腹腔镜辅助下截取带血管蒂回肠段转移阴道成形术

Laparoscopic small intestinal flap colpopoiesis

目的 探索在腹腔镜辅助下截取带血管蒂回肠段转移再造阴道的可能性，为临床提供阴道成形术的新方法。方法 应用腹腔镜引导下，配合使用超声刀，通过小切口完成肠系膜分离、回肠段截取、肠端吻合、回肠段下拉转移形成阴道。结果 2002年2月至2006年7月，共为38例需再造阴道患者成功地施行腹腔镜辅助下截取带血管蒂回肠段转移阴道成形术。随访1个月～4年，其中36例移植回肠段成活良好，再造阴道符合生理要求。结论 由于避免了剖腹和以往术式的供区瘢痕，较好地缓解了此类患者巨大的心理压力，腹腔镜下回肠段代阴道是目前较为理想的阴道成形术新方法。

Objective To investigate the possibility of Laparoscopic reconstruction of vagina using pedicled ileal autograft and provide a new procedure of colpopoiesis. Methods The abdominal and perineal approaches were performed simultaneously under a sufficiently deep general anaesthesia. Laparoseopiclly, a 1518cm segment of the ileum on its vascular pedicle, ileal branches of the superior mesenteric artery and its concomitant veins, was selected and isolated for transplantation using ultrasonically-powered instruments. The distal of the transferred ileal segment was 15cm apart from the ileocecal junction. The ileum continuity was restored immediately by end-to-end anastomosis and the distal oral of the transplant was closed using a curved intraluminal stapler. Meanwhile, a neovaginal tract was completed to dissect from the perineum into the peritoneum and the tract widened laterally. Then the ileum transplant was reversed to reach the perineum through the peritoneal incision at the top of the neovaginal tract without subjecting the mesenteric neurovascular pedicle to undue tension and subsequent necrosis. The oral edge of the ileum transplant was sutured to the perineal skin. Results Followed up for over 1 - 53 months postoperatively, 36 patients who received laparoscopic vaginoplasty by transferring ileal segment flaps got satisfactory neovaginal function similar to a normal vagina with mucus and moistness. Conclusions The advantages of using a laparoscopic ileum colpopoiesis are that ① satisfactory neovaginal function similar to a normal vagina with mucus and moistness, ② no disturbance of bowel function,③ minimal scarring in abdominal wall and less secondary deformity in perineum and ④ no need for frequent dilation or stent wearing to the reconstructed vagina. And so laparoseopic vaginoplasty was a preferable alternative of vaginoplasty.