腹腔镜下腹膜代阴道成形术的阴道模具使用和性生活满意度测评  

Use of vaginal moulds and sexual satisfaction after laparoscopic peritoneal vaginoplasty

作　　者：陆子阳 肖喜荣 诸葛听 李斌 顾超 

机构地区：[1]复旦大学附属妇产科医院妇产科,上海200011

出　　处：《上海医学》2017年第10期593-597,共5页Shanghai Medical Journal

摘　　要：目的评价腹腔镜下腹膜代阴道成形术的疗效,了解术后放置阴道模具和开始规律性生活的最佳时间,以及患者术后性生活满意度。方法选取2006年1月—2013年1月间在复旦大学附属妇产科医院明确诊断为MRKH(Mayer-Rokitansky-Küster-Hauser)综合征并接受改良式腹腔镜下腹膜代阴道成形术的患者(MRKH组)22例,另选取同期进行健康体格检查的32名健康女性(对照组),根据年龄按与MRKH组2:1配对进行随访。2013年8月对两组患者进行女性性功能指数调查(FSFI)量表评分,2017年8月对MRKH组患者进行FSFI量表评分,并记录MRKH患者术后放置阴道模具时间和开始规律性生活时间。通过拟合方程,得出患者术后方置阴道模具和开始规律性生活的最佳时间。结果 MRKH组均顺利完成腹腔镜下腹膜代阴道成形术,术中无1例患者发生膀胱、尿道损伤或直肠破裂等并发症。患者接受手术的平均年龄为(22.9±2.7)岁,平均手术时间为(93.4±25.1)min,平均术中出血量为(81.3±44.5)mL,术中平均阴道长度为(10.4±1.4)cm,术后平均住院日为(8.6±1.9)d。MRKH组16例接受随访(随访率为72.8%),术后均有性生活,术后放置阴道模具的平均时间为(12.5±5.6)个月,术后开始规律性生活的平均时间为(8.0±3.5)个月。两组间2013年8月的FSFI量表各项得分和总分的差异均无统计学意义(P值均>0.05)。MRKH组2017年8月的阴道润滑得分显著低于2013年8月(P<0.01),性欲望、性唤起、性高潮、性满意度、性交痛得分和总分与2013年8月间的差异均无统计学意义(P值均>0.05)。选取术后放置阴道模具时间和开始规律性生活时间这两个因素中决定系数(R^2)最大的两个方程(即多项式方程)进行拟合分析。术后放置阴道模具时间的回归方程为y=-0.028 7x^2+0.399 2x+25.537,当放置阴道模具时间为术后6.9个月时,FSFI量表总分最高;术后开始规律性生活时间的回归方程为y=-0.109 4x^2+1.215 1x+23.Objective To evaluate the curative effect of laparoscopic peritonealvaginoplasty and patients~ satisfaction, and to seek out the optimal time of wearing vaginal moulds and starting regular sex life after surgery. Methods in this retrospective analysis, 22 patients diagnosed as Mayer-Rokitansky-Kuster-Hauser （MRKH） syndrome and treated by modified laparoscopic peritonealvaginoplasty in our hospital between January 2006 and January 2013 were assigned to MRKH group. Meanwhile, 32 healthy women undergoing physical examination were enrolled into control group. According to the age, they were followed up at a ratio of 2 ： 1 between control group and MRKH group. Female sexual function index（FSFI） questionnaire was used for the management of the follow-up in August 2013 and August 2017. The time of wearing vaginal moulds and starting regular sex life after surgery were recorded. And the optimal time were calculated by fitting equation. ResultsThe vaginoplasty was performed successfully in all the 22 MRKH patients. No injury of urethra or bladder, or rectal rupture occurred. The mean age of the MRKH patients was （22.9 ±2.7} years. The average surgical time was （93.4 ±25.1 ） minutes and blood loss was （81.3± 44.5） mL. Intraoperative length of the vagina was （ 10.4 ± 1.4） cm on average. The mean hospital stay was （8. 6± 1. 9） d. Eventually, 16 MRKH patients （72.8%） answered the FSFI questionnaire in the year of 2013 and 2017. And their mean time of wearing vaginal moulds and starting regular sex life after surgery was （12.5±5.6） months and （8.0±3.5） months, respectively. There was no statistical difference in either total score or each item＇s score of FSFI between the MRKH group and control group in August 2013 （all P〉0.05）. In the MRKH group, compared with those scores assessed in August 2013, the score of vaginal lubrication was significantly decreased in August 2017 （P〈0. 017, while the total score as well as the scores of sexual desire, arousal, orgasm, satisfac

关 键 词：MRKH(Mayer-R0kitansky_Knster-Hauser)综合征 腹腔镜下腹膜代阴道成形术 回顾性分析 女性性功能指数调查量表 

分 类 号：R713.31[医药卫生—妇产科学]