腹腔镜下腹膜代阴道与乙状结肠代阴道成形术的疗效分析  

Efficacy of laparoscopic-assisted vaginoplasty using sigmoid colon or peritoneum for congenital absence of vagina

作　　者：卢春冬[1] 包碧惠[1,2] 陈勇[1] 梁小龙[1] 徐忠兰[1,3] 宋娟[1,4] 徐惠成[1] 

机构地区：[1]第三军医大学西南医院妇产科,重庆400038 [2]成都军区总医院妇产科,成都610083 [3]涪陵区妇幼保健院妇科,重庆408000 [4]成都军区机关第一门诊部,成都610011

出　　处：《第三军医大学学报》2016年第17期1963-1967,共5页Journal of Third Military Medical University

摘　　要：目的探讨腹腔镜下腹膜代阴道成形术与乙状结肠代阴道成形术对无阴道患者的疗效差异。方法对38例2010年1月至2014年12月西南医院妇产科收治的无阴道患者术前随机化完全区组设计进行腹腔镜下腹膜代阴道成形术(17例)和乙状结肠代阴道成形术(21例),对比分析2组患者的围手术期情况及术后随访疗效。结果腹膜代阴道成形术组手术时间、术中出血量、术后肛门排气及进食时间优于乙状结肠代阴道成形术组(P<0.01),但乙状结肠代阴道成形术组阴道长度优于腹膜代阴道成形术组(P<0.01),腹膜代阴道成形术组需术后长时间放置阴道模具。2组患者均未发生手术并发症,阴道通畅、红润,有6例乙状结肠代阴道患者阴道分泌物较多,但对性生活满意程度和阴道成形效果差异无统计学意义(P>0.05)。结论腹腔镜下腹膜代阴道成形术与乙状结肠代阴道成形术均可取得良好的预期疗效,腹腔镜腹膜代阴道成形术后放置模具扩张阴道更严格,但手术创伤小于乙状结肠代阴道成形术,手术各自的优势可实现先天性无阴道患者的个体化治疗。Objective To compare the therapeutic effects of laparoscopic peritoneal vaginoplasty and sigmoid vaginoplasty for the patients with congenital absence of vagina. Methods A total of 38 patients with congenital absence of vagina undergoing laparoscopie-assisted vaginoplasty in southwest hospital from January 2010 to December 2014 were enrolled in this study. Patients＇ clinical conditions in perioperative period and regular follow-up were comparatively analyzed between 17 randomly selected patients receiving laparoseopie peritoneal vaginoplasty and 21 patients sigmoid vaginoplasty. The peri-operative situation and post-operative outcomes during follow-up were observed and analyzed. Results Assisted laparoscopic vaginoplasty using peritoneum underwent a shorter operating time, less blood loss, much earlier for dieting and anorectum exhaust than those with sigmoid colon. But the neovaginas of the sigmoid group were better in the length and breadth of the vagina than that of the peritoneal group. The neovaginas of the peritoneal needed a mold in the artificial vagina for a prolonged period of dilatation after the operation. No peri-operative complications were seen in the both groups. All patients had a satisfactory smooth sensation of artificial vagina. Just 6 patients with sigmoid vaginoplasty complained of excessive mucus discharge. However, peritoneal and sigmoid colon laparoscopic vaginoplasty were similar in satisfactory sexual intercourse and physiological effects （P 〉 0.05 ）. Conclusion Both sigmoid colon and peritoneum can achieve the desired therapeutic effect in laparoscopic-assisted vaginoplasty. And yet, laparoscopic peritoneal vaginoplasty need more restrict in mold dilatation , but less trauma than sigmoid vaginoplasty to achieve a patent and functional vagina. With their respective advantages, 2 surgical options can offer individualized therapy to create a satisfied artificial vagina.

关 键 词：阴道缺失 腹腔镜下乙状结肠代阴道 腹腔镜下腹膜代阴道 临床疗效 

分 类 号：R572[医药卫生—消化系统] R711.1[医药卫生—内科学]