Candiani Massimo, Vercellini Paolo, Fedele Francesco, Parma Marta, Salvatore Stefano, Fedele Luigi
Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Obstetrics and Gynecology, Fondazione "Policlinico-Mangiagalli-Regina Elena" University of Milan, Italy.
J Pediatr Adolesc Gynecol. 2023 Feb;36(1):72-78. doi: 10.1016/j.jpag.2022.04.008. Epub 2022 Apr 28.
The surgical treatment of girls with cervical atresia and complete absence of the vagina remains a problem because of the rarity of cases and the controversial study results.
To describe the surgical technique and long-term results of laparoscopically assisted uterovestibular anastomosis in patients with cervical atresia and complete absence of the vagina STUDY DESIGN: Sixteen consecutive patients with cervical atresia and complete absence of the vagina were conservatively treated with laparoscopically assisted uterovestibular anastomosis in 2 tertiary care referral centers. The follow-up assessments included clinical examination, determination of the presence and quality of sexual intercourse, and vaginoscopy.
All patients underwent laparoscopically assisted uterovestibular anastomosis. No perioperative complications occurred. The mean follow-up period was 8 ± 3.2 years. In all patients, the length of the neovagina was greater than 4 cm at 1 year after the surgery and approximately 6 cm after 2 years. After the start of sexual intercourse, the neovagina exceeded 7 cm in length in 2 of the 11 sexually active patients. At 12 months after the surgery, iodine-positive epithelium was present in all patients and was maintained over time. The continuity of the neovagina, neocervix, and uterine body was maintained without further interventions in 15 of the 16 patients. During the follow-up, 11 patients were sexually active, 5 were married, 4 were seeking conception, and 2 had spontaneous pregnancy.
Laparoscopically assisted uterovestibular anastomosis seems to be a safe and effective treatment for patients with cervical atresia and complete absence of the vagina, at least in terms of the recovery of menstrual function and sexual activity.
由于病例罕见且研究结果存在争议，宫颈闭锁且完全无阴道的女孩的外科治疗仍是一个难题。
描述腹腔镜辅助子宫前庭吻合术治疗宫颈闭锁且完全无阴道患者的手术技术及长期效果。
在2家三级医疗转诊中心，对16例连续的宫颈闭锁且完全无阴道的患者采用腹腔镜辅助子宫前庭吻合术进行保守治疗。随访评估包括临床检查、判断性交情况及质量，以及阴道镜检查。
所有患者均接受了腹腔镜辅助子宫前庭吻合术。未发生围手术期并发症。平均随访时间为8±3.2年。所有患者术后1年新阴道长度均大于4cm，2年后约为6cm。开始性交后，11例有性生活的患者中有2例新阴道长度超过7cm。术后12个月时，所有患者均有碘阳性上皮，且随时间维持。16例患者中有15例新阴道、新宫颈和子宫体的连续性得以维持且无需进一步干预。随访期间，11例患者有性生活，5例已婚，4例寻求受孕，2例自然受孕。
腹腔镜辅助子宫前庭吻合术似乎是治疗宫颈闭锁且完全无阴道患者的一种安全有效的方法，至少在月经功能和性功能恢复方面如此。
