腹腔镜下先天性无阴道合并盆腔包块切除腹膜代阴道成型术研究

Clinical anaysis on laparoscopic peritoneal vaginoplasty for congenital absence of vagina accompanied with pelvic lump.

目的探讨腹腔镜下畸形子宫合并肌瘤、卵巢囊肿切除、腹膜代阴道治疗先天性无阴道的可行性研究。方法先天性无阴道畸形子宫合并子宫肌瘤、子宫腺肌病、宫腔积血2例，卵巢肿瘤3例。在腹腔镜下子宫肌瘤、卵巢囊肿切除术，同时行腹膜代阴道成形术进行分析，观察手术中出血、手术时间、手术并发症及手术后疗效。结果5例患者中，1例腹膜部分撕裂，用前庭粘膜替代，1例直肠前壁损伤，术中修补。5例手术均获成功，术中平均出血量60．15±27ml，手术平均时间101．24min±40．16min，住院平均时间9．2天。术后随访6～24个月，人工阴道壁呈淡粉色，柔软，滑润，弹性好，具有正常阴道外观。结论腹腔镜下切除子宫肌瘤、卵巢囊肿，同时行腹膜代阴道成形术是一种安全、手术效果好并具有康复快的优点，是先天性无阴道畸形子宫合并肌瘤等切除术同时腹膜代阴道成形理想的手术方式。

Objective： To investigate the possibility of laparoscopic peritoneal vaginoplasty for the treatment of congenital absence of vagina with pelvic lump. Methods ： A total of 5 patients with congenital absence of vagina in which 2 patients accompanied with uterine myoma or adenomyosis or hematometra and 3 patients accompanied with tumor of the ovary, went laparoscipic peritoneal vaginoplasty and myomectomy. Results ： In our research, one were partly lacerated on the peritonaeum and substituted by the mucosa of vestibule, the other one got a injury on intestinum rectum and were reparied. All patients were performed successfully. In operation, the average bleeding is 60ml ±26, The mean operative time was 101min ±40min, and the mean postoperative hospital stay was 9 days, in the followed - up, the artifical vagina is mild pink, soft, warm, have a good elasticity. Conclusion： Laparoscopic pertoneal vaginoplasty and myomectomy is a safe, minimally invasive and reliable method for the treatment of congenital absence of vagina accompa- nied with pelvic lump.