Zhang Dawei, Zhang Jun, Wang Huanying, Li Bin, Zhu Xiaoxing, Wang Liying, Wu Jixiang
Department of Obstetrics and Gynecology,Beijing Anzhen Hospital, Capital Medical University,Beijing 100029, China.
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Zhonghua Fu Chan Ke Za Zhi. 2014 Mar;49(3):172-5.
To study the clinical effect of laparoscopic vaginoplasty using pedicled ileal and sigmoid colon segment.
From January 2004 to December 2009, 105 cases undergoing laparoscope-assisted vaginoplasty using a vascularized pedicled intestinal flap were studied retrospectively. Operation time, blood loss in operating, bowel movement after operation, postoperation hospital duration, side effect, and artificial vagina were compared between two surgical management.
The vaginoplasty were preformed successfully in all 105 cases. There were 48 patients treated by aparoscope-assisted ileal vaginoplasty and 57 patients treated by laparoscope-assisted sigmoid colon vaginoplasty. The values of the operation time [(141 ± 22) minutes versus (159 ± 18) minutes, P = 0.000], blood loss in operating [(42 ± 6) ml versus (83 ± 14) ml, P = 0.000], bowel movement after operation (36 ± 9) hours versus (68 ± 8) hours(P = 0.000), and postoperation hospital duration [(9.8 ± 2.0) days versus (11.1 ± 1.3) days, P = 0.004] in the sigmoid colon vaginoplasty group were longer or higher than those in ileal vaginoplasty group (P < 0.05).No intraoprative complication occurred. There were four postoperative complications: 2 cases with intestinal obstruction in sigmoid colon vaginoplasty group, 1 case with urethral orifice stenosis and 1 case with vaginal-rectal fistula in ileal vaginoplasty group. At follow-up of 6-62 months, all artificial vaginas had a capacity of over two fingers in wideness and 12-15 cm in length. Vaginal discharges resembled a milky white water or mucus without odour. Fifty-five patients with sexual intercourse reported satisfactory results.Six patients complained vaginal stenosis:5 patients in ileal vaginoplasty group and 1 patient in sigmoid colon vaginoplasty group.
Laparoscope-assisted vaginoplasty using pedicled ileum or sigmoid colon segment are both the effective ways in forming vagina. The latter management takes more time and blood loss while operating, yet the incidence of vaginal opening contracture appeared to be decreasing trend.
探讨带蒂回肠段和乙状结肠段腹腔镜阴道成形术的临床效果。
回顾性分析2004年1月至2009年12月期间105例行腹腔镜辅助带血管蒂肠瓣阴道成形术的患者。比较两种手术方式的手术时间、术中出血量、术后排便时间、术后住院时间、副作用及人工阴道情况。
105例患者均成功完成阴道成形术。其中48例行腹腔镜辅助回肠阴道成形术，57例行腹腔镜辅助乙状结肠阴道成形术。乙状结肠阴道成形术组的手术时间[（141±22）分钟对（159±18）分钟，P = 0.000]、术中出血量[（42±6）毫升对（83±14）毫升，P = 0.000]、术后排便时间（36±9）小时对（68±8）小时（P = 0.000）及术后住院时间[（9.8±2.0）天对（11.1±1.3）天，P = 0.004]均长于或多于回肠阴道成形术组（P < 0.05）。术中无并发症发生。术后有4例并发症：乙状结肠阴道成形术组2例肠梗阻，回肠阴道成形术组1例尿道口狭窄和1例阴道直肠瘘。随访6 - 62个月，所有人工阴道宽度超过两指，长度12 - 15厘米。阴道分泌物呈乳白色水样或黏液样，无异味。55例有性生活的患者报告效果满意。6例患者抱怨阴道狭窄：回肠阴道成形术组5例，乙状结肠阴道成形术组1例。
腹腔镜辅助带蒂回肠或乙状结肠段阴道成形术均是形成阴道的有效方法。后者手术时间更长，术中出血量更多，但阴道口挛缩发生率呈下降趋势。
