10.9%).2.The average age of consultation was(18.38 ± 6.24)years.The average ages of patients with type I to IV were(13.57 ± 3.50)years,(21.58 ± 5.57)years,(21.50 ± 2.12)years,and(23.00 ± 6.07)years.The median time from menarche to the discovery of the disease was 1.5 years.The median time from menarche to discovery of the disease in patients with type I to IV was 0.4 years,7 years,7 years,and 7.5 years,respectively.There was a statistically significant difference in the average age of visiting patients and the time between menarche and discovery of the disease between type I and type II patients(P <0.05).3.All 55 patients underwent gynecological examination,pelvic and urinary ultrasound examination.The blood routine examination rate of 55 ovss patients was 100%,and the average white blood cell count was(7.99 ± 2.86)* 10 ^ 9 / L.Among them,type I to IV white blood cell counts are(8.23 ± 2.00)* 10 ^ 9 / L,(7.38 ± 2.38)* 10 ^ 9 / L,(5.10 ± 0.14)* 10 ^ 9 / L,and(10.43 ± 5.68)* 10 ^ 9 / L.There was no statistically significant difference between type I and type II white blood cell counts(P> 0.05).4.OVSS patients have various clinical manifestations.Patients of type I,III and IV were mainly treated with periodic lower abdominal pain,accounting for 69.6%(16/23),50%(1/2)and 33.3%(2/6).The main reasons for visiting of type II were periodic lower abdominal pain,menstrual dripping bleeding,or abnormal secretions,which accounted for 33.3%(8/24),16.7%(4/24),and 16.7%(4/24),respectively.5.The longest menstrual period in OVSS patients averaged(6.9 ± 2.70)days,28 cases of vaginal wall cysts,the median diameter of the cysts was 6(5.0,8.0)cm,and the number of cases with effective vaginal blood volume was 15 cases,including 8 cases of type I and 7 cases of type II,with median volume of 40(21.25,125.0)ml and 30(10.0,50.0)ml,respectively.There was no significant difference between type I and type II in the longest menstrual periods,maximum diameter of vaginal wall cysts,and vaginal blood volume(P> 0.05).6.Of the 55 cases of OVSS,63.6%(35/55)were right oblique septum and 36.4%(20/55)were left oblique septum.In 87.3%(48/55)of patients with urinary tract malformations,renal defects are most common,all on the same side of the oblique septum,of which 54.5%(30/55)are combined with right renal defects,and 27.3%(15/55)are combined with left renal malformation.There was no significant difference in the location of type I and type II renal deficiency(P> 0.05).7.Treatment method: All patients were treated with surgery,and the surgical rate was 100%.Among them,type I is mainly consisted of hysteroscopic oblique septum resection,type II has a variety of surgical methods,type III 100%(2/2)consisted of direct transvaginal oblique septum resection,type IV 100%(6/6)consisted of vaginal oblique septum resection and laparoscopic hysterectomy on the affected side.8.Follow-up: Fifty-five patients were followed up in 43 cases and lost to follow-up in 12 cases.The follow-up rate was 78.2%(43/55),and the median follow-up time was 5.9 years.The remission rates of type I to IV dysmenorrhea were 100(18/18),90.9%(10/11),100(1/1),and 100%(3/3).41.9%(18/43)of the patients were married,10 of which had postoperative fertility requirements,and 60%(6/10)of whom were successfully pregnant,all of them were conceived in the contralateral uterus of the oblique septum.Conclusions:1.The onset of OVSS is mainly after menarche.The severity of symptoms is related to the degree of obstruction.The age of complete obstruction is earlier than that of patients with incomplete obstruction.The age of onset of type I is less than II to IV,and the time from onset of type I to menarche is shorter than that.2.The clinical manifestations of OVSS are mainly periodic lower abdominal pain and vaginal dripping bleeding,and lacking specificity.Clinical attention should be paid to prevent misdiagnosis and missed diagnosis.3.OVSS is often associated with urinary system malformation,which is dominated by kidney deficiency,with right kidney deficiency more often than left kidney deficiency.4.For the treatment of OVSS,the first choice is to perform vaginal oblique septum resection,and a personalized plan should be developed according to the conditions of the pelvis and abdomen and the complications.5.To strengthen the understanding of OVSS,early diagnosis and treatment can significantly relieve symptoms,reduce complications,protect the fertility of patients,and benefit their physical and mental health. |
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