改良腹腔镜腹膜代阴道成形术与腹腔镜辅助回肠代阴道成形术的对比研究  

Comparison between Modified Laparoscopic Peritoneum Vaginoplasty and Laparoscopy Assisted Ileum Vaginoplasty

作　　者：赵曌[1] 纪妹[1] 

机构地区：[1]郑州大学第一附属医院妇科,郑州450052

出　　处：《中国微创外科杂志》2013年第12期1073-1076,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：河南省卫生厅<改良腹腔镜下腹膜代阴道成形术与传统阴道成形术的对比研究>;编号:2011020032

摘　　要：目的 探讨改良腹腔镜腹膜代阴道成形术与腹腔镜辅助回肠代阴道成形术的疗效.方法 回顾性分析2011年6月-2013年6月我院60例先天性无阴道的临床资料,其中40例行改良腹腔镜腹膜代阴道成形术（腹膜组,n=40）,20例行腹腔镜辅助回肠代阴道成形术（回肠组,n=20）,对比2种术式的围手术期情况及术后疗效.结果 60例手术均成功.腹膜组手术时间（107.6±23.4）min明显短于回肠组（175.3±35.7）min（t=-8 819,P=0.000）;腹膜组术中出血量（23.2±1.8）ml显著少于回肠组（56.5±3.9）ml（t=-45.438,P=0.000）;腹膜组手术费用（4360±252）元明显少于回肠组（10 210±430）元（t=-66.471,P=0.000）;腹膜组术后住院时间（8.3±1.1）d明显短于回肠组（9.2±1.6）d（t=-2.557,P=0.013）;腹膜组无术后并发症,回肠组术后出现1例不全肠梗阻,保守治疗后痊愈,2组并发症发生率无统计学差异（Fisher＇s检验,P=0.333）.腹膜组人工阴道长度（7.5±2.1）cm与回肠组（8.5±3.4）cm无统计学差异（t=-1.405,P=0.165）.术后随访：2组人工阴道均可容2指,阴道壁黏膜粉红,弹性良好.腹膜组：3例人工阴道顶端出现肉芽组织,经切除、换药后愈合;阴道分泌物正常,1例已婚术后性生活满意,8例术后结婚,性生活满意.回肠组：阴道分泌物较多,无色水样液或黏液,无异味,但总量呈减少趋势,3个月后基本稳定;6例术后结婚,性生活基本满意.腹膜组9例性生活启动者女性性功能指数量表（female sexual function index,FSFI）总分（26.73±0.93）分,与回肠组6例性生活启动者FSFI总分（26.19±1.24）分比较无统计学差异（t=0.961,P=0.354）.结论 改良腹腔镜腹膜代阴道成形术与腹腔镜辅助回肠代阴道成形术均是满意可行的手术方式,但改良腹腔镜腹膜代阴道成形术手术时间短、术中出血量少、手术费用低,值得推广应用.Objective To investigate the efficacy of modified laparoscopic peritoneal vaginoplasty and the laparoscopic ileal vaginoplasty. Methods The clinical data of 60 cases of congenital absence of vagina from June 2011 to June 2013 were analyzed retrospectively, including 40 cases undergoing modified laparoscopic peritoneal vaginoplasty （modified vaginoplasty group） and 20 cases undergoing laparoscopic ileal vaginoplasty （ileal vaginoplasty group）. The perioperative and postoperative curative effect of the two groups were analyzed comparatively. Results All the 60 operations were successful. The operation time of modified vaginaoplasty group was （ 107.6 ± 23.4） min, significantly less than that of ileal vaginoplasty group [ （ 175. 3 ± 35.7 ） min; t = - 8. 819,P = 0. 000 ] ; the blood loss of modified vaginaoplasty group was （23. 2 ± 1. 8 ） ml, significantly less than that of ileal vaginoplasty group [ （56.5 ± 3.9 ） ml; t = - 45. 438, P = 0. 000 ] ; the operation costs of modified vaginoplasty group was （4360 ± 252） RMB, significantly less than that of ileal vaginoplasty group [ （10 210 ±430） RMB; t = -66. 471, P =0. 000] ; postoperative hospital stay of modified vaginoplastry group was shorter than that of ileal vaginoplasty group [ （8.3 ± 1.1 ） d vs. （9.2 ± 1.6） d; t = -2. 557 ,P = 0. 013 ]. No complication occurred in modified vaginoplastry group, while one case of the ileal group had incomplete intestinal obstruction and recovered after conservative treatment. No statistical difference was found between the two groups（ Fisher＇ s Exact Test,P = 0. 333 ）. The length of reconstructed vagina had no significant difference between the two groups [ （7.5 ± 2.1 ） cm vs. （ 8.5 ± 3.4） cm ; t = - 1. 405 ,P = 0. 165 ]. The follow-up showed that the width of artificial vagina of the two groups were 2 fingers in average with smooth and elastic mucosa. In the modified vaginoplastry group, 3 cases had granulation tissue on the top of the artificial vagina and recovere

关 键 词：腹腔镜 腹膜 回肠 阴道成形术 

分 类 号：R713.31[医药卫生—妇产科学]