应用腹壁下动脉穿支皮瓣再造阴道

DEEP INFERIOR EPIGASTRIC PERFORATOR FLAP FOR VAGINAL RECONSTRUCTION

目的探讨应用腹壁下动脉穿支皮瓣再造阴道的优缺点。方法2004年1月~2005年5月,采用腹壁下动脉穿支(deepinferiorepigastricperforator,DIEP)皮瓣再造阴道5例,年龄19~40岁。先天性无阴道4例,阴道肿瘤1例。术前常规用超声多普勒检测DIEP,设计10cm×9cm^12cm×11cm的菱形皮瓣,将穿支点包括在皮瓣内。皮瓣切取后作内翻缝合成皮筒状,于腹股沟韧带与耻骨之间沿耻骨结节及耻骨上支内侧面,形成皮筒通过的隧道。将阴道皮筒经隧道移位至人工阴道腔隙或阴道肿瘤切除后的创面中再造阴道。结果5例阴道再造均获得成功,1例患者术后2周出现阴道后壁血肿,经清除血肿后愈合。腹壁供区无任何并发症发生。术后随访1~6个月,再造阴道质地柔软,宽敞,3例有性生活,患者感觉满意。结论应用DIEP皮瓣再造阴道是一种较理想的术式,对广泛的阴道肿瘤切除,由于需填充较多组织,仍是较好选择。

Objective To evaluate a new alternative method for the reconstruction of vagina with deep inferior epigastric perforator （DIEP） flap. Methods From January 2004 to May 2005, DIEP flaps were used for vaginal reconstruction in 5 patients（19 to 40 years）, including 4 cases of congenital vaginal agenesis and 1 case of vaginal tumor. Before operation, the perforators were detected by the Doppler and the flaps based on the perforators ranged from 10 cm× 9 cm to 12 cm× 11 cm. DIEP flaps were elevated and then transferred to reconstruct the vagina. Results Deep inferior epigastric perforator flaps were used in 5 patients. Only 1 patient developed haematoma in the posterior aspect of the reconstructed vagina, but the flap was viable. The wounds healed secondarily after conservative therapy. All the flaps survived completely. No complication occurred at donor site of abdominal wall. Conclusion Despite technical difficulties in elevating the deep inferior epigastric perforator flap, the flap is a good choice for vaginal reconstruction.