单孔腹腔镜联合经会阴入路乙状结肠代阴道成形术

Single-port Laparoscopy Combined Transperineal Sigmoid Vaginoplasty

目的探讨经脐单孔腹腔镜联合经会阴入路乙状结肠代阴道成形术治疗先天性无阴道(Mayer-RokitanskyKüster-Hauser syndrome,MRKHS)可行性和效果。方法 2013年7月～2017年12月我们对25例MRKHS施行经脐单孔腹腔镜联合经会阴入路乙状结肠代阴道成形术。通过脐部trocar置入腹腔镜,在直肠和尿道之间分离穴道放置Tri Port,游离切取带血管蒂的乙状结肠肠段,经会阴穴道游离牵出降结肠,远端置入钉钻头荷包缝合固定后送还腹腔,经直肠插入腔内圆型吻合器端端吻合结直肠,再将带血管蒂的移植肠段经穴道拖出成形新阴道。结果 25例手术顺利完成。手术时间(152.6±13.3) min,住院时间(7.5±0.7) d。术后1例盆腹腔积血再手术引流;1例术后新阴道放置支撑磨具穿透后壁及直肠前壁再手术修补直肠,重新截取回肠代阴道成形术;1例术后新阴道肠管迟发坏死脱落保守治疗待其上皮修复。21例随访6～36个月,重建阴道正常且均具有良好的性行为功能。结论经脐单孔腹腔镜联合会阴入路乙状结肠代阴道成形术为MRKHS患者提供一种安全可行的无可见瘢痕的手术方法。

Objective To evaluate the feasibility and effectiveness of single-port laparoscopy combined transperineal vaginoplasty by using a sigmoid graft for Mayer-Rokitansky-Küster-Hauser syndrome ( MRKHS).Methods A total of 25 young girls with MRKHS underwent single-port laparoscopy combined transperineal sigmoid vaginosplasty.One trocar was placed through the umbilicus for a laparoscope.The sigmoid graft was mobilized and transected at the proximal and distal end by using the TriPort through perineal approach between the rectum and urethra.The distal descending colon was drawn out through the perineal tunnel.An anvil was placed in it and a purse-string suture was done.Then it was returned into the peritoneal cavity.An intracorporeal end-to-end colorectal anastomosis was made by using a transrectal introduced circular stapler to restore the bowel continuity.The sigmoid graft with its vessel pedicle was pulled down through the perineal tunnel to form a neovagina.Results The operations were successfully completed in all the 25 patients.The operative time and hospital stay were ( 152.6 ± 13.3) minutes and ( 7.5 ± 0.7) days.There were 3 cases of peri-operative complications: one case underwent reoperative drainage for pelvic and peritoneal hemorrhage;one case underwent reoperation of ileal vaginoplasty to repair rectum due to supporting device penetration through the posterior and anterior rectal walls;one case underwent conservative treatment for delayed necrosis and exfoliation of the neo-vaginal intestinal canal until its epithelium was repaired.A functioning vagina was created and had subsequent sexual activities in 21 patients during 6 - 36 months of follow-ups.Conclusion Single-port laparoscopy combined transperineal sigmoid vaginoplasty offers a feasible scarless approach for women with MRKHS.