Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil.
Eur J Obstet Gynecol Reprod Biol. 2012 Aug;163(2):204-9. doi: 10.1016/j.ejogrb.2012.04.018. Epub 2012 Jun 26.
To present and evaluate the histological, anatomical and functional results of the McIndoe procedure, as modified by the application of oxidized cellulose (Surgicel™) in women with vaginal agenesis.
Eleven patients with vaginal agenesis underwent vaginoplasty using a mould that had been wrapped with oxidized cellulose. The surgeries were performed between January 2009 and January 2010. Eight of the patients had been diagnosed with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, and the remaining three had been diagnosed with cervicovaginal agenesis (CVA). The mean follow-up time was 14 months (range, 6-24 months), and it included clinical examinations and evaluation of the Female Sexual Function Index (FSFI). Neovaginal biopsies were taken at the time of surgery and 1-12 months after surgery. The histology of the samples was evaluated to determine squamous epithelialization of the neovaginal tissue over time, and the total collagen content of the neovaginas were compared with normal control subjects. For statistical analysis we employed the ANOVA test and the t-test.
At 6 months, anatomical success was achieved in 100% of the MRKH syndrome patients (neovaginal length ≥ 6 cm), and functional success was achieved in 100% of the patients who started their sexual life (FSFI score ≥ 30). Biopsy results showed complete epithelialization of the neovagina after 5 months in all samples, and the collagen content was comparable to that of a normal vagina. One major postoperative complication occurred in a patient with CVA, which culminated in death. The uterovaginal canalization procedure was unsuccessful at creating an outflow tract for regular menses in all cases.
The procedure described here offers patients a functional vagina by means of a simple and low-cost procedure that elicits squamous epithelialization of the neovaginal vault, with total collagen content similar to that of normal vaginal tissue. It is a potential alternative therapeutic approach for MRKH syndrome but not applicable to cases of CVA.
介绍并评估经氧化纤维素（Surgicel™）改良的 McIndoe 手术在阴道闭锁女性中的组织学、解剖学和功能结果。
2009 年 1 月至 2010 年 1 月，11 例阴道闭锁患者接受了用氧化纤维素包裹模具的阴道成形术。8 例患者被诊断为 Mayer-Rokitansky-Kuster-Hauser（MRKH）综合征，其余 3 例被诊断为宫颈阴道发育不全（CVA）。平均随访时间为 14 个月（6-24 个月），包括临床检查和女性性功能指数（FSFI）评估。在手术时和手术后 1-12 个月取阴道新生物活检。评估样本的组织学以确定阴道新生物组织的鳞状上皮化随时间的变化，并将阴道新生物的总胶原含量与正常对照组进行比较。统计学分析采用方差分析和 t 检验。
在 6 个月时，MRKH 综合征患者（阴道新生物长度≥6cm）的解剖学成功率达到 100%，开始性生活的患者（FSFI 评分≥30）的功能成功率达到 100%。活检结果显示所有样本在 5 个月后均完全上皮化，胶原含量与正常阴道相似。1 例 CVA 患者发生 1 例主要术后并发症，最终死亡。所有病例的子宫阴道通道化手术均未能成功建立正常月经的流出道。
本研究中描述的手术方法通过一种简单、低成本的方法为患者提供功能性阴道，引起阴道新生物穹窿的鳞状上皮化，总胶原含量与正常阴道组织相似。它是一种治疗 MRKH 综合征的潜在替代方法，但不适用于 CVA 病例。
