自体口腔黏膜结合小阴唇皮肤微粒移植在阴道再造中的应用

Clinical application of auto micro grafting of buccal mucosa and labia minora in vaginal reconstruction

目的探讨自体微粒口腔黏膜结合小阴唇内侧皮肤微粒移植在阴道再造中的应用疗效。方法从2011年1月至2019年1月,共收治36例先天性无阴道患者,年龄17~33岁,平均(24.08±3.99)岁。所有患者第二性征发育正常,激素水平正常,染色体核型均为46 XX。腹部B超及盆腔MRI显示均为无子宫或始基子宫,卵巢正常。术中切取患者口腔黏膜及小阴唇内侧皮肤,将其剪碎成直径约0.5mm的微粒,移植于尿道与直肠之间的再造腔穴,使用模具及负压吸引装置固定成形。结果所有患者均顺利实施手术,阴道再造术手术时间约1~2h,术中出血约50~300ml。再造阴道的深度约6~10cm,宽度约两横指,阴道内壁黏膜光滑红润。口腔内及会阴部供区愈合良好,无继发畸形。23例患者随访10个月,性交时均未出现疼痛、出血。结论自体口腔黏膜结合小阴唇皮肤微粒移植再造阴道是一种疗效可靠、创伤小的方法。

Objective To investigate the effect of vaginal reconstruction with autologous buccal mucosa and labia minora graft.Methods From January 2011 to January 2019,36 patients with congenital absence of vagina were treated,aged 17~33(24.08±3.99)years.They all exhibited normal secondary sexual characteristics,normal hormonal levels and 46 XX karyotype.Their abdominal ultrasonography and pelvic magnetic resonance imaging(MRI)revealed the normal ovaries and tubes but absence of the uterus or small rudimentary horns.The buccal mucosa and labia minora were minced into 0.5mm in size and were grafted to the cavity which was dissected between the urethra and the rectum.The mould and vacuum sealing drainage(VSD)material were inserted into the newly created cavity.Result The operation was performed successfully in all cases.The operative time was about 1-2 hours and operative blood loss was 80-100 ml.The depth of neovagina which was formed was 6-10 cm and the width was about two fingers.The lining was pink-colored and smooth.The donor sites healed uneventfully with no change in mouth opening.The perineal area was not disturbed.23 cases were follow-up for 10 months,and they were satisfied with their sexual life without pain and bleeding.Conclusion Vaginal reconstruction with autologous buccal mucosa and labia minora graft is a reliable,minimally invasive and useful method.