改良乙状结肠代阴道成形术在阴道再造和修复中的运用(附105例临床观察)

Application of improved sigmoid vaginoplasty in reconstruction and repair of vagina(with clinical observation of 105 patients)

目的探讨改良乙状结肠代阴道成形术治疗先天性无阴道或其他各种阴道缺失的方法和疗效。方法通过对105例先天性无阴道患者行改良乙状结肠代阴道成形术的临床实践和疗效观察,对切口长度、移植带血管蒂乙状结肠的长度及测量方法、对乙状结肠系膜过短的处理方法、术后乙状结肠代阴道新形成的人工阴道的防异味处理的认识和方法,术后患者的便秘情况以及结肠癌的发病情况进行了深入研究。结果105例各种原因导致的阴道缺失或残缺以乙状结肠代阴道方法进行再造或修复无一例失败,且手术时间为120-190分钟,平均(136±23)分钟,术中出血为100-300 ml,平均(108±26)m1,切口平均长度为5.0-8.0cm,平均(6.5±1.5)cm(传统方法切口长度为15-18cm),切取带血管的乙状结肠长度为15-19cm,平均(16.5±1.5)cm,术后18-26h,平均(19.5±1.5)h;肠道功能恢复44-56h,平均(46.5±3.5)h肛门排气,术后住院10-14天,平均(11±2.5)天后出院,出院后停止阴道戴模具,术后1个月来院复诊阴道宽度3.2-4.8cm,平均(3.6±1.2)cm、深度12-16cm,平均(13.8±1.5)cm,阴道无异味,开始正常性生活,随诊5年无一例阴道狭窄和疤痕形成,光滑度良好,夫妻性生活协调,大便通畅,且未出现任何肠道梗阻症状。随访病人中未发现结肠癌病人。结论改良乙状结肠代阴道成形术,方法简单,适用范围广,移植带血管蒂的乙状结肠测量准确、方便,手术成功率高,术后疗效好,对病人创伤相对较小,术后恢复快,阴道无异味,还能缓解女性便秘、有效预防结肠癌。

Objective To study the curative effect of improved sigmoid vaginoplasty in treating congenital or other kinds of absence of vagina.Methods 105 cases of congenital or other kinds of absence of vagina were treated with sigmoid vaginoplasty.Clinical data including the length of incision,the length of sigmoid colon graft with vascular pedicle,the approaches coping with very short mesosigmoid,the anti odor treatment of artificial vagina were collected and the incidence of colon cancer after improved sigmoid vaginoplasty was analyzed.Results 105 cases with absence or damaged vagina resulting from various causes were treated with improved sigmoid vaginoplasty.The operation time was 120-190 minutes and the mean time was(136±23)minutes.The length of incision was 5-8 cm(The traditional method of incision length is 15-18 cm),and the mean length was(6.5±1.5)cm;the length of sigmoid colon graft ranged from 15 to 19 cm,and the mean length was(16.5±1.5)cm;The recovery time of intestinal function was 18-26 h and the mean time was(19.5±1.5)h.The hospitalization time was 10-14 days,with the mean time of(11±2.5)days.The vaginal mould was removed after discharging.At one month after the surgery,the artificial vaginas exhibited excellent cosmetic outcomes,including adequate vaginal length,good lubrication and appearance as well as physical functions similar to natural vagina,and all patients started sexual life.In 5 years,all cases had satisfied sexual intercourse and no sign of intestine obstruction and colon cancer,as well as no stenosis developed in artificial vaginas were observed.Conclusion Improved sigmoid vaginoplasty is simple procedures with broad application.The measurement of sigmoid colon graft is accurate and convenient,with high success rate and very good curative effect as well as minimal invasion,absent odor and short recovery.It also relieve female constipation and prevent colon cancer.