三种人工阴道成形术后阴道乳杆菌定植情况研究

Study on the existence of vaginal lactobacillus after three types of vaginoplasty

目的探讨结肠代阴道、皮肤代阴道及猪小肠黏膜下层生物补片代阴道术后阴道乳杆菌定植情况。方法回顾性分析2012年7月至2014年7月在上海交通大学医学院附属第九人民医院行人工阴道成形术的患者资料,根据所用术式分为:结肠代阴道组(23例)、皮肤代阴道组(18例)、补片代阴道组(20例),分别在术后1周、1个月、6个月进行阴道分泌物乳杆菌培养检测;对照组为同期就诊的健康女性(30例)。比较各组阴道乳杆菌的检出情况。结果术后1周的阴道乳杆菌检出率,结肠代阴道组(17.39%)、皮肤代阴道组(16.67%)及补片代阴道组(20%)与对照组(60%)相比,差异均有统计学意义(P<0.05);术后1个月的阴道乳杆菌检出率,结肠代阴道组(34.78%)、补片代阴道组(35.00%)与对照组相比差异均无统计学意义(P>0.05),皮肤代阴道组(22.22%)与对照组相比差异有统计学意义(P<0.05);术后6个月的阴道乳杆菌检出率,结肠代阴道组(47.83%)、补片代阴道组(40.00%)与对照组相比差异均无统计学意义(P>0.05),皮肤代阴道组(27.78%)与对照组相比差异有统计学意义(P<0.05)。结论术后1周内乳杆菌即可在人工阴道内定植;术后1、6个月时结肠代阴道和补片代阴道患者阴道内乳杆菌检出情况与健康妇女水平相近,皮肤代阴道乳杆菌检出率较低,有必要进一步研究。

Objective To investigate the existence of vaginal lactobacillus after sigmoid vaginoplasty, skin graft vaginoplasty and porcine small intestinal submucosa （SIS） vaginoplasty.Methods Totally 23 women with sigmoid vaginoplasty, 18 women with skin graft vaginoplasty and 20 women with SIS vaginoplasty who visited Shanghai Ninth People＇ s Hospital were enrolled in this restropective study, and vaginal lactobacillus were cultured and detected in all the cases at 1 week, 1 month, and 6 months respectively after the vaginoplasty.Thirty healthy females were collected as control group. The positive rates of vaginal lactobacillus were compared in all the groups. Results The positive rates of vaginal lactobacillus at 1 week in sigmoid vaginoplasty group （17.39%）, skin graft vaginoplasty group （16.67%） and SIS vaginoplasty group （20%） were lower than those in the control group（60%）, with statistic differences（P 〈 0.05）.With regard to the positive rate of vaginal lactobacillus at 1 month after vaginoplasty, there were no significant differences between sigmoid vaginoplasty group （34.78%）, SIS vaginoplasty group （35%） and the control group（P〉 0.05）, whereas statistic difference was found between the skin graft vaginoplasty group（22.22%） and the control group（P〈 0.05）.The positive rates of vaginal lactobacillus at 6 months in sigmoid vaginoplasty group （47.83%） and SIS vaginoplasty group （40%） were similar to those of the control group（P〉0.05）, while in the skin graft vaginoplasty group（27.78%）, it was statisticly different from the control group（P 〈 0.05）.Conclusion Within 1 week, lactobacillus begins to appear and clone in the vagina after vaginoplasty.One month and 6 months after vaginoplasty, the lactobacillus in patients receiving the sigmoid vaginoplasty and SIS vaginoplasty nearly reaches the normal lactobacillus positive rate, while the lactobacillus positive rate in patients undergoing skin graft vaginoplasty is lower, which needs further study.