自体微粒口腔黏膜移植在阴道成形术中的应用  

CLINICAL APPLICATION OF AUTOLOGOUS BUCCAL MICRO-MUCOSA GRAFT IN VAGINAL RECONSTRUCTION

作　　者：赵穆欣[1] 李强[1] 李鹏程[1,2] 周传德[1] 段晨旺[1] 黄循镭[1] 陈斌[1] 刘晓吉[1] 李森恺[1] 

机构地区：[1]中国医学科学院北京协和医学院整形外科医院南二病房,北京100144 [2]解放军总医院第二附属医院泌尿一科

出　　处：《中国修复重建外科杂志》2009年第3期309-312,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：中国医学科学院整形外科医院院所基金~~

摘　　要：目的探讨自体微粒口腔黏膜移植在阴道成形术中的应用疗效。方法2007年3月-2008年4月,收治9例先天性无阴道及1例阴道再造术后7年继发阴道狭窄患者。年龄18～31岁,平均26岁。患者第二性征发育正常,阴道前庭处未探及阴道或仅有浅凹陷,双侧卵巢正常,激素水平正常,染色体均为46,XX。B超示阴道狭窄患者的子宫正常,余均为无子宫或始基子宫。术中取患者双侧6.0cm×2.5cm的口腔黏膜,将其剪碎成直径约0.5mm的微粒,移植于直肠与尿道之间的阴道再造腔穴。结果阴道成形术手术时间为1～2h,术中出血80～100mL。1例因包扎压力不足于术后1d继发出血,对症处理后愈合;其余9例无术后并发症发生。10例均获随访,随访时间4～16个月。再造阴道深6～10cm,黏膜光滑红润,弹性好,近阴道外口处阴道壁可见皱襞,病理检查示复层鳞状上皮。外阴外观与正常女性相似,无手术瘢痕。口腔内供黏膜区域无继发畸形。4例已婚妇女性交时均未出现疼痛、出血。余患者无性生活。结论自体微粒口腔黏膜移植阴道成形术,疗效可靠,创伤小,口腔及外阴形态无破坏,使阴道再造手术简便易行。Objective To investigate theffe ect of vaginal reconstruction with autologous buccal micro-mucosa graft. Methods From March 2007 and April 2008,10 patients with absence of vagina were treated,aged 18-31 years （mean 26 years）. Nine of them were congenital absence of vagina,and the remaining one was vaginal stenosis after vaginal reconstruction. They all exhibited normal secondary sexual characteristics,normal hormonal levels and 46,XX karyotype. Their abdominal ultrasounography revealed the normal ovaries and tubes but absence of the uterus or small rudimentary horns. However the one with vaginal stenosis had normal uterus. The buccal mucosa graft was minced into 0.5 mm in size and was transplanted to the cavity which was dissected between the bladder and the rectum. Results The operation was performed successfully in all cases. The operative time was about 1-2 hours and operative blood loss was 80-100 mL. Postoperative complication occurred in only one case for vaginal bleeding. The patient recovered and the wound healed well after immediate management. The others healed primarily without any complications. All cases were followed up for 4-16 months. The depth of neovagina which was formed was 6-10 cm and the width was about two ngers. The lining was pink-colored and smooth,and was con rmed as nonkeratizing squamous strati ed mucosa by histopathological examination. The donor sites healed uneventfully with no change in mouth opening. The perineal area was not disturbed. Four patients were married and satis ed with their sexual life without pain and bleeding. Conclusion Vaginal reconstruction with autologous buccal micro-mucosa graft is an easy,minimally invasive and useful method.

关 键 词：阴道缺如 口腔黏膜 微粒黏膜移植 阴道再造 

分 类 号：R713.31[医药卫生—妇产科学] R711.1[医药卫生—临床医学]