腹腔镜下乙状结肠代阴道成形术的临床应用

Study of operative procedures of laparoscopy and laparoscopically assisted sigmoid transplantation for vaginal construction

目的 探讨腹腔镜下进行乙状结肠代阴道成形术的方法及其临床应用效果。方法施行腹腔镜辅助下乙状结肠代阴道成形术4例,于腹腔镜下采用直线切割缝合器切断乙状结肠的远端后,在左下腹做一辅助切口,经此切口牵拉出近端乙状结肠,再次切断乙状结肠,缝合关闭移植乙状结肠段近端开口,将吻合器底座置入保留的乙状结肠段近端,并行荷包缝合后,将肠管还纳腹腔。经肛门置入管状吻合器,腹腔镜下将保留的乙状结肠段行端端吻合,下牵移植的乙状结肠段入阴道穴道。施行全腹腔镜下乙状结肠代阴道成形术5例,上述手术操作均于腹腔镜下完成。结果9例手术均获成功,患者平均手术时间312 min,平均出血量308 ml;随访时间1-19个月,腹部切口美观,人工阴道生长良好,5例性生活满意。结论腹腔镜下乙状结肠代阴道成形术创伤小,患者恢复快,能够达到开腹手术的效果。

Objective To explore the procedures and the clinical significance of laparoscopy and laparoscopically assisted sigmoid transplantation for vaginal construction. Methods Nine cases were assigned randomly to laparoscopically assisted sigmoid colpopoiesis and laparoscopic sigmoid colon colpopoiesis. The procedure of laparoscopically assisted sigmoid colpopoiesis: with the auxiliary of laparoscopy, dissectted the distal portion of the sigmoid with endoscopic linear cutter, then a 4-cm incision was made in the left lower abdomen to retract and dissect the proximal portion of sigmoid. After the proximal portion of transplant-sigmoid was closed, the proximal cut end of reserved-sigmoid was placed with the anvil and made a purse-string suture, then put back sigmoid into the peritoneal cavity. A curved intraluminal stapler was inserted from the anus to the most distal cut end of reserved-sigmoid to end-end anastomose the reserved-sigmoid. Finally, an artificial canal was made between urethravesicae and rectum and the transplant-sigmoid with the blood supply was placed into the artificial canal to create an artificial vagina. The procedure of laparoscopic sigmoid colpopoiesis was performed under laparoscopy thoroughly. Results We have successfully completed the operations for 9 patients, and made 1-19 month following-up. The results of the artificial vaginae of all cases were satisfactory; the abdominal scar was small with remarkable cosmetic effects. Moreover, 5 cases had pleasant sexual intercourses. Conclusion The procedures of laparoscopy and laparoscopically assisted sigmoid transplantation for vaginal construction can replace the traditional laparotomy.