Congenital cervical atresia staging diagnosis and staging treatment

  Department of Obstetrics and Gynecology, Fuyang Clinical College of Anhui Medical University, based on systematic research on the anatomical and pathological features of congenital cervical atresia cases, based on the theory of embryonic development and the experimentally confirmed hypothesis of female reproductive tract development, combined with the international classification of abnormal cervical development, proposed diagnostic criteria for cervical atresia typing, namely: Type I for normal isthmus of the uterus: atresia at the histological endoport of the uterus, above which the Type I is normal isthmus: the isthmus is atretic at the endometrium, the isthmus above it and the anatomical endometrium are normally developed, and the cervical canal is absent; Type II is atretic isthmus: the isthmus between the anatomical and histological endometrium is atretic, the cervical canal is absent, and most of them are associated with uterine body dysplasia; Type III is complete atresia of the cervix: the isthmus and cervical canal below the anatomical endometrium are completely atretic, and the length, diameter and shape of the atretic cervix are different, and most of them are associated with uterine Type IV is the type with absent isthmus: the lower end of the uterine body is directly connected to the cervical canal which is blinded, the anatomical internal opening of the uterus is not obvious, and the isthmus is absent.  According to the diagnostic criteria for cervical atresia, the surgical treatment plan for cervical atresia is as follows: for type I cervical atresia, the isthmus of the atretic uterus is an enlarged cystic cavity with blood accumulation, and the wall of the cyst is myxomatous tissue about 6 mm thick. Intermittent sutures are placed on the epithelial margin of the vaginal wall, so that the cervical canal wall is smooth after shaping, and no uterine tube is needed to prevent adhesions after surgery.  In type II and III patients, the atretic segment of the cervix is long and tough, so it is difficult to open it, and even if it is opened, it will be re-atretic, so the uterus should be removed and vaginoplasty should be performed before marriage. In addition, in these two types of cervical atresia, the cervix can be removed and the body of the uterus preserved, and the tip of the vagina is directly connected to the lower end of the cervix, but the lower port of the body of the uterus is open without a cervical mucus plug, which can lead to subsequent infection of the uterine cavity, and eventually the uterus should also be removed.  In type IV patients, because there is no isthmus in these patients, the lower segment of the uterus cannot be formed during pregnancy resulting in sterility. Whether to preserve the uterus can be based on the opinion of the affected party; if the uterus is preserved, all the traumatic surfaces from the built-in tube of the cervical canal to the ectocervix must be epithelialized and attention should be paid to contraception in the future.  The diagnosis and treatment of congenital cervical atresia can be done in a staged manner to avoid blindness in the treatment of congenital atresia. The research passed the expert appraisal organized by the Department of Science and Technology of Anhui Province in September 2007, and was awarded the third prize of the Science and Technology Progress Award of Anhui Province in 2009. The research results have demystified the atresia of the cervix, and the new typology of atresia of the cervix, compared with the traditional typology, can enable more than 60% of type I patients to be treated correctly and thus preserve the physiological and reproductive functions; type II and III patients can avoid the risk of hysterectomy despite the pain and risk of multiple surgeries, and then undergo vaginoplasty before marriage, without the embarrassment of having to go through a long period of adolescence with Patients with type IV have a choice of whether to keep their uterus or not, and they can avoid the harm caused by blind pregnancies and abortions by using wise contraception. The typing diagnosis is concise, intuitive and practical.