腹腔镜下带血管蒂回肠移植阴道成型术31例临床分析

Clinical study on laparoscopic technique for vaginoplasty using an ileum with long vascular pedicle

目的探讨腹腔镜下带血管蒂回肠移植阴道成型术的手术方法及其临床应用效果.方法回顾性分析31例腹腔镜下带血管蒂回肠移植阴道成型术患者的临床资料,其中先天性无阴道患者25例,易性癖患者6例.采用全腹腔镜下手术8例,腹腔镜辅助腹部小切口手术23例.结果31例手术均获得成功,术后随访3～13个月,有10例佩带阴道模具达8个月,人工阴道壁生长良好,基本具备女性阴道的形态和生理功能;有性生活者29例,均满意.手术并发症1例,为全腹腔镜下手术后的不完全性肠梗阻, 经手术及对症处理治愈.结论腹腔镜下带血管蒂回肠移植阴道成型术创伤小、成型后的阴道外观美、符合阴道生理状态,该手术是目前较理想的阴道成型方法.术后需佩带阴道模具至少8个月,以防止阴道口狭窄.

Objective To study the operative colpopoiesis with long vascular pedicle. Methods methods and clinical outcome of laparoscopic ileal We reviewed 31 cases which had received ileal colpopoiesis, including 25 cases of congenital absence of vagina and 6 cases of male-to-female transsex. All cases were operated on by laparoscopic （8 cases） and laparoscopy assisted （23 cases） ileal colpopoiesis. The postoperative results were analyzed through physical examination and interview regarding the patient＇s functional status and satisfaction during sexual intercourse. Results Ileal colpopoiesis were preformed successfully on all 31 cases. Follow-ups of 3-13 months were done for all of them. Patients used vaginal mould for at least 8 months. All artificial vaginas had excellent cosmetic results, including adequate vaginal length, good lubrication, and appearance and physical functions similar to female natural vagina, and sexual function was reportedly satisfactory. One of the patients had an operative complication of an intestinal obstruction, which was cured by a second operation and other treatments. Conclusions The laparoscopic and laparoscopy assisted ileal vaginoplasty is a feasible, safe and ideal method of current vaginoplasty due to its minor damage, excellent cosmetic results and similarity to normal vaginal features. However, vaginal mould should be used for a long period of time （ at least 8 months） after an operation, to prevent vaginal orifice shrinkage.