Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria.
Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria.
Fertil Steril. 2016 Dec;106(7):e20-e21. doi: 10.1016/j.fertnstert.2016.08.030. Epub 2016 Sep 24.
To provide a review of the literature regarding this technique as well as a step-by-step description with the goal of increasing its use as a safe surgical option. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by vaginal agenesis and a variety of mullerian duct anomalies. To date, a variety of procedures have been described for creating a neovagina, but the best treatment remains debated. The Wharton-Sheares-George method, a minimally invasive surgical approach for the creation of a neovagina, is remarkably simple to perform.
Surgical video tutorial.
University hospital and referral center for pediatric and adolescent gynecology.
PATIENT(S): A 20-year-old woman with MRKH syndrome who underwent Wharton-Sheares-George neovaginoplasty.
INTERVENTION(S): With the Wharton-Sheares-George neovaginoplasty the rudimentary müllerian ducts are dilated incrementally by pushing Hegar dilators in the direction of the pelvic axis, and the resulting median raphe is then intersected using diathermy. Subsequently a vaginal mold is inserted into the newly created cavity and held in position by two sutures.
MAIN OUTCOME MEASURE(S): Discussion of the surgical steps according to the Wharton-Sheares-George method and review of the anatomic and functional results.
Reviewing the existing literature shows that a mean vaginal length and width of 8.3 and 3.3 cm, respectively, can be achieved, and so far no major intraoperative or postoperative complications or prolapse of the neovagina has been reported. Patients can achieve a high degree of general well-being as well as sexual and psychosocial functioning. However, as with most other methods, the presented method requires diligent patient compliance due to the lifelong need to actively avoid contraction of the neovagina. Also, as revealed by vaginal cultures and biopsies, the neovaginas remarkably resemble natural vaginas with regard to type of bacterial colonization and structure of epithelium. The process of spontaneous epithelialization of the neovagina is not fully understood, but has been observed to begin at the vaginal orifice and take several months to reach the apex. This leads to the assumption that the nonkeratinizing, stratified squamous epithelium originates from the preexisting vaginal epithelium of the vaginal dimple and migrates in a cranial direction. Alternatively, epithelialization might arise from pluripotent stem cells located in the obliterated müllerian ducts.
CONCLUSION(S): The creation of a neovagina using the Wharton-Sheares-George method does not require allogenic or autologous transplants, nor does it require traction devices or specialized surgical equipment. Furthermore, the procedure is comparatively simple to perform and easy to learn. By following our step-by-step description of this technique, surgeons can offer a minimally invasive, quick, and safe surgical option that provides long-term results that are both functionally and anatomically satisfying. We believe that this technique represents a valuable alternative for the creation of a neovagina in patients with MRKH syndrome and thus should be investigated on a broader scale in the future.
回顾该技术的文献，并提供逐步描述，旨在增加其作为安全手术选择的使用。 Mayer-Rokitansky-Kuster-Hauser（MRKH）综合征的特征是阴道发育不全和多种苗勒管畸形。迄今为止，已经描述了多种用于创建新阴道的手术方法，但最佳治疗方法仍存在争议。Wharton-Sheares-George 方法是一种微创外科手术方法，用于创建新阴道，其操作非常简单。
手术视频教程。
大学医院和儿科及青少年妇科转诊中心。
一名 20 岁的 MRKH 综合征患者，接受了 Wharton-Sheares-George 阴道成形术。
在 Wharton-Sheares-George 阴道成形术中，通过将 Hegar 扩张器推向骨盆轴的方向逐渐扩张原始 Müller 管，然后使用电烙术切开中间的会阴。随后将阴道模具插入新形成的腔中，并通过两条缝线固定位置。
根据 Wharton-Sheares-George 方法讨论手术步骤，并回顾解剖学和功能结果。
回顾现有文献表明，平均阴道长度和宽度分别为 8.3 和 3.3cm，迄今为止，没有报告出现主要的术中或术后并发症或新阴道脱垂。患者可以获得高度的整体健康以及性和心理社会功能。然而，与大多数其他方法一样，由于需要终身积极避免新阴道收缩，该方法需要患者的勤勉配合。此外，正如阴道培养物和活检所揭示的那样，新阴道在细菌定植类型和上皮结构方面与天然阴道非常相似。新阴道自发上皮化的过程尚未完全理解，但已观察到从阴道开口开始，并需要几个月的时间才能到达顶端。这使得人们假设非角化、复层鳞状上皮起源于阴道凹痕中的现有阴道上皮，并向颅侧迁移。或者，上皮化可能来自位于闭锁的苗勒管中的多能干细胞。
使用 Wharton-Sheares-George 方法创建新阴道不需要同种异体或自体移植，也不需要牵引装置或专门的手术设备。此外，该程序相对简单，易于学习。通过遵循我们对该技术的逐步描述，外科医生可以提供一种微创、快速且安全的手术选择，可提供长期的功能和解剖学上满意的结果。我们认为，这种技术是治疗 MRKH 综合征患者新阴道的一种有价值的替代方法，因此应该在未来更广泛地进行研究。
