Aslan K, Gurbuz T B, Orhan A, Kasapoglu I, Ozerkan K, Uncu G
Facts Views Vis Obgyn. 2023 Sep;15(3):235-242. doi: 10.52054/FVVO.15.3.091.
Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome has an incidence of 1 in 4000. The absence of the vagina and uterus results in sexual dysfunction and infertility. The first-line treatment is vaginal dilatation. There exists a number of second-line surgical options including the Uncu-modified Davydov procedure.
To determine the complication rate, anatomical outcomes, and long-term sexual outcomes of MRKH syndrome patients after Uncu-modified Davydov procedure.
Patients with MRKH syndrome who underwent paramesonephric remnant-supported laparoscopic double-layer peritoneal pull-down vaginoplasty (aka Uncu-modified Davydov procedure) between January 2008 and December 2021. The procedure involves laparoscopic circular dissection of the pelvic peritoneum followed by pulling down, through the opened vaginal orifice, and suturing the vaginal cuff with the support of uterine remnants. The long-term complication rate, anatomical outcomes, and sexual function outcomes (as measured by Female Sexual Function Index (FSFI)) were ascertained.
Main Outcome Measures: The long-term complication rate, anatomical outcomes and FSFI survey results.
A total of 50 patients with MRKH syndrome underwent the Uncu-modified Davydov procedure between Jan 2008- Dec 2021. There were four perioperative complications: three bladder injuries (6%) and one rectal serosa injury (2%). Four long-term postoperative complications were identified: one vesicovaginal fistula (2%), one recto-vaginal fistula (2%), and two vaginal stenoses (4%). All patients were physically examined at least one year after surgery. The mean vaginal length was 8.4 + 1.9 cm. The mean FSFI score was 31.5 + 3.9 (minimum score of 24, maximum score of 36).
Conclusion: The Uncu-modified Davydov procedure has been demonstrated to be a safe and effective treatment option with high female sexual function index scores for patients with MRKH syndrome.
WHAT IS NEW?: The long-term complication rate, anatomical and sexual outcomes of Uncu-modified laparoscopic peritoneal pull-down vaginoplasty were reported in this study. The results indicated that the surgical approach could be used in selective MRKH patients who failed first-line self-dilatation therapy.
迈耶-罗基坦斯基-库斯特-豪泽（MRKH）综合征的发病率为四千分之一。阴道和子宫缺如会导致性功能障碍和不孕。一线治疗方法是阴道扩张。还有多种二线手术选择，包括改良的Uncu-Davydov手术。
确定改良的Uncu-Davydov手术后MRKH综合征患者的并发症发生率、解剖学结果和长期性功能结果。
2008年1月至2021年12月期间接受副中肾管残余支持的腹腔镜双层腹膜下拉阴道成形术（即改良的Uncu-Davydov手术）的MRKH综合征患者。该手术包括腹腔镜下盆腔腹膜环形分离，然后通过开放的阴道口下拉，并在子宫残余物的支持下缝合阴道袖口。确定长期并发症发生率、解剖学结果和性功能结果（通过女性性功能指数（FSFI）测量）。
主要观察指标：长期并发症发生率、解剖学结果和FSFI调查结果。
2008年1月至2021年12月期间，共有50例MRKH综合征患者接受了改良的Uncu-Davydov手术。围手术期有4例并发症：3例膀胱损伤（6%）和1例直肠浆膜损伤（2%）。术后发现4例长期并发症：1例膀胱阴道瘘（2%）、1例直肠阴道瘘（2%）和2例阴道狭窄（4%）。所有患者在术后至少一年进行了体格检查。平均阴道长度为8.4 + 1.9厘米。平均FSFI评分为31.5 + 3.9（最低分24分，最高分36分）。
结论：改良的Uncu-Davydov手术已被证明是一种安全有效的治疗选择，对于MRKH综合征患者具有较高的女性性功能指数评分。
新发现是什么？：本研究报告了改良的腹腔镜腹膜下拉阴道成形术的长期并发症发生率、解剖学和性功能结果。结果表明，该手术方法可用于一线自我扩张治疗失败后的选择性MRKH患者。
