肠道行阴道再造术后并发症的处理及观察  

Treatment of complications after vaginal reconstruction utilizing bowel,as well as follow-up observation

作　　者：王娟[1] 韩岩[1] 贾宝庆[2] 李秀丽[3] 马斌[2] 曾玮[1] 郭伶俐[1] 芦笛[1] 柴密[1] 

机构地区：[1]解放军总医院整形修复科,北京100853 [2]解放军总医院普通外科 [3]解放军总医院海南分院

出　　处：《中国美容整形外科杂志》2016年第8期476-479,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的分析在腹腔镜或达芬奇手术系统辅助下乙状结肠或回肠移植阴道再造术后肠管发生不同程度回缩的原因、处理方法并进行随访观察。方法回顾分析3例典型阴道再造术后肠管回缩病例，就术后肠管回缩发生原因、处理方法以及术后随访情况进行讨论。结果1例患者术后因肠管回缩约5．0cm，遗留创面较大，行双侧阴股沟皮瓣修复；2例患者肠管回缩程度轻微为2．0～3．0cm，经换药处理后创面呈肠管上皮化愈合。6个月后随访，患者外阴形态良好，再造阴道长度大于12．0cm，可容纳直径约3．2cm柱状假体，阴道无挛缩狭窄；肠镜检查提示肠黏膜炎症表现，局部增生。结论肠系膜长短、肠系膜动脉分支以及保留血管分支的位置是影响术后肠管回缩的重要因素。Objective To find out the causes of bowel retraction after vaginal reconstruction with sig- moid or ileum colon under laparoscopy or da Vinci robot. Methods Retrospective analysis was performed on 3 patients with bowel retraction after vaginal reconstruction and the postoperative causes, treatment methods and follow-up observation of bowel retraction were explored. Results The length of bowel retraction on 1 patient was about 5.0 cm, and it was reconstructed with pudendal thigh flap because of such a relatively large surface of wound. Length of bowel retraction ranging from 2.0 to 3.0 cm occurred on the other 2 patients and they were treated by dressing change techniques and finally the wound was epithelized with intestinal mucosa. After 6 months follow-up, there was good configuration of vulvae and the depth of the neovagina was more than 12.0 cm, the cavity was wide enough for cylindrical implant in 3.2 cm diameter without stenosis; the colonoscopy showed inflammation and local hyperplasia of mucosa. Conclusion The key factors of bowel retraction were insufficient length of mesentery, tension of bowel and insufficient blood supply of the distal anastomosis.

关 键 词：先天性无阴道 腹腔镜 阴道再造 肠移植 肠管回缩 

分 类 号：R713.3[医药卫生—妇产科学]