腹腔镜下带血管蒂回肠移植阴道成形术2种术式比较  

Comparison on two methods of laparoscopic colpopoiesis using a vascularized pedicled ileal flap

作　　者：沙立春[1] 范颖[2] 李斌[2] 伍冀湘[3] 

机构地区：[1]北京普仁医院妇产科,北京100062 [2]首都医科大学附属北京安贞医院妇产科,北京100029 [3]北京普仁医院普外科,北京100062

出　　处：《中国微创外科杂志》2007年第3期215-218,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的总结全腹腔镜和腹腔镜辅助下带血管蒂回肠移植再造阴道2种术式的临床效果。方法2004年1月-2005年11月我院行腹腔镜下带血管蒂回肠移植阴道成形术40例,其中全腹腔镜下回肠代阴道成形术18例(全腹腔镜组):腹腔镜引导下,配合使用超声刀、直线切割闭合器,不开腹完成肠系膜分离、回肠段切取、肠端吻合、回肠段下拉移植成形阴道;腹腔镜辅助下回肠代阴道成形术22例(腹腔镜辅助组):腹腔镜下选择移植肠段,肠系膜游离后,延长耻骨联合上穿刺孔至3-4 cm进入腹腔,经该切口将回肠拉出腹腔外,直视下切取移植肠襻及回肠端端吻合术,将移植肠段及吻合后的回肠送入腹腔,腹腔镜辅助下造洞穴,打开盆底腹膜,完成回肠段下拉移植成形阴道。结果40例手术均获得成功。全腹腔镜组与腹腔镜辅助组术中出血量、术后排气时间、住院时间无统计学差异,分别为(48.1±9.4)ml vs.(50.5±7.7)ml(t=-0.888,P=0.380),(33.9±9.1)h vs.(33.3±8.3)h(t=0.218,P=0.829),(12.3±2.4)d vs.(11.4±2.0)d(t=1.294,P=0.203)。全腹腔镜组手术时间、住院费用显著高于腹腔镜辅助组,分别为(213.2±37.4)min vs.(139.2±29.5)min(t=6.999,P=0.000),(22 386.5±2153.7)元vs.(10 027.4±1758.5)元(t=19.991,P=0.000)。40例随访3-18个月,平均13个月,移植回肠段成活良好,再造阴道符合生理要求。结论全腹腔镜下回肠代阴道手术在腹壁上不留手术瘢痕,美容效果理想,但操作难度大,费用较高;腹腔镜辅助下回肠代阴道成形,腹壁留有小手术瘢痕,操作简便,手术时间短,手术费用低,可根据患者需求选择相应术式。Objective To compare clinical outcomes between total laparoscopic and laparoscopic assisted vaginoplasty using a vascularized pedicled ileal flap. Methods Total laparoscopic or laparoscopic assisted vaginoplasty using a vascularized pedicled ileal flap was preformed in 40 patients between January 2004 and November 2005.For total laparoscopic operation(18 patients): under laparoscopic visualization and by using the harmonic scalpel and the endo-GIA stapler,an ileal segment on its vascular pedicle was isolated and pulled to reach the perineum through the neovaginal tract.For laparoscopic assisted vaginoplasty(22 patients): an ileal segment on its vascular pedicle was selected under laparoscope and was directly dissected outside the abdomen through an enlarged point incision(3~4 cm) above the pubic symphysis;then the ileal continuity was restored immediately by end-to-end anastomosis;finally the ileal flap was introduced back to the abdomen and pulled through via the neovaginal tract to the perineum under laparoscope,with an opening made on the flap sutured to the perineal skin.Results The colpopoiesis was performed successfully in all the 40 patients.There were no significant differences between total laparoscopic operation and laparoscopic assisted operation in intraoperative hemorrhage volume(48.1±9.4 ml vs 50.5±7.7 ml;t=-0.888,P=0.380),time to first postoperative passing flatus(33.9±9.1 h vs 33.3±8.3 h;t=0.218,P=0.829),and duration of hospital stay(12.3±2.4 d vs 11.4±2.0 d;t=1.294,P=0.203).Compared with total laparoscopic vaginoplasty,laparoscopic assisted vaginoplasty presented advantages of less time-consuming(139.2±29.5 min vs 213.2±37.4 min;t=6.999,P=0.000) and less hospitalization costs(10 027.4±1758.5 yuan vs 22 386.5±2153.7 yuan;t=19.991,P=0.000).During a follow-up for 3~18 months(mean,13 months),all the 40 patients got satisfactory neovaginal function similar to that of normal vagina.Conclusions Compared with laparoscopic assisted vaginoplasty,total laparoscopic vaginoplasty has advantages of m

关 键 词：阴道成形术 腹腔镜 回肠 

分 类 号：R713[医药卫生—妇产科学]