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女性下生殖道创伤的评估与处理

Authors
Gretchen Makai, MD
Marc R Laufer, MD
Section Editor
William J Mann, Jr, MD
Deputy Editor
Sandy J Falk, MD, FACOG
Translators
瞿全新, 主任医师，副教授

引言

对于所有诉阴道疼痛或生殖道出血或肿胀的女性儿童、青少年和成人，都应仔细检查，以寻找有无外阴或阴道的创伤或裂伤。还应谨记，外阴或阴道创伤的患者有时因作为主诉症状的腹痛或腰痛就诊。很容易发现外部损伤，但需要仔细评估损伤是否向深部延伸。内部创伤较难评估。

患者可能不愿意提供引起创伤的事件的细节，因此识别那些有风险的患者是处理的关键步骤。病史应该始终与体格检查结果一致；如果不一致，进一步询问很重要。必须始终考虑到性虐待或性侵犯的可能性。

病因

产科 — 宫颈、阴道和/或外阴撕裂伤通常发生在分娩过程中。与下生殖道创伤相关的产科危险因素包括未经产、巨大儿、急产、阴道助产和/或会阴切开术。 (参见“Operative vaginal delivery”和“肩难产：危险因素及相应高危妊娠时的计划分娩”和“会阴切开术方法概述”)

妇科

●外阴创伤—会阴血供丰富，因此创伤后有出血的风险。外阴血肿是最常见的后果。

成年女性大阴唇是由大的脂肪垫组成的，其作用是保护外阴免受损伤。相比之下，儿童该部位缺乏充分发育的脂肪垫，而且儿童经常玩游戏，容易发生外阴创伤；因此，儿童比成人更可能遭受外阴损伤。 (参见“儿童骑跨伤的评估和处理”)

                   

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Literature review current through: 2017-06 . | This topic last updated: 2017-07-06.
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References
Top
  1. Bond GR, Dowd MD, Landsman I, Rimsza M. Unintentional perineal injury in prepubescent girls: a multicenter, prospective report of 56 girls. Pediatrics 1995; 95:628.
  2. Merrit DF. Genital trauma. In: Pediatric & Adolescent Gynecology, 6th ed, Emans SJ, Laufer MR (Eds), Wolters Kluwer Lippincott Williams & Wilkins, Philadelphia 2012. p.293.
  3. Kanai M, Osada R, Maruyama K, et al. Warning from Nagano: increase of vulvar hematoma and/or lacerated injury caused by snowboarding. J Trauma 2001; 50:328.
  4. Merritt DF. Vulvar and genital trauma in pediatric and adolescent gynecology. Curr Opin Obstet Gynecol 2004; 16:371.
  5. Okur H, Küçïkaydin M, Kazez A, et al. Genitourinary tract injuries in girls. Br J Urol 1996; 78:446.
  6. Virgili A, Bianchi A, Mollica G, Corazza M. Serious hematoma of the vulva from a bicycle accident. A case report. J Reprod Med 2000; 45:662.
  7. Jana N, Santra D, Das D, et al. Nonobstetric lower genital tract injuries in rural India. Int J Gynaecol Obstet 2008; 103:26.
  8. Goldberg J, Horan C, O'Brien LM. Severe anorectal and vaginal injuries in a jet ski passenger. J Trauma 2004; 56:440.
  9. Niv J, Lessing JB, Hartuv J, Peyser MR. Vaginal injury resulting from sliding down a water chute. Am J Obstet Gynecol 1992; 166:930.
  10. Smith BL. Vaginal laceration caused by water skiing. J Emerg Nurs 1996; 22:156.
  11. Wilson F, Swartz DP. Coital injuries of the vagina. Obstet Gynecol 1972; 39:182.
  12. Emans SJ, Woods ER, Flagg NT, Freeman A. Genital findings in sexually abused, symptomatic and asymptomatic, girls. Pediatrics 1987; 79:778.
  13. Jones JS, Dunnuck C, Rossman L, et al. Significance of toluidine blue positive findings after speculum examination for sexual assault. Am J Emerg Med 2004; 22:201.
  14. Parker JD, Hibbert ML, Dainty LD, et al. Micro-hydrovaginoscopy in examining children. Obstet Gynecol 2000; 96:772.
  15. Goldman HB, Idom CB Jr, Dmochowski RR. Traumatic injuries of the female external genitalia and their association with urological injuries. J Urol 1998; 159:956.
  16. Netto Júnior NR, Ikari O, Zuppo VP. Traumatic rupture of female urethra. Urology 1983; 22:601.
  17. Niemi TA, Norton LW. Vaginal injuries in patients with pelvic fractures. J Trauma 1985; 25:547.
  18. Takayama T, Mugiya S, Ohira T, et al. Complete disruption of the female urethra. Int J Urol 1999; 6:50.
  19. Friedel W, Kaiser IH. Vaginal evisceration. Obstet Gynecol 1975; 45:315.
  20. Lal P, Mohan P, Sharma R, et al. Postcoital vaginal laceration in a patient presenting with signs of small bowel perforation: report of a case. Surg Today 2001; 31:466.
  21. McColgin SW, Williams LM, Sorrells TL, Morrison JC. Hemoperitoneum as a result of coital injury without associated vaginal injury. Am J Obstet Gynecol 1990; 163:1503.
  22. Sadler DW, Pounder DJ. Fatal air embolism occurring during consensual intercourse in a non-pregnant female. J Clin Forensic Med 1998; 5:77.
  23. American College of Obstetricians and Gynecologists. Antibiotic Prophylaxis for Gynecologic Procedures. Clinical Management Guidelines for Obstetrician-Gynecologists, ACOG bulletin Number 24, American College of Obstetricians and Gynecologists, Washington DC 2001. p.268.
  24. Minassian VA, Jazayeri A, Prien SD, et al. Randomized trial of lidocaine ointment versus placebo for the treatment of postpartum perineal pain. Obstet Gynecol 2002; 100:1239.
  25. Kettle C, Dowswell T, Ismail KM. Absorbable suture materials for primary repair of episiotomy and second degree tears. Cochrane Database Syst Rev 2010; :CD000006.
  26. Lundquist M, Olsson A, Nissen E, Norman M. Is it necessary to suture all lacerations after a vaginal delivery? Birth 2000; 27:79.
  27. Dhulkotia JS, Alazzam M, Galimberti A. Tisseel for management of traumatic postpartum haemorrhage. Arch Gynecol Obstet 2009; 279:437.
  28. Benrubi G, Neuman C, Nuss RC, Thompson RJ. Vulvar and vaginal hematomas: a retrospective study of conservative versus operative management. South Med J 1987; 80:991.
  29. Gianini GD, Method MW, Christman JE. Traumatic vulvar hematomas. Assessing and treating nonobstetric patients. Postgrad Med 1991; 89:115.
  30. Mok-Lin EY, Laufer MR. Management of vulvar hematomas: use of a Word catheter. J Pediatr Adolesc Gynecol 2009; 22:e156.
  31. Sachs, PB. Women's diagnostic imaging, case fifteen: Factor II deficiency with vulvar hematoma. www.uhrad.com (Accessed on May 03, 2012).
  32. Kunishima K, Takao H, Kato N, et al. Transarterial embolization of a nonpuerperal traumatic vulvar hematoma. Radiat Med 2008; 26:168.
  33. Whiteside JL, Asif RB, Novello RJ. Fibrin sealant for management of complicated obstetric lacerations. Obstet Gynecol 2010; 115:403.
  34. Harlow BL, Wise LA, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol 2001; 185:545.
  35. Munarriz R, Talakoub L, Somekh NN, et al. Characteristics of female patients with sexual dysfunction who also had a history of blunt perineal trauma. J Sex Marital Ther 2002; 28 Suppl 1:175.