Georgas Konstantinos, Belgrano Valerio, Andreasson My, Elander Anna, Selvaggi Gennaro
a Department of Plastic Surgery , Sahlgrenska Universitetssjukhuset , Göteborg , Sweden.
b Department of Surgery, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden.
J Plast Surg Hand Surg. 2018 Oct;52(5):265-273. doi: 10.1080/2000656X.2018.1482220. Epub 2018 Jul 24.
Among surgical procedures for constructing a neovagina, positive outcomes are reported in literature for bowel vaginoplasty for male-to-female transgenders and patients with vaginal aplasia. This systematic review shows outcomes of bowel vaginoplasty procedures, and rates the quality of evidence of the included studies. A search of the literature was performed in PubMed, Medline, Cochrane Library and SveMed+, in accordance with the PRISMA statement, between January 2016 and February 2018. The PICOS (patients, intervention, comparator, outcomes and study design) approach was used as inclusion criteria. Among 251 analyzed studies only 34 met inclusion criteria. Quality of evidence and methodology were rated according to GRADE and MINORS, respectively. Data from the included studies were extracted based on study characteristics, participants? specifics, type of intervention/treatment and type of outcome measures into data extraction forms. All studies were non-randomized with a high risk of bias and very low quality of evidence according to GRADE. Vaginal reconstruction with isolated bowel segments provides a self-lubricating neovagina with low rates of failure and revision, and without routine dilatation need. Furthermore, the use of laparoscopic techniques offers a better postoperative cosmetic appearance of the abdomen and a shorter hospital stay. Vaginoplasty using bowel segment is a safe and effective procedure that obtains excellent long-term results as reported by the included studies. Despite that further researches are needed improving methodology with larger populations, retrospective qualitative studies and report of outcome measurements using standardized evaluation tools as the Female Sexual Function Index.
在构建新阴道的外科手术中，文献报道了男性变女性的跨性别者和阴道发育不全患者进行肠道阴道成形术的积极结果。本系统评价展示了肠道阴道成形术的手术结果，并对纳入研究的证据质量进行了评级。根据PRISMA声明，于2016年1月至2018年2月在PubMed、Medline、Cochrane图书馆和SveMed+中进行了文献检索。采用PICOS（患者、干预措施、对照、结局和研究设计）方法作为纳入标准。在251项分析研究中，只有34项符合纳入标准。分别根据GRADE和MINORS对证据质量和方法进行评级。根据研究特征、参与者详情、干预/治疗类型和结局测量类型，将纳入研究的数据提取到数据提取表中。根据GRADE，所有研究均为非随机研究，存在高偏倚风险且证据质量极低。使用孤立肠段进行阴道重建可提供自我润滑的新阴道，失败率和修复率低，且无需常规扩张。此外，腹腔镜技术的应用可使腹部术后外观更好，住院时间更短。如纳入研究报道的那样，使用肠段进行阴道成形术是一种安全有效的手术，可获得优异的长期效果。尽管如此，仍需要进一步的研究，以通过更大规模的人群、回顾性定性研究以及使用标准化评估工具（如女性性功能指数）报告结局测量来改进方法。
