Department of General Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing, China.
Chin Med J (Engl). 2009 Aug 20;122(16):1862-6.
The surgical management of the absence of the vagina is a complex problem and constitutes a significant technical challenge. As the laparoscopy has been an important tool for the treatment of uterovaginal anomalies, we evaluated the feasibility of laparoscopic vaginoplasty using an ileal segment retrospectively.
Totally 86 patients who underwent laparoscopic vaginoplasty using an ileal segment in Beijing Anzhen Hospital during February 2004 to July 2007 were enrolled in this study. Of the 86 patients, 70 (81.4%) underwent primary operations and 16 (18.6%) secondary operations. Nineteen (22.1%) patients underwent total laparoscopic vaginoplasty and 67 (77.9%) patients underwent laparoscope-assisted vaginoplasty. The operation time, cost of hospitalization, and hospital duration were compared between the two laparoscopic groups. The Student's t test and the Mann-Whitney test were used to examine the differences.
All the surgeries were successfully completed with no any intraoperative complication. There were three major surgical complications in the postoperative period: one case of intra-abdominal hemorrhage, one case of meatal stenosis, and one case of intestinal obstruction. The mean follow-up period of this series was 18 months. Seventy-eight patients were satisfied with their sexual lives after the surgeries except 5 women complaining of vaginal stenosis and 3 with no sexual partner during the follow-up. Significant differences were obtained between total laparoscopic and laparoscope-assisted vaginoplasty groups, such as the operation time, cost of hospitalization, and hospital duration (P < 0.01). There were no significant differences in sexual function between the two groups.
The laparoscopic vaginoplasty using an ileal segment is satisfactory for cosmetic, functional, and anatomic results. Vaginoplasty with an ileal segment, performed by either total laparoscopic or laparoscope-assisted techniques, has a high success rate for a functional vagina.
阴道缺失的手术治疗是一个复杂的问题，构成了一个重大的技术挑战。由于腹腔镜已成为治疗子宫阴道异常的重要工具，我们回顾性地评估了使用回肠段进行腹腔镜阴道成形术的可行性。
本研究共纳入 2004 年 2 月至 2007 年 7 月在北京安贞医院接受回肠段腹腔镜阴道成形术的 86 例患者。86 例患者中，70 例（81.4%）行初次手术，16 例（18.6%）行二次手术。19 例（22.1%）患者行全腹腔镜阴道成形术，67 例（77.9%）患者行腹腔镜辅助阴道成形术。比较两组腹腔镜手术的手术时间、住院费用和住院时间。采用 Student's t 检验和 Mann-Whitney 检验比较差异。
所有手术均顺利完成，无术中并发症。术后有 3 例严重手术并发症：1 例腹腔内出血，1 例尿道口狭窄，1 例肠梗阻。本系列的平均随访时间为 18 个月。除 5 例女性抱怨阴道狭窄和 3 例随访期间无性伴侣外，其余 78 例患者对性生活均满意。全腹腔镜与腹腔镜辅助阴道成形术组在手术时间、住院费用和住院时间方面存在显著差异（P < 0.01）。两组患者的性功能无显著差异。
回肠段腹腔镜阴道成形术在美容、功能和解剖学方面效果满意。使用全腹腔镜或腹腔镜辅助技术进行回肠段阴道成形术，可获得功能良好的阴道，成功率高。
