罗湖四式治疗合并功能性子宫的阴道闭锁(Ⅰ型)5例报告

Application of Luohu Ⅳ Technique for Patients with Congenital Partial Vaginal Atresia Combined with Functional Uterus

目的：探讨罗湖四式（腹腔镜下闭锁阴道切开术＋游离积血囊壁及腹膜行阴道成形术）治疗先天性阴道闭锁Ⅰ型合并正常子宫患者的可行性及近期效果。方法2015年7月～2016年1月对5例先天性阴道闭锁Ⅰ型合并正常子宫施行罗湖四式，术中切开闭锁阴道，腹腔镜下游离子宫下方积血囊壁作为人工阴道前壁覆盖物，游离腹膜作为人工阴道后壁覆盖物，覆盖闭锁阴道切开后创面，形成通畅的新阴道。结果5例顺利完成手术，手术时间140～198 min，平均165 min；术中出血量100～200 ml，平均140 ml。术后1个月月经来潮。5例平均随访7．4月（3～10个月），月经正常，无周期性腹痛。结论罗湖四式治疗先天性阴道闭锁Ⅰ型合并正常子宫是一种可行的微创方法，近期效果满意。使用游离的积血囊肿壁及腹膜作为人工阴道壁覆盖物和术后阴道扩张是手术成功的关键，术后无须长期放置子宫阴道支架。

Objective To evaluate the feasibility of the Luohu Ⅳ technique （ laparoscopic vaginal section and vaginoplasty with hyphema cyst wall and peritoneum ） for patients with partial congenital vaginal atresia combined with functional uterus . Methods We treated 5 patients who had partial congenital vaginal atresia combined with functional uterus from July 2015 to January 2016. During the operation the vagina was opened firstly .And then the hyphema cyst wall below the uterus was mobilized under laparoscope to fix the anterior wall of the artificial vagina , while the peritoneum was used to fix the posterior wall of the artificial vagina .Finally the wound was covered to form the neovagina . Results The operations were completed successfully .The operation time was 140-198 min （mean, 165 min）.The intraoperative blood loss was 100 -200 ml （ mean, 140 ml）.The menstruation recovered at first postoperative month.Follow-up for 3 -10 months （mean, 7.4 months） in 5 patients found regular menstruation without recurrent abdominal pain . Conclusion The Luohu Ⅳtechnique is an effective and minimally invasive treatment option for patients who had partial vaginal aplasia combined with functional uterus .Proper peritoneal and flap vaginoplasty and neovagina dilation post-operation are keys to a successful fertility preserving procedure .