Department of Urology, University of Miami Miller School of Medicine, Miami, Florida.
Department of Pediatric Urology, Miami Children's Hospital, Miami, Florida.
J Urol. 2014 May;191(5 Suppl):1537-42. doi: 10.1016/j.juro.2013.08.073. Epub 2014 Mar 26.
No consensus exists regarding the most effective procedure for neovagina formation. We describe our experience with modified single Monti tube colovaginoplasty in pediatric patients with disorders of sexual differentiation.
Six patients were retrospectively identified who underwent primary sigmoid vaginoplasty with a modified single Monti tube between 2009 and 2012. Data were collected from patient charts. The procedure is performed by isolating an 8 to 10 cm segment of distal sigmoid colon or proximal rectum, which is detubularized along the anterior mesentery, folded and retubularized longitudinally, leaving the mesentery in a cephalad position. A channel is dissected in the pelvis to accommodate the neovagina.
Mean patient age was 12.7 years (range 6 to 17). The primary diagnosis was androgen insensitivity in 3 cases (50%), and Mayer-Rokitansky syndrome, partial androgen insensitivity and persistent cloaca in 1 each (16.7%). Chromosomal analysis revealed 46XY in 4 patients (66.7%). Median followup was 7.9 months (range 3 to 41). One patient who engages in vaginal intercourse reported satisfactory vaginal length without discomfort. In 1 patient an anastomotic stricture developed, which was managed by buccal mucosal grafting.
Modified single Monti tube sigmoid vaginoplasty is a safe, effective technique for neovagina formation in pediatric patients with disorders of sexual differentiation. Compared to other existing methods, our technique allows for the use of shorter bowel segments with decreased tension of the vascular pedicle.
对于阴道重建术，目前尚无最佳术式的共识。本研究旨在报道我们在儿童性别发育障碍患者中应用改良单 Monti 管乙状结肠代阴道术的经验。
回顾性分析 2009 年至 2012 年期间，6 例接受改良单 Monti 管乙状结肠代阴道术的患者的临床资料。数据来自患者病历。手术过程为游离 8-10cm 长的乙状结肠或直肠下段，从前肠系膜游离管状化，对折后纵行包埋，系膜顶端。在骨盆内分离一个通道以容纳新阴道。
患者平均年龄 12.7 岁（6-17 岁）。原发性诊断为雄激素不敏感 3 例（50%），Mayer-Rokitansky 综合征、部分雄激素不敏感和持续性肛膜 1 例（16.7%）。4 例（66.7%）患者染色体核型分析为 46XY。中位随访时间为 7.9 个月（3-41 个月）。1 例有性生活的患者报告新阴道长度满意，无不适。1 例吻合口狭窄，行颊黏膜移植治疗。
改良单 Monti 管乙状结肠代阴道术是一种安全、有效的儿童性别发育障碍患者阴道重建方法。与其他现有方法相比，该技术可使用更短的肠段，减少血管蒂张力。
