腹腔镜下腹膜代阴道成形术21例临床分析

Laparoscopic Peritoneal Vaginoplasty: Report of 21 Cases

目的探讨腹腔镜下腹膜代阴道成形术的临床价值。方法 2006年1月～2011年1月对21例先天性无阴道在腹腔镜监视下,分离盆腔腹膜,于尿道、膀胱与直肠间隙间建立阴道"隧道",将4根腹膜牵引线经人工阴道牵出,覆盖人工阴道腔穴,直达阴道口,与前庭黏膜切口做间断缝合,腹腔镜下关闭盆腔内腹膜,将木制阴道模型置入人工阴道内,术后定期扩张阴道。随访Olson婚姻质量问卷ENRICH性生活因子评分。结果 21例手术均成功,无尿道、膀胱、直肠损伤。手术时间(80.5±10.7)min,术中出血量(10.8±4.6)ml,术后住院时间(5.0±1.6)d。截止2011年1月,21例术后随访10 d～5年,(2.0±0.3)年,术后有性生活的20例性生活因子评分为(35.50±4.54)分,问卷常模为(37.60±6.90)分,无显著性差异(t=2.070,P=0.052)。结论腹腔镜下腹膜代阴道成形术具有创伤小、恢复快和术后性生活满意的特点。

Objective To explore the value of laparoscopic peritoneal vaginoplasty. Methods Totally 21 cases of congenital absence of vagina received laparoscopic peritoneal vaginoplasty in our hospital from January 2006 to January 2011. Under a laparoscope, we separated the pelvic peritoneum so that to establish a ＂vagina tunnel＂ in the space between the bladder and rectum. With four threads, we pulled out the artificial vagina to cover the artificial vagina cavity through the vaginal orifice, and then interrupted suture was made at the vestibular mucosa incision. After laparoscopic closure of the inner pelvic peritoneum, a wooden vaginal mould was placed into the artificial vagina so that to dilate the vagina regularly after the operation. ENRICH marital inventory （Olson et al. ） was used for follow-up. Results The procedure was completed in all the 21 patients without causing injury to the ureter, bladder, or rectum. The operation time was （80.5 ± 10.7） min, and intraoperative blood loss was （10.8 ± 4.6） ml. The patients were discharged from hospital in a mean of （5.0 ± 1.6） days after the operation, and then were followed up for a mean of （2.0± 0.3） years （until January 2011, ranged from 10 days to 5 years）. In the patients, 20 cases had sexual life after the operation, the ENRICH sex factors score of these patients was 35.50 ± 4.54, and the constant score was 37.60 ± 6.90, while no significant difference existed between the two scores （ t = 2. 070, P = 0. 052 ）. Conclusions Laparoscopic peritoneal vaginoplasty is a minimally invasive procedure. It is a good choice to achieve rapid recovery and content sexual life.