改良全腹腔镜乙状结肠代阴道成形术治疗MRKH综合征8例临床疗效分析  

Modified total laparoscopic sigmoid colon vaginoplasty in women with MRKH syndrome:clinical outcome of eight cases

作　　者：杨清[1] 殷丽丽[1] 朱连成[1] 王明乾[1] 

机构地区：[1]中国医科大学附属盛京医院妇产科,辽宁沈阳110004

出　　处：《中国实用妇科与产科杂志》2010年第9期698-700,共3页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨改良全腹腔镜乙状结肠代阴道成形术治疗Mayer—Rokitansky．Kuster—Hauser syndrome（MRKH综合征）的临床疗效。方法对中国医科大学附属盛京医院2006年6月至2009年4月收治的30例患者行腹腔镜乙状结肠代阴道成形术，其中8例在腹腔镜手术中，使用内镜线型切割闭合器切断乙状结肠移植肠段的近端和远端后，先经会阴于尿道膀胱与直肠之间造穴，经穴道将乙状结肠近端拉出．置入抵钉座荷包缝合包埋后送还腹腔内，自肛门插入腔内圆型吻合器，端端吻合乙状结肠，再将带血管蒂的移植肠段牵入穴道，完成阴道成形（改良组）。22例行腹腔镜辅助经腹壁下横切口于腹壁外处理肠管的乙状结肠代阴道手术（对照组）。对两组术式的可行性、手术参数进行对比，术后随访采用自尊量表调查的方式。结果30例术后乙状结肠吻合12均无感染及肠瘘发生，形成的阴道术后均无狭窄，阴道深度为11～13cm，阴道外口均似正常阴道，无术中和术后并发症的发生。改良组手术时间为（165．6±21．9）min，对照组（209．5±46．9）min（P〈0．05）；改良组术中失血量为（87．5±11．6）mL，对照组为（157．7±42．5）mL（P〈0．05）；自尊量表调查评分改良组平均为38分，对照组平均为36分（P〉0．05）。结论改良组经阴道造穴肠吻合手术方法是可行和安全的，使肠吻合过程操作简便，具有腹壁上不留辅助切口瘢痕，避免腹壁切口感染的优点，缩短了手术时间，手术效果较理想。Objective To summarize the clinical outcome of modified total laparoscopic sigmoid colon vaginoplasty in 8 patients with MRKH syndrome. Methods Thirty patients with MRKH syndrome underwent laparoscopic sigmoid colon vaginoplasty between June 2006 and April 2009 in Shengjing Hospital of China Medical University. Eight paitiens underwent modified total laparoscopic sigmoid colon vaginoplasty （ modified group）. The sigmoid colon transplant was transected laparoscopically between the proximal and distal end using the endoscopic linear cutter. An artificial canal was prepared between the urethravesica and the rectum through the perineum. The proximal end of the sigmoid colon was drawn out from the artificial canal. An anvil was placed in it and a purse-string suture was done. Then the sigmoid colon was pulled back into the peritoneal cavity. An end-to-end sigmoid colon anastomosis was created when a intraluminal curved stapler was inserted into the anus. The sigmoid colon transplant with the vessel pedicle was placed into the artificial canal to form a neovagina. Twenty-two patients underwent laparoscopically assisted sigmoid colon vaginoplasty（ control group）. The feasibility and operative technique were compared between two groups. Rosenberg Self-Esteem Scale（SES） was applied during postoperative follow up. Results There was no infection or leakage of sigmoid colon anastomotic stoma , and no postoperative stenosis of the neovagina and its length was 11 - 13cm . The external orifice of the neovagina was similar to a natural one. No complications occurred during or after the operation. The mean operation time and mean intraoperative blood loss were （165.6 ± 21.9）rain, （87.5 ±1.6）mL in the modified group, and （209.5 ±46.9）rain,（157.7 ± 42.5） mL in the control group respectively with significant difference （P 〈 0.05 ）. The score of SES was 38 in the modified group and 36 in the control group with no significant difference （P 〉 0.05）. Conclusion The mo.dified sigmoid colon anas

关 键 词：腹腔镜 乙状结肠移植 阴道畸形 阴道成形术 肠吻合 

分 类 号：R71[医药卫生—妇产科学]