Kaiser C, Stoll I, Ataseven B, Morath S, Schaff J, Eiermann W
Rotkreuzklinikum München, Frauenklinik, München. muefi
Handchir Mikrochir Plast Chir. 2011 Aug;43(4):240-5. doi: 10.1055/s-0030-1267241. Epub 2011 Aug 10.
FtM reassignment surgeries are rare and require interdisciplinary cooperation of plastic surgeons and gynaecologists. There are only few homogeneous data and standardised recommendations about the operative access to hysterectomy and bilateral adnexectomy of FtM transsexual patients.
Between 2006 and 2009 106 FtM transsexuals were hysterectomised in an interdisciplinary concept of plastic surgeons and gynaecologists in the Frauenklinik des Rotkreuzklinikums München. Firstly plastic surgeons performed a complete colpectomy, after that a vaginal hysterectomy with bilateral adnexectomy was carried out by gynaecologists. Simultaneously plastic surgeons performed a bilateral subcutaneous adenomammectomy on the FtM patients, and the removed vaginal tissue was prepared for preforming a new urethra. In the next step the vagina was closed by plastic surgeons and the urethra preformed.
In 103 of 106 cases (97.2%) hysterectomy and bilateral adnexectomy were performed through the vagina. The complication rate was 5.4%. The vaginal hysterectomy and the bilateral adnexectomy lasted 52 min on average.
Vaginal, abdominal or laparoscopic approaches provide possible operative access for hysterectomy and bilateral adnexectomy in FtM transsexuals. A data comparison shows that the rate of complications with our FtM transsexuals operated through the vagina was not higher than that with non-transsexual patients operated through the vagina for benign illnesses of the uterus. There are advantages of the vaginal hysterectomy for patients concerning a reduced occurrence of scars and avoiding injuries of the rectus muscle as an important precondition for phalloplasty. The bilaterally performed subcutaneous adenomammectomy and the preparation of the removed vaginal tissue for the preformation of the urethra can be carried out simultaneously, meaning that the time for operation and the stay in hospital will be shortened and costs will be reduced as well. The problem of a relatively narrow field for the operation will be minimised or even solved by the preceding colpectomy.
Realising the vaginal hysterectomy with bilateral vaginal adnexectomy after performing a total colpectomy from our point of view is the optimal choice concerning operative methods for reassignment surgeries.
男性向女性性别重置手术较为罕见，需要整形外科医生和妇科医生的跨学科合作。关于男性向女性变性患者子宫切除及双侧附件切除的手术入路，仅有少量同类数据和标准化建议。
2006年至2009年间，慕尼黑红十字医院妇科在整形外科医生和妇科医生的跨学科理念下，为106例男性向女性变性者实施了子宫切除术。首先由整形外科医生进行全阴道切除术，之后由妇科医生进行经阴道子宫切除及双侧附件切除术。同时，整形外科医生为男性向女性变性患者实施双侧皮下乳腺切除术，并将切除的阴道组织用于预制新尿道。下一步，由整形外科医生关闭阴道并预制尿道。
106例中有103例（97.2%）经阴道实施了子宫切除及双侧附件切除术。并发症发生率为5.4%。经阴道子宫切除及双侧附件切除术平均持续52分钟。
经阴道、经腹或腹腔镜入路为男性向女性变性者的子宫切除及双侧附件切除提供了可能的手术途径。数据比较显示，我们对男性向女性变性者经阴道手术的并发症发生率并不高于因子宫良性疾病经阴道手术的非变性患者。经阴道子宫切除术对患者有诸多优点，如瘢痕形成减少以及避免腹直肌损伤，这是阴茎成形术的重要前提条件。双侧皮下乳腺切除术以及将切除的阴道组织用于预制尿道可同时进行，这意味着手术时间和住院时间将缩短，费用也会降低。先前的阴道切除术可将手术视野相对狭窄的问题降至最低甚至解决。
从我们的角度来看，在进行全阴道切除术后实施经阴道子宫切除及双侧阴道附件切除术是性别重置手术手术方法的最佳选择。
