腹腔镜下腹膜代阴道成型术的临床应用

Study of operative procedures of laparoscopy and laparoscopic vaginal reconstruction using peritoneum.

探讨腹腔镜下腹膜代阴道成型术的方法及临床应用效果。方法：为13例Mayer-Rokitansky-Kuster-Hauser综合征（MRKH综合征）患者成功地进行了腹腔镜下腹膜代阴道成形术。使用4个穿刺点：脐部穿刺形成CO2气腹并放置第1个直径为10mm的穿刺套管，分别于左右下腹及耻骨上放置直径5mm的穿刺套管3个。于盆腔中部膀胱及直肠反折腹膜下，注入生理盐水以分离腹膜。从此处横行剪开，并分离腹膜前后叶长8—10cm，呈H形。在阴道前庭处横行剪开，于膀胱直肠间钝性分离成穴道，长约10cm，使穴道与腹腔相通。自穴道牵出游离的前后片，缝合于阴道口的前庭粘膜于腹腔镜下剪开直肠和膀胱表面的浆膜，缝合关闭阴道顶端及盆腔。术后使用弹形头的阴道硬模型。结果：13例手术均获成功，患者平均手术时间95±14min，平均出血量57±14ml，平均随访时间9±4个月，腹部切口美观，人工阴道生长好，性生活正常。结论：腹腔镜下腹膜代阴道成形术是可行和安全的，能够取得开腹手术的效果。

Objective ：To explore the procedures of laparoscopy and laparoscopic vaginal reconstruction using peritoneum. Methods ：The successful use of laparoscopy for reconstrution of a vaginal in 13 patients with the Mayer-Rokitansky-Kuster-Hauser syndrome was described. Four ports were used,the 10ram port of which was inserted below the umbilicus.The next 5mm ports were inserted at the right lower quadrant,the left lower quadrant and suprapubic,respectively. Under laparoscopic control,the peritoneum between bladder and rectum was injected using sodium chloride for isolating a 8-10cm length and H shape. An incision was made in he deepest part of the westlbule, performing a blunt dissection a 10cm length space was created between the urethra,bladder and rectum,which allowed passage of the isolated peritoneum. The top of the graft was fixed to the mucosa of the vaginal vestibule using suture. After incising serosa of bladder and rectum a suture was made for closure the vaginal summit and pelvic cavity. The bullet sape vaginal stent was used. Results： The authors had successfully completed the operations for 13 patients,and made 9 ±4 month following-up. The results of artificially vaginae of all cases were satisfactory; the abdominal scar was small with remarkable cosmetic effects. All had normal sexual intercourse. Condusion：Laparoscopic vaginal reconstruction using peritoneum is feasible and safe,and can be used as an ahemative to open surgery.