Gynecology- Tocogynechology Department, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.
JBRA Assist Reprod. 2021 Oct 4;25(4):581-585. doi: 10.5935/1518-0557.20210016.
To evaluate the newly formed epithelium that develops following a neovaginoplasty performed with Amniotic Membrane.
A retrospective study conducted at the University Hospital of the Federal University, in Curitiba, Paraná, Brazil. A group of 33 patients with Vaginal Agenesis, most of them amenorrhoeic, either incapable of or having difficulty to perform sexual activity, were separated in Subgroup A (27 patients) with Mayer-Rokitansky-Kuster-Hauser Syndrome, and Subgroup B (six patients) with Androgenic Insensitivity Syndrome (Morris Syndrome). Intervention: Banister-McIndoe neovaginoplasty was performed using amniotic membrane graft in 33 patients of Subgroups A and B and evaluated 60-90 days later by vaginal epithelium biopsies. Main Outcome Measure(s): Transmission Electronic Microscopy (TEM) performed Biopsies of neovaginal epithelium in 10 patients. In 20 patients, we analyzed the levels of intensity and presence of Estrogenic Receptors.
Vaginal length was measured (vaginometry) before and after surgery. Before surgery, the vagina was absent in 5 patients (15.15%), vaginal length was 1 cm in 19 patients (57.58%) and in 9 patients (27.27%), it was between 2-3 cm. After surgery, all patients had a vaginal length greater or equal to 5 cm and, in 26 patients (78.8%), vaginal length was 7-8 cm. Seven to eight centimeters average neovagina length allowed patients to have a satisfactory sexual activity after all the surgical procedures to dilate, widen and distend the neomucosa lining. The ERs presented different levels of intensity in the three layers of the neovaginal mucosa. TEM analysis of the vaginal neoepithelium obtained from the amniotic membrane graft revealed all the characteristics of a trophic vaginal epithelium.
In a developing country like Brazil, neovaginoplasty with amniotic membrane graft is considered a great option, being an inexpensive, safe, and easy technique, not requiring any special materials. After a few days (60-90 days), or months, a new epithelium and vagina are obtained allowing patients to have proper sexual activity.
评估采用羊膜进行新阴道成形术后形成的新上皮。
这是在巴西库里蒂巴联邦大学附属医院进行的一项回顾性研究。将 33 名阴道发育不全的患者（大多数为闭经，要么无法进行，要么难以进行性行为）分为 A 亚组（27 名患者）和 B 亚组（6 名患者）。A 亚组为 Mayer-Rokitansky-Kuster-Hauser 综合征，B 亚组为雄激素不敏感综合征（Morris 综合征）。干预措施：采用 Banister-McIndoe 新阴道成形术，用羊膜移植物对 A 亚组和 B 亚组的 33 名患者进行治疗，并在 60-90 天后通过阴道上皮活检进行评估。主要观察指标：对 10 名患者的新阴道上皮进行透射电子显微镜（TEM）检查。在 20 名患者中，我们分析了雌激素受体的强度和存在水平。
手术前后测量阴道长度（阴道测径术）。术前，5 名患者（15.15%）无阴道，19 名患者（57.58%）阴道长度为 1cm，9 名患者（27.27%）阴道长度为 2-3cm。术后，所有患者的阴道长度均大于或等于 5cm，26 名患者（78.8%）的阴道长度为 7-8cm。平均 7-8cm 的新阴道长度使所有患者在所有手术过程（扩张、加宽和伸展新黏膜衬里）后都能进行满意的性生活。ER 在新阴道黏膜的三层中表现出不同的强度水平。从羊膜移植物获得的阴道新上皮的 TEM 分析显示出所有营养性阴道上皮的特征。
在像巴西这样的发展中国家，采用羊膜移植物的新阴道成形术被认为是一种很好的选择，因为它是一种廉价、安全且易于操作的技术，不需要任何特殊材料。在数天（60-90 天）或数月后，会获得新的上皮和阴道，使患者能够进行适当的性生活。
