腹腔镜Vecchietti与Davydov阴道成形术治疗MRKH综合征的对比研究

Comparison study between Vecchietti′ s and Davydov′ s laparoscopic vaginoplasty in Mayer-Rokitansky-K＆#252;ster-Hauser syndrome

目的：比较腹腔镜Vecchietti与Davydov阴道成形术治疗先天性生殖道畸形Mayer-Rokitansky-ster-Hauser（MRKH）综合征的临床效果。方法2010年1月至2013年12月，对28例MRKH综合征患者分别采用腹腔镜Vecchietti阴道成形术（Vecchietti组，n=13）与腹腔镜Davydov阴道成形术（Davydov组，n=15）治疗，对比分析两组患者的手术效果。结果两组患者的手术均获成功，成形的阴道柔软、润滑、有弹性、宽可容2指。Vecchietti组患者的手术时间为（39±7）min，术中出血量（21±6）ml，术后肛门排气时间（19±5）h，术后体温恢复正常时间（35±10）h，术后住院时间（7.5±0.9）d，术后阴道长度（8.8±0.5）cm，术后女性性功能指数量表（FSFI）评分（26.8±2.0）分。Davydov组患者的手术时间为（73±11）min，术中出血量（63±10）ml，术后肛门排气时间（28±6）h，术后体温恢复正常时间（46±10）h，术后住院时间（7.1±0.7）d，术后阴道长度（9.6±0.5）cm，术后FSFI评分（28.5±1.7）分。Vecchietti组的手术时间、术中出血量、术后肛门排气时间、术后体温恢复正常时间均小于Davydov组，两组分别比较，差异均有统计学意义（P〈0.05）；但术后阴道长度及FSFI评分不及Davydov组（P〈0.05）；两组术后住院时间无明显差异（P〉0.05）。两组术中均无并发症发生，术后Davydov组有2例患者发生阴道息肉，8例出现疼痛，而Vecchietti组均有疼痛发生。结论腹腔镜Vecchietti与Davydov阴道成形术都具有简单、安全、有效的特点。相比之下，Vecchietti术式虽然更加快捷、微创，但术后疼痛更多见，且阴道长度及性生活满意度不及Davydov术式理想。

Objective To compare Vecchietti′s and Davydov′s laparoscopic techniques for vagino-plasty in patients with Mayer-Rokitansky-Kster-Hauser （MRKH） syndrome. Methods From January 2010 to December 2013, 13 patients underwent the Vecchietti′s laparoscopic procedure （Vecchietti group）, and 15 patients underwent the Davydov′s laparoscopic procedure （Davydov group）. Intraoperative parameters and postoperative results were compared. Results Both of the two groups were successfully treated. The neovagina in both groups were wide with good elasticity, softness and smoothness. The operation time [（39± 7） versus （73 ± 11） minutes], the intraoperative blood loss [（21 ± 6） versus （63 ± 10） ml], the anal exsufflation time after surgery [（19 ± 5） versus （28 ± 6） hours] and the recovery period of body temperature after surgery [（35 ± 10） versus （46 ± 10） hours] of the Vecchietti group were less than those of the Davydov group （all P〈0.05）. But the neovagina length [（8.8±0.5） versus （9.6±0.5） cm] was shorter and the Female Sexual Function Index scale score [26.8 ± 2.0 versus 28.5 ± 1.7] was lower in the Vecchietti group than those in the Davydov group （all P〈0.05）. The postoperation hospital duration didn′t reached statistical difference between the two groups [（7.5 ± 0.9） versus （7.1 ± 0.7） days, P〉0.05]. No intraoperative complication occurred. After surgery, 2 patients were found vaginal polyps and 8 patients were suffered from pain in the Davydov group, while all patients were suffered from pain in the Vecchietti group. Conclusions Both Vecchietti′s and Davydov′s laparoscopic techniques are simple, safe and effective surgical methods for vaginal reconstruction. In contrast, the Vecchietti′s procedure is more time efficient and minimally invasive, while the Davydov′s procedure can get less pain, longer vagina and higher sexual satisfaction.