Benedetti Panici Pierluigi, Maffucci Diana, Ceccarelli Simona, Vescarelli Enrica, Perniola Giorgia, Muzii Ludovico, Marchese Cinzia
Department of Gynecologic-Obstetrical and Urologic Sciences, "Sapienza" University of Rome, Rome, Italy.
Department of Gynecologic-Obstetrical and Urologic Sciences, "Sapienza" University of Rome, Rome, Italy.
J Minim Invasive Gynecol. 2015 Feb;22(2):205-11. doi: 10.1016/j.jmig.2014.09.012. Epub 2014 Oct 2.
To present the procedure and the results of a technique in which in vitro autologous cell cultures were used for the canal lining in patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) subjected to vaginoplasty with a modified Abbè-McIndoe technique. MRKHS is a rare anomaly characterized by vaginal agenesis with variable müllerian duct abnormalities. The Abbè-McIndoe procedure is 1 of the most frequent surgical treatments adopted in these women. In the last decades, several modifications have been introduced by different authors, mostly changing the lining material, but no consensus has been reached on what material should be used for the neovagina canal wall lining.
A pilot study (Canadian Task Force classification II-1).
Policlinico Umberto I, "Sapienza" University of Rome.
A consecutive series of 23 women with MRKHS underwent neovaginoplasty with autologous vaginal tissue as the graft material between 2006 and 2013.
Each patient with MRKHS was subjected to a full-thickness mucosal biopsy from the vaginal vestibule. After enzymatic dissociation, cells were inoculated onto collagen IV-coated plates and cultured for 2 to 3 weeks. The patients were subjected to vaginoplasty with a modified Abbè-McIndoe technique with autologous in vitro cultured vaginal tissue. Patients underwent clinical follow-up visits at 1, 3, 6, and 12 months after surgery and every year thereafter. Anatomic, functional, and sexual results were assessed.
In all cases, the vagina appeared normal in length and depth. A vaginal cytology and a vaginal biopsy obtained at the 3-month follow-up visit revealed physiological vaginal tissue. All 23 patients completed the Female Sexual Function Index questionnaire at 12 months after surgery. The results showed a total score of 27.2. These results indicate a satisfactory quality of sexual life.
The modified Abbè-McIndoe technique with autologous vaginal tissue appears to be safe and feasible. This technique allows normal and satisfying sexual intercourse. Larger series with longer follow-ups will be necessary to confirm if this technique represents the ideal procedure for vaginal agenesis.
介绍一种技术的操作过程及结果,该技术是在采用改良阿贝 - 麦金杜技术进行阴道成形术的迈耶 - 罗基坦斯基 - 库斯特 - 豪泽综合征(MRKHS)患者中,使用体外自体细胞培养物进行阴道管内衬。MRKHS是一种罕见的先天性异常,其特征为阴道发育不全并伴有不同程度的苗勒管异常。阿贝 - 麦金杜手术是这些女性最常采用的外科治疗方法之一。在过去几十年中,不同作者引入了多种改良方法,主要是改变内衬材料,但对于新阴道管壁内衬应使用何种材料尚未达成共识。
一项初步研究(加拿大工作组分类II - 1)。
罗马“萨皮恩扎”大学翁贝托一世综合医院。
2006年至2013年期间,连续23例患有MRKHS的女性接受了以自体阴道组织作为移植材料的阴道成形术。
每位患有MRKHS的患者均接受阴道前庭全层黏膜活检。酶解后,将细胞接种到包被有IV型胶原的培养板上,培养2至3周。患者采用改良阿贝 - 麦金杜技术及自体体外培养的阴道组织进行阴道成形术。患者在术后1、3、6和12个月以及此后每年接受临床随访。评估解剖学、功能和性方面的结果。
在所有病例中,阴道的长度和深度均正常。术后3个月随访时进行的阴道细胞学检查和阴道活检显示为生理性阴道组织。所有23例患者在术后12个月完成了女性性功能指数问卷。结果显示总分为27.2。这些结果表明性生活质量令人满意。
采用自体阴道组织的改良阿贝 - 麦金杜技术似乎是安全可行的。该技术可实现正常且令人满意的性交。需要更大规模且随访时间更长的系列研究来证实该技术是否为阴道发育不全的理想治疗方法。