CAJ | 학술논문

目的探讨女童异常阴道出血的病因.方法收集武汉市儿童医院内分泌科住院部2009年3月至2013年10月接诊的65例异常阴道出血女童的资料,通过调阅病历、进行随访获取资料.采用盆腔彩超、骨龄片、宫腔镜、激素水甲检测以及基因检测等方法对65例3个月～10岁女童异常阴道出血的病因进行分析.结果 65例患儿中37例有乳房增大,21例伴乳头、乳晕、外阴色素沉着,16例伴外阴分泌物增多、异味,21例有身高增长加速,5例伴腹痛,6例有皮肤牛奶咖啡斑.阴道出血的病因主要为性早熟,其中外周性性早熟占首位(30/65例,46.2％),其次为中枢性性早熟(20/65例,30.8％),另外包括阴道炎症(8/65例,12.3％)、阴道异物(6/65例,6.2％)和生殖道肿瘤(3/65例,4.6％).30例外周性性早熟患儿中包括外源性性早熟11例(16.9％),孤立性卵巢囊肿、McCune-Albright综合征各8例(各占12.3％),卵巢肿瘤3例.20例中枢性性早熟患儿中包括特发性中枢性性早熟12例(18.5％),中枢神经系统器质性病变导致的中枢性性早熟4例(6.2％),甲状腺功能减低症4例(6.2％).65例患儿中12例失访,1例放弃治疗,其余根据不同的病因进行相应的治疗后阴道出血均得到有效控制,随访3个月～2.5年,均未发生再次出血情况,但有2例孤立性卵巢囊肿、3例McCune-Albright综合征患儿转化为中枢性性早熟.结论内分泌相关性疾病是引起女童阴道出血的常见病因.恶性肿瘤在儿童阴道出血中并不罕见.
목적 탐토녀동이상음도출혈적병인.방법 수집무한시인동의원내분비과주원부2009년3월지2013년10월접진적65례이상음도출혈녀동적자료,통과조열병력、진행수방획취자료.채용분강채초、골령편、궁강경、격소수갑검측이급기인검측등방법대65례3개월～10세녀동이상음도출혈적병인진행분석.결과 65례환인중37례유유방증대,21례반유두、유훈、외음색소침착,16례반외음분비물증다、이미,21례유신고증장가속,5례반복통,6례유피부우내가배반.음도출혈적병인주요위성조숙,기중외주성성조숙점수위(30/65례,46.2％),기차위중추성성조숙(20/65례,30.8％),령외포괄음도염증(8/65례,12.3％)、음도이물(6/65례,6.2％)화생식도종류(3/65례,4.6％).30예외주성성조숙환인중포괄외원성성조숙11례(16.9％),고립성란소낭종、McCune-Albright종합정각8례(각점12.3％),란소종류3례.20례중추성성조숙환인중포괄특발성중추성성조숙12례(18.5％),중추신경계통기질성병변도치적중추성성조숙4례(6.2％),갑상선공능감저증4례(6.2％).65례환인중12례실방,1례방기치료,기여근거불동적병인진행상응적치료후음도출혈균득도유효공제,수방3개월～2.5년,균미발생재차출혈정황,단유2례고립성란소낭종、3례McCune-Albright종합정환인전화위중추성성조숙.결론 내분비상관성질병시인기녀동음도출혈적상견병인.악성종류재인동음도출혈중병불한견.
Objective To investigate the etiological factors fc,r abnormal vaginal bleeding in girls.Methods Data of 65 female children aged from 3 months and 10 years old with abnormal vaginal bleeding,who were treated in Department of Endocrinology,Wnhan Children's Hospital from March 2009 to October 2013 were collected by using medical records and follow-ups.By means of pelvic ultrasound,bone age assessment,hysteroscope,hormone level and genetic testing,the causes of the disease were analyzed.Results Of 65 patients,37 cases had breast developed,21 ca-ses had nipple,areola and vulva pigmentation increased,16 cases with genital secretions increasing and odor,the height growth in 21 cases accelerated,abdominal pain was presented in 5 cases,and 6 cases had skin milk coffee spots.The leading etiological factors for vaginal hemorrhage in these girls were sexual precocity.The peripheral precocious puberty accounted for the first place (30/65 cases,46.2％),and followed by the central precocious puberty (20/65 cases,30.8 ％).Hyperphlogosis accounted for 12.3 ％ (8/65 cases),vaginal foreign body accounted for 6.2 ％ (6/65 cases),and genital tract tumors accounted for 4.6％ (3/65 cases).In the 30 peripheral precocious puberty cases,exogenous precocious puberty accounted for 16.9％ (11 cases),8 cases(12.3％) were of solitary ovarian cyst,8 cases(12.3％) of McCune-Albright syndrome,and 3 cases of ovarian tumors.In the 20 central precocious puberty cases,idiopathic central precocious puberty accounted for 18.5％ (12 cases),4 cases(6.2％) were of organic disease of central nervous system,and 4 cases (6.2％) of hypothyroidism.Of 65 children,12 cases lost follow-up and 1 case abandoned treatment.The rests received appropriate treatment according to different causes,and the vaginal bleeding were effectively controlled after 3 months to 2.5 years of follow-ups without recurrence of bleeding.But there were 2 cases of isolated ovarian cyst and 3 cases of McCune-Albright syndrome turned into central precocious puberty.Conclusions Endocrine diseases are the common factors for children's vaginal bleeding.Neoplasm is not rare in girl's abnormal vaginal hemorrhage.