腹腔镜下腹膜阴道成形术

Peritoneal vaginoplasty with laparoscopic assistance

目的：评价Mawr-Rokitansky—Kuster—Hauser Syndrome（MRKH综合征）患者行腹腔镜下腹膜阴道成形术的方法和结局。方法：应用腹腔镜手术治疗6例MRKH综合征患者，采用4个穿刺孔，在镜下游离及切开盆腔腹膜。以60ml生理盐水自前庭切口处注入直肠膀胱间隙，切开粘膜钝性分离直肠与尿道膀胱间隙，然后分别将前腹膜片及后腹膜片与阴道前庭粘膜缝合，最后在镜下间断缝合上端腹膜，关闭盆底形成新的阴道穹窿。结果：6例手术均成功，手术时间平均80min，术中出缸量平均60ml，术后住院日12～15天。术后2个月性生活满意。随访2年以上，阴道可容2指，湿润、伸展性好，外阴正常无疤痕。结论：腹腔镜腹膜阴道成形术安全、快速、创伤小，该手术的优点是避免开腹、功能及整形效果俱佳。

Objective： To evaluate the methods and outcomes of laparoscopic technique for peritoneal vaglnoplasty in women with Mayer - Rokitansky - Kuster - Hauser Syndrome （ MRKH syndrome） . Methods： Six patients with MRKH syndrome underwent vaglnoplasty with laparoscopic assistance. Surgical reconstruction was used 4 ports, 60 ml saline was injected into the recto - vesical space, the mucosa was incised and the rectovesical space was dissected bluntly. The pelvic peritoneum was isolated and opened, and then the anterior ant posterior flaps were sutured to the mucosa of the vaginal vestibule. Finally the superior peritoneal leaf was closed using interrupted sutures under laparoscopic control. Results： No intraoperative and postoperative complications were observed. Average operative time was 80 min, average blood loss was 60 ml during operation. Postoperative stay was 10 to 12 days. In all the patients the mucosa was pink and moist 2 months after the proeodure. Two fingers were introduced easily into neovagina. The vulva was normal in appearance and no external scars. On further follow - up in 2 ～ 3 years, sexual intercourse was satisfactory in all cases. Conclusion： The laproscopic vaginoplasty using sliding peritoneum is safe, rapid and minimally invasive. The advantage of this modality is the avoidance of laparotomy, produces excellent cosmetic and functional effects.