目的:探讨先天性肾上腺皮质增生症(CAH)患者行阴道成形术后行阴道镜(EUA-V)麻醉检查的应用。
方法:回顾性队列方法:对所有诊断为经典CAH的患者的术后随访护理进行了IRB批准的回顾性图表回顾,这些患者在三级儿童医院寻求治疗2000-2017年,并在该机构接受了阴道成形术。
结果:26例患者符合纳入标准。阴道成形术的中位年龄为1.25岁(IQR:0.67,9)。术后随访中位数为5.5年(IQR:1.5,9)。进行了26次EUA-V,22名患者四个用于并发症评估(直肠阴道瘘(1);尿道阴道瘘(3)-同一患者)。其余22辆EUA-V,对20名患者进行了手术,每人两名接受了两次EUA-Vs,计划进行阴道通畅性的常规评估。手术后,他们的年龄中位数为0.67岁(IQR:0.25,2),年龄中位数为6.67岁(IQR:1.75,12)。其中,五个EUA-V在五名患者(25%)中发现狭窄,手术后的中位数为0.91年(IQR:0.5,7),年龄中位数为8.42岁(IQR:2,10.92)。在没有接受EUA-V的四个人中,其中1人在经超声检查证实的血肿的临床检查中出现狭窄。其余三个在最后一次随访时都是青春期前。
结论:大多数阴道成形术后的CAH患者接受了常规的EUA-V,其中大约四分之一检测到狭窄。EUA-Vs可能在CAH患者阴道成形术后的常规术后护理中起有益作用。
OBJECTIVE: To explore the use of exam under anesthesia with vaginoscopy (EUA-V) following vaginoplasty in patients with congenital adrenal hyperplasia (CAH).
METHODS: Retrospective cohort METHODS: An IRB-approved retrospective chart review was performed of the post-surgical follow-up care of all patients diagnosed with classical CAH who sought care at a tertiary children\'s hospital from 2000-2017 and had undergone vaginoplasty at that institution.
RESULTS: Twenty-six patients met inclusion criteria. The median age at vaginoplasty was 1.25 years (IQR: 0.67, 9). Median post-surgical follow-up was 5.5 years (IQR: 1.5, 9). Twenty six EUA-Vs were performed, on 22 patients. Four were for complication assessment (rectovaginal fistula (1); urethrovaginal fistula (3)-on the same patient). The remaining 22 EUA-Vs, performed on 20 patients with two each undergoing two EUA-Vs, were planned for routine evaluation of vaginal patency. They were done a median of 0.67 years (IQR: 0.25, 2) following surgery and at a median of 6.67 years of age (IQR: 1.75, 12). Of these, five EUA-Vs identified
stenosis in five patients (25%), a median of 0.91 years (IQR: 0.5, 7) after surgery, at a median age of 8.42 years (IQR: 2, 10.92). Of the four who did not undergo EUA-V, one had
stenosis on clinical exam with ultrasound-verified hematocolpos. The remaining three were all prepubertal at last follow-up.
CONCLUSIONS: The majority of CAH patients following vaginoplasty underwent routine EUA-V, roughly a quarter of which detected
stenosis. EUA-Vs may play a beneficial role in routine post-op care following vaginoplasty in patients with CAH.