腹腔镜腹膜代阴道成形术和乙状结肠代阴道成形术治疗先天性无阴道临床疗效比较

A randomized comparison of the laparoscopic peritoneal vaginoplasty and laparoscopic auxiliary sigmoid colon colpopoiesis techniques for congenital absence of vagina

目的探讨腹腔镜腹膜代阴道成形术和乙状结肠代阴道成形术的临床疗效。方法采用随机对照的研究方法 ,对2001年1月至2010年12月第三军医大学附属西南医院40例先天性无阴道患者按随机表法,1:2随机化分组,分别接受腹腔镜乙状结肠代阴道成形术(14例)和腹膜代阴道成形术(26例),比较2组的围手术期参数及术后疗效。结果 40例患者均在腹腔镜下成功完成手术,腹膜代阴道组较乙状结肠代阴道组手术时间短,术中出血量少,术后恢复快(P﹤0.05)。术后随访6～108个月,阴道平均深度、性生活启动时间和性功能指数量表评分比较,两组差异均无统计学意义(P﹥0.05)。结论腹腔镜腹膜代阴道成形术和乙状结肠代阴道成形术均是安全、疗效满意的手术方式,但腹腔镜腹膜代阴道成形术更微创、术后患者恢复更快。

Objective To evaluate the therapeutic results of the laparoscopic peritoneal vaginoplasty and laparoscopic auxiliary sigmoid colon eolpopoiesis procedures for congenital absence of vagina. Methods A single-center, random control study was carried out in 40 patients with congenital absence of vagina. According to random number table method, patients were randomized in 1 ： 2 ratio to received vaginal angioplasty, in which congenital absence of vagina under lapa- roscopie auxiliary sigmoid colon vagin0plasty 14 eases, laparoseopie peritoneal generation vaginal angioplasty 26 cases. Both surgical perioperative parameters and effects were investigated. Results All surgical procedures were successfully completed in laparoseopie surgery. Compared with the laparoseopic sigmoid vaginal replacement, laparoscopic vaginal re- construction using peritoneum approach seems to be superior in perioperative parameters. The procedure is faster and less blood loss, postoperative course was uneventful and postoperative hospital stay days ＂were lower than the laparoscopic-as- sisted sigmoid vagina （P 〈 0. 05）. Clinical follow-up after surgery of this series was 46 months （ range, 6 months to 108 months）, the laparoscopic peritoneal vaginoplasty is equally effective with those of the sigmoid colon colpopoiesis tech- niques. There were no statistically significant differences of the lengths of the reconstructed vagina, sexual life initiation time, and the female sexual function index questionnaire scores between the two groups （P 〉 0. 05）. Conclusion For patients with congenital absence of vagina, the laparoscopic peritoneal vaginoplasty and the sigmoid colpopoiesis are safe, and reliable method for the correction of vaginal abnormalities. However, the laparoscopic peritoneal vaginoplasty is more invasive, retrieval time faster after surgery.