小阴唇瓣在阴道整形中的应用

APPLICATION OF LABIUM MINUS FLAPS IN VAGINAL PLASTIC SURGERY

目的总结对阴道口后壁瘢痕伴小阴唇肥大患者行阴道缩小整形时,采用小阴唇瓣移位修复瘢痕切除后阴道口创面的手术方法及临床效果。方法2007年5月-2008年5月,收治10例产后阴道松弛伴阴道口后壁瘢痕及小阴唇肥大患者。年龄28～40岁。小阴唇宽3～5cm,6例自述有性交痛。术中行阴道缩小整形的同时将肥大的小阴唇分别形成4cm×1cm～5cm×1cm的前蒂小阴唇瓣和大小为3cm×2cm～4cm×3cm的后蒂小阴唇瓣。将后蒂小阴唇瓣去内表皮并向内翻转90°移位至阴道口,修复切除瘢痕后创面;前蒂小阴唇瓣原位缝合形成新的小阴唇。结果术后3例后蒂小阴唇瓣远端1cm范围表皮脱落,经1∶5000高锰酸钾溶液坐浴2周后表皮自行愈合;余7例均完全成活。前蒂小阴唇瓣全部成活。切口均Ⅰ期愈合。10例术后均获随访,随访时间2～8个月。患者对外阴形态满意,阴道口无压痛,弹性良好。移位至阴道口的小阴唇瓣触压及疼痛等敏感程度与小阴唇相似。术前性交痛者述术后疼痛消失,7例自述性生活质量较术前明显改善,3例自述术后性生活质量较术前无明显改善。结论小阴唇瓣移位至阴道外口,修复因阴道外口瘢痕引起的性交疼痛临床效果较好。

Objective To investigate the surgical procedures and outcomes of repairing the wound in the posterior wall of vaginal orifice by labium minus flap transfer, when vagina tightening plastic surgery is performed on the patient with scar in the posterior wall of vaginal orifice and labium minus hypertrophy. Methods From May 2007 to May 2008, 10 patients suffering from postpartum vaginal relaxation combined with scar in the posterior wall of vaginal orifice and labium minus hypertrophy were treated. The patients aged 28-40 years old and the width of their labium minus was 3-5 cm. Six of them had coitus pain. Vaginal tightening surgery was performed, meanwhile the hypertrophic labium minus was prepared into the anterior-pedicle labium minus flap （4 cm × 1 cm-5 cm × 1 cm） and the posterior-pedicle labium minus flap （3 cm × 2 cm-4 cm × 3 cm）, respectively. The posterior-pedicle labium minus flap was transferred inwards by 90° to repair the wound caused by the resection of the scar, and the anterior-pedicle labium minus flap was sutured in situ to form the new labium minus. Results All the posterior-pedicle labium minus flaps survived, except for 3 cases in which the epidermis 1 cm around the distal end of posterior-pedicle labium minus flap was exfol iated and recovered 2 weeks after hi p bath with potassium permanganate solution （1： 5 000）. All the anterior-pedicle labium minus flaps survived, and all the incisions healed by first intention. Over the follow-up period of 2-8 months, all the patients were satisfied with their vulva configuration, good elasticity of vaginal orifice and no tenderness pain of vaginal orifice. The sensitivities to feel ing, such as touch and pain, of the transferred labium minus flap were similar to the normal labium minus. Postoperatively, the coitus pain disappeared, 7 cases had much better sex l ife and 3 cases had no significant improvement in sex l ife. Conclusion Transferring labium minus flap to vaginal orifice is an effective way to improve the coital pain resulted from the scar of vaginal orifice.