腹腔镜下乙状结肠代阴道和腹膜代阴道成形术治疗Ⅱ型阴道闭锁

Laparoscopic-assisted vaginoplasty by using sigmoid colon and peritoneum for congenital complete colpatresia

目的探讨腹腔镜下乙状结肠代阴道和腹膜代阴道成形术治疗Ⅱ型阴道闭锁的效果。方法我院2015年5月至2015年10月收治8例先天性阴道完全闭锁(Ⅱ型阴道闭锁)患者,均顺利实施腹腔镜下乙状结肠代阴道、腹膜代阴道成形手术;比较分析2组基本手术情况、预后疗效、预期性生活等情况,总结较理想的治疗方法。结果腹膜代阴道成形术手术时间、出血量、创伤和术后恢复更理想,而乙状结肠代阴道成形术更接近生理意义上的阴道,粘连、狭窄的风险低,对手术操作要求高,但术后黏液样分泌物较多。2例子宫发育良好者术后经血通畅,无痛经等症状,4例子宫缺如、2例始基子宫患者术后性生活满意。结论完全性阴道闭锁而子宫功能良好者应于青春期手术,以恢复其生理与生殖功能,无子宫或子宫发育不良者可在成年后一次性手术矫正阴道闭锁,而腹腔镜下腹膜代阴道和乙状结肠代阴道手术实现了微创、美观、润滑、通畅的人工阴道。

Objective To study the desired therapeutic effect of vaginoplasty using sigmoid colon or peritoneum for entire vaginal atresia. Methods From May 2015 to October 2015,8 patients with complete vaginal atresia in our hospital performed vaginoplasty using sigmoid colon or peritoneum successfully. The operation methods,prognosis and therapeutic effect and quality of sexual life of two groups were compared and analyzed to investigate a perfect operative method and ideal nursing. Results Laparoscopic vaginoplasty using the peritoneum compared with that using sigmoid colon has advantages of shorter time of operation,less bleeding,less trauma and quicker recovery. However,artificial vagina using sigmoid colon was much more similar to a natural vagina in morphological and physiological characteristics,merely accompanied by excessive mucus discharge during the postoperative period. At lower risk of vaginal adhesion and stenosis,laparoscopically assisted vaginoplasty using sigmoid colon graft also puts high technical requirements. Two patients normally developed uterus menstruate regularly. Four patients without uterus and 2 patients with rudimentary uterus experienced good sexual intercourse after vaginoplasty. Conclusion Patients with complete colpatresia who have normal womb should creat a patent and functional vagina until adolescence to restore its physiological and reproductive function. Anatomical reconstructive treatment of vaginal agenesis for patients with absent or hypoplastic uterus can be postponed till the late teens or in the adult. Both laparoscopic sigmoid vaginoplasty and peritoneal vaginoplasty achieve a minimal-invasive,cosmetic,natural lubricous,smooth artificial vagina for patient＇s sex life satisfactory.