悬吊式腹腔镜行乙状结肠代阴道成形术31例  

Abdominal Wall Lifting Laparoscopic Sigmoid Colon Vaginoplasty: Report of 31 Cases

作　　者：王焕英[1] 王君[1] 伍冀湘[2] 李斌[1] 

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

出　　处：《中国微创外科杂志》2011年第9期805-807,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨悬吊式腹腔镜行乙状结肠代阴道成形术的临床效果。方法回顾性分析2007年1月-2009年12月31例悬吊式腹腔镜乙状结肠代阴道成形术的临床资料,其中先天性无阴道29例,男性易性癖阴道成形术后人工阴道狭窄2例。手术时在骶岬高度截取乙状结肠肠襻（13 cm左右）,超声刀游离乙状结肠系膜,直线切割闭合器切断闭合选取的乙状结肠,缝合关闭移植肠襻的顶端,乙状结肠的近端荷包缝合并放入抵钉座,圆形吻合器行乙状结肠端端吻合术。转阴式人工阴道建腔,将移植段乙状结肠远端拉出阴道隐窝,与阴道前庭黏膜间断缝合,形成人工阴道口,人工阴道顶端与骶岬处腹膜缝合固定。结果 31例手术均获得成功,手术时间100-200 min,平均144.7 min;术中出血50-200 ml,平均104.8 ml。1例术后12天出现粘连性不全肠梗阻,经保守治疗治愈。31例随访14-22个月,平均18个月,均佩带阴道模具达3个月以上,人工阴道扩张良好,接近女性阴道的形态和生理功能,分泌物为少量乳白色黏液,无异味。有性生活者25例,均满意。结论悬吊式腹腔镜行乙状结肠代阴道成形手术临床可行,是可选择的阴道成形方法之一。Objective To study the clinical effectiveness of abdominal wall lifting laparoscopic sigmoid colon vaginoplasty.Methods We reviewed the clinical data of 31 cases of gasless laparoscopic vaginoplasty using a vascularized pedicled sigmoid colon flap from January 2007 to December 2009.The cases included 29 patients with congenital absence of the vagina,and 2 cases of male transsexual.A 13-cm transplantation sigmoid colon segment was selected at the level of thesacrum point.The mesentery was separated by ultrasonic knife,and then the sigmoid colon segment was cut and closed with Endo-Cutter.The distal end was permanently sealed to form the apex of neovagina,and a purse-string suture was placed in the distal end of descending colon to accommodate the anvil of the end-to-end stapler,the anastomosis was created by the curved and straight intraluminal stapler to restore the bowel continuity.The vaginal mucomembrane at the pit of the vaginal vestibule was cut and the space between the urethra,bladder and rectum was bluntly separated upward to the Douglas pouch to make it big enough as an artificial vaginal cavity.Afterwards,the distant end of the transplantation sigmoid colon segment was pulled into the cavity and sutured with the mucous membrane at the pit of the vaginal vestibule with interrupted sutures to establish an artificial vaginal orifice.The apex of the artificial vagina was then sutured and fixed with the peritoneum at the level of the sacrum point.Results The sigmoid colon vaginoplasty was preformed successfully in all of the 31 cases.The operation time was 100-200 min（mean,144.7 min）.Intraoperative blood loss was 50-200 ml（mean,104.8 ml）.One of the patients had an operative complication consisting of an intestinal adhesive obstruction 12 days after operation and was then cured by conservative treatments.A follow-up was employed for 14-22 months（average 18 months） in the 31 cases with a vaginal mould over 3 months.The appearance and physical functions of the artificial vaginas were similar to fema

关 键 词：悬吊式腹腔镜 阴道成形 先天性无阴道 乙状结肠 

分 类 号：R713.31[医药卫生—妇产科学]