先天性无阴道三种手术方式的临床疗效分析

Analysis of three different vaginoplasty for patients with congenital absence of vagina

目的探讨腹腔镜腹膜代阴道成形术、羊膜代阴道成形术及经腹带血管蒂回肠代阴道成形术的手术方法及临床疗效。方法回顾性分析因先天性无阴道就诊并行手术治疗53例患者的临床资料。根据术式的不同分为腹腔镜腹膜代阴道成形术18例(腹膜代阴道组)、羊膜代阴道成形术27例(羊膜代阴道组)、经腹带血管蒂回肠代阴道成形术8例(回肠代阴道组),比较三种术式的临床疗效。结果 53例患者手术均获得成功,单纯行阴道成形术的49例患者中,腹膜代阴道组手术时间(96.8±18.6)min及羊膜代阴道组(74.6±15.7)min,优于回肠代阴道组的(155.0±20.9)min(P<0.05);腹膜代阴道组术中出血量(38.7±19.1)m L,少于羊膜代阴道组(27.0±13.9)m L及回肠代阴道组的(101.6±27.8)m L(P<0.05)。随访45例术后再造阴道长度,腹膜代阴道组(8.6±1.7)cm以及回肠代阴道组(8.6±1.2)cm,均长于羊膜代阴道组的(7.3±1.4)cm(P<0.05)。结论三种手术方式均是可行、安全、有效,但是腹腔镜腹膜代阴道成形术相比较经腹回肠代阴道成形术具有术式微创、术后患者恢复快的优点,术后再造人工阴道长度亦长于羊膜代阴道成形术,是治疗先天性无阴道患者理想术式之一。

Objective To evaluate the surgical techniques and therapeutic results of laparoscopic peritoneal vaginoplasty, amni- otic membrane vaginoplasty and vaginoplasty with transplanting vascularized ileal flap. Methods There were 53 patients with congenital absence of vagina diagnosed and treated, clinical data of which were analyzed retrospectively. In these patients, 18 underwent laparoscopic peritoneal vaginoplasty （peritoneal group） ,27 underwent vaginoplasty with amniotic membrane （amniotic membrane group）, and 8 un- derwent vaginoplasty with transplanting vascularized ileal flap （ileal flap group）. The surgical situation （operative time, blood loss, anal exhaust time,complications） and surgical results （the length and sexual function of artificial vagina） were summarized. Results The operating time of peritoneal group （96.8 ± 18.6） min and amniotic membrane group （74.6 ± 15.7） rain were shorter than that of ileal flap group （ 155.0± 20.9） min （ P 〈 0.05 ）. The intraoperative blood loss of peritoneal group （38.7 ± 19.1 ） mL and amniotic mem- brane group （27.0 ±13.9） mL was less than that of ileal flap group （ 101.6 ± 27.8） mL （ P 〈 0.05 ）. The lengths of reconstructed vagi- na to postoperative between peritoneal group （ 8.6± 1.7） cm and ileal flap group （8.6 ± 1.2） cm have no different （P 〉 0.05）. How- ever, The lengths of these two group were longer than that of amniotic membrane group （7.3 ±1.4） cm （ P 〈 0.05 ）. Conclusion For patients with congenital absence of vagina, laparoscopic peritoneal, amniotic membrane and vaginoplasty with transplanting vascularized il- eal flap are feasible, safe and effective methods for the correction of vaginal abnormalities. The advantages of laparoscopic peritoneal vagi- noplasty are minimal invasion, quick recovery and it is a kind of the ideal vaginoplasty.