MRKH综合征患者顶压法人工阴道成形术的性功能评价一项前瞻性队列研究  

Sexual functional outcomes of vaginal dilation therapy for MRKH syndrome:a prospective study

作　　者：段佳丽 陈娜[1] 高倩倩 黄柔婕 宋爽 康佳[1] 刘霞[1] 顾翔宇 邓姗[1] 朱兰[1] Duan Jiali;Chen Na;Gao Qianqian;Huang Roujie;Song Shuang;Kang Jia;Liu Xia;Gu Xiangyu;Deng Shan;Zhu Lan(Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,National Clinical Research Center for Obstetric and Gynecologic Diseases,The State Key Laboratory for Complex,Severe,and Rare Diseases,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科、国家妇产疾病临床医学研究中心、疑难重症及罕见病国家重点实验室,北京100730

出　　处：《中华妇产科杂志》2024年第7期540-547,共8页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金(82171614,82271656);国家重点研发计划(2021YFC2701400);中国医学科学院临床与转化医学研究专项(2022-I2M-C&T-B-029);北京市自然科学基金(7232125);中德交流基金(M-0110)。

摘　　要：目的评估顶压法人工阴道成形术的Mayer-Rokitansky-Küster-Hauser(MRKH)综合征患者的性功能、功能学成功率及并发症。方法本研究为前瞻性队列研究,选取2020年3月至2023年2月于北京协和医院行顶压法人工阴道成形术的MRKH综合征患者共97例,其中45例顶压治疗开始后有阴茎插入式性生活被纳入本研究(即观察组)。采用经中文验证的女性性功能指数量表(FSFI)对患者性功能进行评估,采用FSFI总分>23.45分为功能学成功标准;同时选择40例年龄匹配的正常妇女作为对照组。采用Kaplan-Meier法计算顶压开始至成功所需的时长。采用Pearson相关性分析计算阴道长度与FSFI评分之间的关系。通过随访问卷记录患者顶压过程中出现的并发症。结果89%(40/45)的观察组MRKH综合征患者顶压后达到功能学成功标准,成功所需的中位时长为4.3个月(95%CI为3.0~6.1个月)。与对照组相比,虽然观察组的性高潮评分[分别为(4.72±1.01)、(4.09±1.20)分;P=0.013]和疼痛程度评分[分别为(5.03±0.96)、(4.26±0.83)分;P<0.001]低于对照组,但观察组在FSFI总分[(26.77±2.70)、(26.70±2.33)分;P=0.912]、性欲望评分[(3.33±0.85)、(3.95±0.73)分;P<0.001]、性唤起评分[(4.43±0.77)、(4.56±0.63)分;P=0.422]、阴道润滑程度评分[(4.37±0.56)、(5.20±0.67)分;P<0.001]和满意度评分[(4.88±0.98)、(4.65±0.86)分;P=0.269]方面均不劣于对照组。功能学成功的观察组患者各项性功能障碍的发生率与对照组比较显示,性欲低下[分别为3%(1/40)、23%(9/40);P=0.007]和阴道润滑障碍[分别为5%(2/40)、25%(10/40);P=0.012]的发生率显著低于对照组,而性唤起障碍[均为3%(1/40);P>0.999]、性高潮障碍[分别为40%(16/40)、20%(8/40);P=0.051]、性交痛[分别为30%(12/40)、15%(6/40);P=0.108]的发生率无显著差异。顶压过程中出现的并发症主要包括轻中度阴道疼痛(67%,30/45)、阴道点滴出血(33%,15/45)和尿路刺激征(9%,4/45)。结论无�Objectives To report the sexual functional outcomes of vaginal dilation therapy in Mayer-Rokitansky-Küster-Hauser(MRKH)syndrome patients.Methods From March 2020 to February 2023,97 MRKH syndrome patients performed vaginal dilation therapy with guidance from Peking Union Medical College Hospital,and 45 of them engaged in penetrative intercourse and were included in this prospective cohort study.The Chinese version of female sexual function index(FSFI)was used to assess sexual function.Functional success was defined as FSFI>23.45.Forty age-matched healthy women were selected as controls.Kaplan-Meier survival analysis was used to calculate the median time to success.Pearson correlation analysis was used to explore the relationship between neovagina length and sexual function.Complications were collected using follow-up questionnaires.Results The functional success rate of vaginal dilation therapy was 89%(40/45)with a median time to success of 4.3 months(95%CI:3.0-6.1 months).Compared to controls,MRKH syndrome patients had significantly lower scores in the orgasm domain(4.72±1.01 vs 4.09±1.20;P=0.013)and pain domain(5.03±0.96 vs 4.26±0.83;P<0.001).However,there were no significant differences in the FSFI total score(26.77±2.70 vs 26.70±2.33;P=0.912),arousal domain(4.43±0.77 vs 4.56±0.63;P=0.422)and satisfaction domain(4.88±0.98 vs 4.65±0.86;P=0.269)between MRKH syndrome patients and controls.MRKH syndrome patients had significantly higher scores in the desire domain(3.33±0.85 vs 3.95±0.73;P<0.001)and lubrication domain(4.37±0.56 vs 5.20±0.67;P<0.001).The prevalence of sexual dysfunction in MRKH patients was non-inferior to controls:low desire[3%(1/40)vs 23%(9/40);P=0.007],arousal disorder[3%(1/40)vs 3%(1/40);P>0.999],lubrication disorder[5%(2/40)vs 25%(10/40);P=0.012],orgasm disorder[40%(16/40)vs 20%(8/40);P=0.051],sexual pain[30%(12/40)vs 15%(6/40);P=0.108].Conclusions MRKH syndrome patients undergoing non-invasive vaginal dilation therapy could achieve satisfactory sexual life.Given its high function

关 键 词：46 XX性发育障碍 先天畸形 子宫 阴道 修复外科手术 前瞻性研究 

分 类 号：R713.31[医药卫生—妇产科学]