16年95例阴道成形术的临床分析  

Analysis on 95 Cases of Vaginal Reconstruction in 16 Years

作　　者：郝焰[1] 卢丹[1] 郑平[1] 张亚兰[1] 吴霞[1] 周琦[1] 段爱红[1] 

机构地区：[1]首都医科大学附属北京妇产医院妇科,北京100026

出　　处：《中国微创外科杂志》2011年第7期604-608,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨先天性无阴道的治疗方法。方法回顾性分析1995年1月1日～2010年12月31日95例阴道成形术的临床资料，并对自体皮片法（n=43）、腹腔镜腹膜法（n=13）及脱细胞异体真皮法（acellular dermal matrix，ADM）（n=10）三种术式的术中情况、术后住院时间以及随访情况等进行对比。结果（1）手术时间ADM法（54．4±7．7）min〈腹腔镜腹膜法（93．5±22．4）min〈自体皮片法（122．1±28．8）rain（P均=0．00）。术中出血ADM法（34．4±26．7）ml〈腹腔镜腹膜法（84．6±57．4）ml和自体皮片法（91．3±43．8）ml（P分别为0．02、0．00），腹腔镜腹膜法与自体皮片法差异无显著性（P=0．65）。术后住院时间ADM法（16．1±2．9）d和腹腔镜腹膜法（20．8±7．1）d〈自体皮片法（35．3±13．9）d（P均=0．00），ADM法与腹腔镜腹膜法差异无显著性（P=0．46）。（2）并发症情况：自体皮片法发生并发症12例（27．9％），其中3例皮瓣脱落，9例术后病率；腹腔镜腹膜法发生并发症6例（46．2％），1例阴道顶端缝线松脱，5例术后病率；ADM法发生并发症1例（10．0％），为术后病率。3组间并发症发生率及术后病率差异均无显著性（P〉0.05）。（3）术后随访情况：自体皮片法、腹腔镜腹膜法及ADM法阴道长度分别为（7．82±1．01）cm、（7．31±1．32）cm及（8．39±0．60）cm；阴道宽度≥3cm者三组分别有32、9、10例，三组比较差异无显著性（P分别=0．064、0．612）。结论应用ADM行阴道成形术，避免了自体移植的损伤和其他异体材料准备的繁琐，手术方法简单，手术风险降低，在阴道成形术的应用中具有一定前景。Objective To investigate therapeutic approaches for congenital absence of the vagina. Methods Clinical data of 95 patients with routine vaginal reconstruction since January 1st, 1995 to December 31st, 2010, were analyzed retrospectively. The patients received operation with the Mclndoe method （ group A, rt = 43） , laparoscopic vaginoplasty with the peritoneum （ group B, n = 13 ） , or acellular dermal matrix method （ADM, group C, n = 10） , respectively. The intraoperative data and postoperative hospital stay and follow-up data were compared among the three groups. Results Group C had the shortest operation time [ （54.4 ~ 7.7 ） minl, followed by group B and group A[（93. 5 - 22. 4） min and （122. 1 - 28. 8） min, respectively, all P = 0. 00]. The intraoperative blood loss and hospital stay in group C were significantly less than that in groups B and A I （34- 4 - 26.7 ） ml and （16. 1 -2.9） d vs. （84.6~57.4） ml and （20.8 ~7.1） d and （91.3 ~43.8） mland （35.3 ~13.9） d, P= 0.02 and0.00, and 0.00 and 0.00 respectively ] , no significant differences existed between groups B and A （ P = 0. 65 and 0. 46 respectively）. Complications occurred in 12 patients in group A （27.9%） , including 3 cases of flap loss and 9 cases with postoperative morbidity; 6 patients in group B, including 1 case of loosened suture at the top of the vagina and 5 cases of postoperative morbidity; and 1 case in group C （ 10% ） , which was postoperative morbidity. No significant difference existed in the rates of complications and postoperative morbidity （P 〉 0.05）. Postoperative examination showed significant difference in the length of the vagina [ group A ： （7.82 ~ 1.01 ） cm, group B： （7.31 21.32） cm, and group C： （8.39 20.60） cm, respectively], 32 cases in group A, 9 in group B, and l0 in group C had the vagina 〉1 3 em （P = 0. 064 and O. 612）. Conclusions ADM transvaginal reconstruction can avoid the injury to autologous transplant and the complicated allogeneic m

关 键 词：先天性无阴道 阴道成形术 脱细胞异体真皮 

分 类 号：R713.31[医药卫生—妇产科学]