脱细胞同种异体真皮与口腔黏膜及自体皮肤混合微粒移植再造阴道  

EFFECTIVENESS OF VAGINOPLASTY WITH ACELLULAR DERMAL MATRIX AND MIXED PARTICLES GRAFT

作　　者：周宇[1] 李强[1] 李森恺[1] 周传德[1] 李峰永[1] 曹玉娇[1] 张思娅[1] 魏蜀一[1] 赵阳[1] 

机构地区：[1]中国协和医科大学中国医学科学院整形外科医院整形十科,北京100144

出　　处：《中国修复重建外科杂志》2015年第6期761-765,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨在口腔黏膜及自体皮肤混合微粒移植基础上联合脱细胞同种异体真皮再造阴道的疗效。方法 2006年7月-2013年6月,收治67例先天性无阴道患者。其中47例采用单纯口腔黏膜及自体皮肤混合微粒（对照组）再造阴道,20例联合脱细胞同种异体真皮（试验组）。两组患者年龄比较差异无统计学意义（t=0.233,P=0.816）。比较两组再造阴道深度、周径、容积,创面上皮化时间及脱离模具时间,以及术后有性生活患者的女性性功能量表（FSFI）评分。结果 两组手术时间、术中出血量比较,差异均无统计学意义（t=—1.922,P=0.059;t=0.398,P=0.692）。两组患者术后均获随访,随访时间11～38个月,平均16.08个月;其中试验组15例、对照组29例有性生活。对照组4例、试验组2例出现术后出血,但再造阴道未出现狭窄。两组创面上皮化时间比较,差异无统计学意义（t=—1.938,P=0.057）,但试验组术后脱离模具时间显著短于对照组（t=7.020,P=0.000）。随访观察见再造阴道湿润、光滑、富有弹性,内无毛发生长。末次随访时,两组再造阴道深度、周径及容积比较,差异均无统计学意义（P〉0.05）。除对照组1例患者FSFI评分〈23分、诊断为性功能不良外,其余患者性功能均正常。两组FSFI评分以及各项评分比较,差异均无统计学意义（P〉0.05）。结论 在口腔黏膜及自体皮肤混合微粒移植基础上联合脱细胞同种异体真皮再造阴道,具有创伤小、外观及性功能恢复正常,且口腔供区无破坏的优点。脱细胞同种异体真皮能提供可靠支架结构,有效抵抗腔穴挛缩,弥补了混合微粒再造术后需长期佩戴模具的不足。Objective To evaluate the effectiveness of acellular dermal matrix （ADM） with autologous buccal micro mucosa and micro skin graft in vaginoplasty. Methods A retrospective analysis was made on the clinical data of 67 patients with vaginal agenesis treated between July 2006 and June 2013. ADM and mixed particles were used in 20 cases （ADM group） and mixed particles graft in 47 cases （control group） in vaginoplasty. There was no significant difference in age between 2 groups （t=0.233, P=0.816）. The depth, diameter, and volume of neovagina, epithelization time, stent needing time, and female sexual function index （FSFI） score were compared between 2 groups. Results There was no significant difference in operation time and amount of bleeding between 2 groups （t= -1.922, P=0.059; t=0.398, P=0.692）. The patients were followed up 11-38 months （mean, 16.08 months）. Fifteen cases in ADM group and 29 cases in control group had sexual life after operation. Bleeding after operation occurred in 6 cases （2 in ADM group and 4 in control group）. No stenosis was observed. Difference in epithelization time was not statistically significant （t= -1.938, P=0.057）. However, the stent needing time of ADM group was significantly shorter than that of control group （t=7.020, P=0.000）. The neovagina was ideal in wetness degree, smoothness, flexibility, and hairlessness during foUow-up. The depth, diameter, and volume of vagina had no significant difference between 2 groups （P〉0.05） at last follow-up, which were close to normal vagina. The other patients had normal sexual function except 1 patient whose FSFI score was less than 23; no statistically significant difference was found in FSFI score between 2 groups （P〉0.05）. Conclusion On the basis of mixed particles grafting, the ADM could improve trestle structure for resisting contracture. The effectiveness is better than merely mixed particles graft. The procedure has satisfactory anatomical and functional results.

关 键 词：阴道再造 口腔黏膜微粒 脱细胞同种异体真皮 先天性无阴道 

分 类 号：R713.3[医药卫生—妇产科学]