腹腔镜腹膜阴道成形术治疗雄激素不敏感综合征

Laparoscopy-insisted vaginoplasty with peritoneum in patients with androgen insensitivity syndrome

目的探讨腹腔镜腹膜阴道成形术治疗雄激素不敏感综合征的手术方法及治疗效果。方法2006年5月至2011年3月，在深圳市第五人民医院对5例雄激素不敏感综合征患者行腹腔镜腹膜阴道成形术，并对其手术情况及手术效果进行分析。结果5例腹膜阴道成形术均在腹腔镜下完成，无中转开腹病例，1例改行腹腔镜下回肠代阴道成形术，4例术中同时行隐睾切除术，平均手术时间60min，平均术中出血量20ml，无直肠膀胱尿道损伤。术后21～28d阴道长度8—10cm，平均9cm，宽度可容2～3指；术后6个月人工阴道黏膜光滑、红润，柔软度及弹性符合解剖结构及生理要求，其中2例有满意性生活。结论腹腔镜腹膜阴道成形术可用于社会性别为女性的雄激素不敏感综合征的治疗，可同时切除双侧隐睾，术后须心理指导及长期服用雌激素。

Objective To investigate the technique and therapeutic effect of laparoscopy-insisted vaginoplasty with peritoneum in patients with androgen insensitivity syndrome. Methods From May. 2006 to Mar. 2011, 5 cases with androgen insensitivity syndrome received laparoscopy-insisted vaginoplasty in the Fifth People＇ s Hospital of Shenzhen. The therapeutic effect was retrospectively analyzed. Results Laparoscopy-insisted vaginoplasty was successfully completely with peritoneum in 4 cases. Ileum segment was used instead of peritoneum in one case. Open operation was not adopted in any cases. The ectopic testicles were removed during operation in 4 cases. The average operation time and bleeding volume was 60 min and 20 ml, respectively. Rectum, bladder and urethra were not injured in any case. The average vaginal length was 9 cm （range 8-10 cm） 21-28 days after operation. 6 months after operation, the surface of reconstructed vagina was smooth, ruddy and flexible, with satisfactory anatomical and functional results. Normal sexual activity was achieved in 2 cases. Conclusions Laparoscopy-insisted vaginoplasty with peritoneum could be used for female patients with androgen insensitivity syndrome. The ectopic testicles should be removed. Estrogen supplement and psychological guide after operation are also important.