腹腔镜乙状结肠与回肠移植阴道成形术的对比分析

Comparison and analysis on laparoscopic vaginoplasty with sigmoid colon transplantation and laparoscopic vaginoplasty with ileal transplantation

目的:比较腹腔镜乙状结肠移植阴道成形术与回肠移植阴道成形术的术式及临床效果。方法:2004年1月～2006年12月行腹腔镜辅助回肠移植阴道成形术13例(回肠组),腹腔镜下游离回肠系膜,经腹壁小切口将回肠拉出,直视下完成切取、闭合移植肠袢及回肠端端吻合,将移植肠袢拉入人工阴道洞穴。2007年1月～2010年1月行腹腔镜乙状结肠移植阴道成形术26例(乙状结肠组),其中无气腹全腹腔镜下乙状结肠移植阴道成形术2例,皮下钢针悬吊腹壁,镜下游离结肠系膜,切断、闭合移植肠袢,乙状结肠端端吻合,将移植肠袢拉入阴道洞穴;腹腔镜辅助乙状结肠移植阴道成形术24例,镜下切断、闭合移植肠袢远端,经腹壁小切口提出移植肠袢并切取缝合、端端吻合乙状结肠。比较2组手术时间、术中出血量、住院时间、切口感染及成形阴道的性状。结果:全部手术均成功。乙状结肠组手术时间(194.8±52.1)min较回肠组(233.1±36.4)min明显缩短(t=2.67,P=0.03);乙状结肠组与回肠组术中出血量、住院时间、切口感染差异无统计学意义,乙状结肠组人工阴道的解剖形状、生理功能更接近正常阴道。结论:无气腹全腹腔镜乙状结肠移植阴道成形术建立了新的手术途径,安全可靠,简捷微创,腹部美观,成形阴道的解剖形态和生理功能更接近正常阴道,是目前较理想的阴道成形术。

Objective：To compare the operation modes and clinical efficacies of laparoscopic vaginoplasty with sigmoid colon transplantation and laparoscopic vaginoplasty with ileal transplantation. Methods：13 cases received laparoscopic vaginoplasty with ileal transplantation（ileal group） from January 2004 to December 2006;26 cases received laparoscopic vaginoplasty with sigmoid colon transplantation（sigmoid colon group） from January 2007 to January 2010,including 2 cases receiving gasless total laparoscopic vaginoplasty with sigmoid colon transplantation and 24 cases receiving laparoscope-assisted vaginoplasty with sigmoid colon transplantation;the operation times,the amounts of blood loss during operation,the hospitalization times,the incidences of incision infection and the anatomical shapes of the artificial vagina in the two groups were compared. Results：All the surgeries were successfully completed.The operation time of sigmoid colon group was（194.8±52.1） minutes,which was shorter than that of ileal group [（233.1±36.4） minutes]（t=2.67,P=0.03）;there was no significant difference in the amount of blood loss during operation,the hospitalization time,the incidence of incision infection between sigmoid colon group and ileal group;compared with ileal group,the anatomical shape and physiological function of artificial vagina in sigmoid colon group were closer to the normal vagina. Conclusion：Gasless total laparoscopic vaginoplasty with sigmoid colon transplantation establishes a new operative approach,which is safe,reliable,simple,microinvasive and cosmetic,the anatomical shape and physiological function of artificial vagina are more closer to the normal vagina,thus,it is an ideal vaginoplasty.