会阴“H”形切口在腹腔镜腹膜阴道成形术中的应用

"H" Incision for Laparoscopic Peritoneum Vaginoplasty

目的探讨会阴"H"形切口在腹腔镜腹膜阴道成形术中的临床应用价值。方法 2005年1月～2011年5月共完成46例腹腔镜下腹膜阴道成形术,其中23例采用传统会阴横切口进行阴道造穴(横切口组),23例采用会阴"H"形切口进行阴道造穴(H形切口组)。比较2组手术时间、术中出血量、术后住院时间及术后6个月时阴道深度、性生活满意率、两口间距、泌尿系感染人次。结果 2组46例手术均取得成功,无术后并发症发生。2组手术时间、术中出血量、术后住院时间均无统计学差异(P>0.05)。与横切口组相比,H形切口组术后6个月时阴道深度长[(9.5±0.6)cm vs.(8.6±0.4)cm,t=5.986,P=0.000],两口间距长[(1.0±0.4)cm vs.(0.6±0.3)cm,t=3.837,P=0.000],性生活满意率高[95%(38/40)vs.80%(32/40),χ2=4.114,P=0.043],泌尿系感染人次少(4人次vs.11人次,χ2=4.847,P=0.028)。结论会阴"H"形切口用于腹腔镜腹膜阴道成形术操作简单,成形的阴道较长,性生活满意率高,有推广应用价值。

Objective To evaluate ＂H＂ incision for laparoscopic peritoneum vaginoplasty. Methods From January 2005 to May 2011, 46 cases of congenital absence of the vagina received laparoscopic peritoneum vaginoplasty in our hospital. Among the patients, horizontal incision was made in 23 cases, and ＂H＂ incision was used in the other 23 cases. The operation time, intraoperative blood loss, postoperative hospital stay, depth of the vagina in six months after the surgery, satisfaction to sexual intercourse, space between the two urethra-vaginal orifices, and frequency of urinary infection were compare between the two groups. Results The procedures were completed successfully in both the groups without leading to any postoperative complications. No significant difference existed in the operation time, intraoperative blood loss, and postoperative hospital stay （ all P 〉 0.05 ）. Whereas, the ＂H＂ incision group showed significantly longer vagina, bigger space between the two urethra-vaginal orifices, higher satisfaction to sexual intercourse, and lower rate of urinary infection （9.5 ±0.6） cmvs. （8.6±0.4） cm, t=5.986, P=0.000; （1.0±0.4） em vs. （0.6 ±0.3） cm, t=3.837, P=0.000; 95% （38/40） vs. 80% （32/40）,X2 =4.114, P=0.043;and 4 person-time vs. 11 person-time, X2 = 4. 847, P = 0. 028 ]. Conclusions ＂H＂ incision for laparoscopic peritoneum vaginoplasty is simple and achieves longer vagina and higher satisfaction to sexual intercourse than a horizontal incision. Therefore, we recommend it to be used as a routine approach.