Tillem S M, Stock J A, Hanna M K
Department of Urology, Long Island Jewish Medical Center and Schneider Children's Hospital, New Hyde Park, New York, USA.
J Urol. 1998 Jul;160(1):186-90.
We evaluated outcomes in 20 patients 1 to 21 years old who underwent vaginal construction between 1980 and 1996.
A total of 21 vaginal constructions was performed in 20 children using ileum in 13, sigmoid colon in 6, bladder mucosa from a diverticulum in 1 and scrotal skin in 1. The diagnoses included the Mayer-Rokitansky syndrome in 6 cases, micropenis in 5, cloacal exstrophy in 3, penile agenesis in 3, and testicular feminization, classic bladder exstrophy and true hermaphroditism in 1 each.
Patients treated with intestinal vaginoplasty had excellent cosmetic results without excessive mucous production or the need for routine dilation. The bladder mucosa vagina achieved good results with periodic dilation. Loss of depth developed in the scrotal skin vagina and it was converted to an ileal vagina. Stenosis at the mucocutaneous junction in 1 patient with a sigmoid and 1 with an ileal vagina was treated with Y-V plasty.
Vaginal construction may be performed using isolated bowel segments with excellent results and minimal morbidity. We have found ileum to be the segment of choice in younger patients, while sigmoid colon is preferred for vaginal construction in adolescents. Vaginal construction with isolated bowel segments provides a cosmetic, self-lubricating neovagina with low rates of failure and revision, and without the need for routine dilation.
我们评估了1980年至1996年间接受阴道再造术的20例1至21岁患者的治疗结果。
对20名儿童共实施了21次阴道再造术，其中13例采用回肠，6例采用乙状结肠，1例采用憩室膀胱黏膜，1例采用阴囊皮肤。诊断包括6例迈耶-罗基坦斯基综合征、5例小阴茎、3例泄殖腔外翻、3例阴茎缺如，以及各1例睾丸女性化、典型膀胱外翻和真两性畸形。
接受肠道阴道成形术的患者美容效果极佳，无过多黏液分泌，也无需定期扩张。膀胱黏膜阴道经定期扩张取得了良好效果。阴囊皮肤阴道出现深度丧失，随后转变为回肠阴道。1例乙状结肠阴道和1例回肠阴道患者的黏膜皮肤交界处狭窄采用Y-V成形术治疗。
可使用孤立肠段进行阴道再造，效果极佳且发病率极低。我们发现，回肠是较年轻患者的首选肠段，而青少年阴道再造则首选乙状结肠。采用孤立肠段进行阴道再造可提供美观、自润滑的新阴道，失败率和修复率低，且无需定期扩张。
