腹腔镜腹膜阴道成形术73例报告

Clinical analysis of 73 cases of laparoscopic vaginoplasty of peritoneum

目的探讨腹腔镜腹膜阴道成形术治疗先天性无阴道的价值。方法2001年7月-2005年11月对73例先天性无阴道在腹腔镜监视下,于尿道、膀胱与直肠间隙间形成阴道“隧道”,利用腹膜推进器将盆底腹膜经“隧道”推至前庭创口,并缝合固定,腹腔镜下关闭盆腔内腹膜,在“隧道”内填入凡士林纱条,数日后取出,术后定期扩张阴道。结果腹腔镜下完成手术70例,中转开腹结肠代阴道成形术1例,中转开腹回肠代阴道成形术1例,腹腔镜辅助回肠代阴道成形术1例。手术时间50-160 min,平均65 min;术中出血量20-100 ml,平均50 ml。术后住院15-20 d,平均16 d。70例术后随访1-24个月,平均13个月,66例腹膜阴道成形术阴道深>9 cm,4例阴道深度为8 cm,均可容阴道窥器插入,阴道黏膜粉红色、湿润,弹性良好;已婚或有性生活44例,其中43例性生活满意,1例诉阴道较浅(8 cm)。结论腹腔镜腹膜阴道成形术具有操作简便、创伤小、康复快的优点,术后阴道外观与功能等同正常女性外生殖器及阴道,值得推广。

Objective To investigate the value of laparoscopic vaginoplasty of peritoneum for treating congenital absence of vagina.Methods Laparoscopic peritoneal vaginoplasty was performed in a series of 73 cases of congenital absence of vagina from July 2001 to November 2005.An artificial vaginal tunnel between the urethra-bladder and the rectum was established.A self-made peritonium pusher was used to move the pelvic peritonium to the vaginal opening.Then the pelvic peritoneum was closed by suture under laparoscope.The vaginal tunnel was filled with a petrolatum for several days.The vagina was routinely expanded after operation.Results Among the 73 cases,the laparoscopic vaginoplasty of peritoneum was successfully completed in 70 cases,and conversions to open or laparoscopically-assisted vaginoplasty were required in 3 cases by using the sigmoid(1 case) or the ileum(2 cases).The operation time was 50~160 min(mean,65 min),the intraoperative hemorrhage volume was 20~100 ml(mean,50 ml),and the length of postoperative hospitalization was 15~20 d(mean,16 d).Follow-up examinations were carried out in 70 cases for 1~24 months(mean,13 months).The length of the vagina was >9 cm in 66 cases and 8 cm in 4 cases.A vaginal speculum was inserted smoothly,showing a pinky,wet,and normal-tensioned vaginal mucous membrane.Of 44 cases with intercourse experience,there were 43 cases with satisfactory sexual life and 1 case with a complaint of too short vagina(vaginal length,8 cm).Conclusions Laparoscopic vaginoplasty of peritoneum has advantages of minimal invasion,simplicity of performance,and rapid recovery.The appearance and functions of 'artificial vagina' after surgery are similar to those of normal vagina.