Liu Xiaotong, Ding Jingxin, Li Yuqi, Hua Keqin, Zhang Xuyin
Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang Road, Shanghai, 200090, China.
Int Urogynecol J. 2023 Jan;34(1):247-254. doi: 10.1007/s00192-022-05327-x. Epub 2022 Sep 16.
As a consequence of the evolution of surgery in reconstructive techniques, cervicovaginal reconstruction has become an option for patients diagnosed with congenital cervical and vaginal atresia. This study was aimed at comparing long-term clinical and anatomical results in patients who had cervicovaginal reconstruction with either a small intestinal submucosa (SIS) graft or a split-thickness skin (STS) graft.
This was a retrospective study of 34 patients who underwent cervicovaginal reconstruction using SIS or STS grafts between January 2012 and August 2017. The patients' postoperative resumption of menstruation, vaginal length, body image satisfaction, and sexual satisfaction were assessed. Quantitative and categorical variables were compared using Student's t test and Chi-squared test respectively.
The mean follow-up time was 81.29 ± 20.69 months. The SIS group had a shorter surgery time, an earlier return to work, and a higher cost (p < 0.05). All patients resumed menstruation, but 4 patients were diagnosed with cervical stricture. There was no significant difference in the length of the neovagina, and the satisfaction score of the sexual life of patients and their sexual partners was similar in both groups. Patients in the SIS group showed greater satisfaction with their bodies (p < 0.001). One patient in the SIS group got pregnant via assisted-reproduction techniques.
Cervicovaginal reconstruction using SIS or STS grafts is an effective treatment for patients diagnosed with congenital cervical and vaginal atresia. The method of SIS graft is simpler, with less surgical injury and greater body satisfaction, but it is more expensive.
随着重建技术在外科手术中的发展，宫颈阴道重建已成为诊断为先天性宫颈和阴道闭锁患者的一种选择。本研究旨在比较采用小肠黏膜下层（SIS）移植物或中厚皮片（STS）移植物进行宫颈阴道重建患者的长期临床和解剖学结果。
这是一项对2012年1月至2017年8月间34例行SIS或STS移植物宫颈阴道重建患者的回顾性研究。评估患者术后月经恢复情况、阴道长度、身体形象满意度和性满意度。定量和分类变量分别采用学生t检验和卡方检验进行比较。
平均随访时间为81.29±20.69个月。SIS组手术时间较短，恢复工作较早，费用较高（p<0.05）。所有患者均恢复月经，但4例患者被诊断为宫颈狭窄。两组新阴道长度无显著差异，患者及其性伴侣性生活满意度评分相似。SIS组患者对身体的满意度更高（p<0.001）。SIS组1例患者通过辅助生殖技术怀孕。
采用SIS或STS移植物进行宫颈阴道重建是诊断为先天性宫颈和阴道闭锁患者的有效治疗方法。SIS移植物方法更简单，手术损伤更小，身体满意度更高，但费用更高。
