腹腔镜下两种阴道成形术治疗MRKH综合征的临床研究

Clinical research of Mayer-Rokitansky-Kuster-Hauser syndrome with two types of laparoscopic vaginoplasty

目的比较腹腔镜辅助乙状结肠阴道成形术与腹膜阴道成形术治疗36例MRKH综合征(MRKHs)的临床效果。方法 2006年4月～2010年2月对该院36例先天性无阴道患者实施腹腔镜辅助阴道成形术,其中22例实施腹腔镜辅助乙状结肠阴道成形术(乙状结肠阴道成形术组),14例实施腹腔镜辅助腹膜阴道成形术(腹膜阴道成形术组),比较两组术中及术后的情况。结果腹腔镜腹膜阴道成形术组手术时间、术后排气时间、术后住院天数明显短于腹腔镜辅助乙状结肠阴道成形术组;术中出血量少于乙状结肠阴道成形术组;住院费用低于乙状结肠阴道成形术组;术后体温恢复时间,两组差异无显著性;人工阴道长度乙状结肠阴道成形术组长于腹膜阴道成形术组。对术后有性生活的患者采用女性性功能指标量表(FSFI)评分,两组相比差异无显著性,与正常女性比较亦差异无显著性。结论腹腔镜阴道成形术治疗MRKH综合征是微创、安全的。与腹腔镜辅助乙状结肠阴道成形术相比,腹腔镜腹膜阴道成形术具有出血少、手术时间短、住院费用低及合并症少的优势。

[Objective] To compare the feasibility and clinical therapeutic effect of thirty-six cases with Mayer-Rokitansky-Kuster-Hauser syndrome underwent laparoscopic peritoneal vaginoplasty and laparoscopic-assisted sigmoid vaginoplasty.[Methods] Twenty-two patients with MRKH syndrome underwent laparoscopic-assisted sigmoid vaginoplasty（sigmoid group）,fourteen patients underwent laparoscopic peritoneal vaginoplasty（peritoneal group）,from April 2006 to February 2010.[Results] The operation time,the passage of gas by anus,and the postoperative hospital stay of the laparoscopic peritoneal group were significantly shorter than sigmoid Group;The amount of bleeding of the peritoneal group was better than sigmoid group;even more,the maintenance charge of the sigmoid group was significantly higher than peritoneal group.Otherwise,there is no statistical difference on the temperature postoperative restoration.And the artificial vaginas after two groups of laparoscopic vaginal angioplasty were basically similar.However,the vaginal length of sigmoid group was deeper than peritoneal group;finally,we use the Female Sexual Index scale（FSFI） to evaluate the sexual functions of patients who had sexual life.All of them were satisfied with sexual desire,sexual excitement,orgasm,vaginal lubrication and sexual satisfaction.Simultaneously,we compared them with 22 randomly selected,age-matched healthy women;there was no statistical difference in the total FSFI score between the case and control groups.[Conclusions] Laparoscopic-assisted vaginoplasty is a safe,effective treatment of Mayer-Rokitansky-Kuster-Hauser syndrome with minimal invasion.And comparing the laparoscopic sigmoid vaginoplasty,the laparoscopic peritoneal vaginoplasty has more advantages of less bleeding,shorter operation time,lower maintenance charge and fewer complications.