Nikolaev V V, Bizhanova D A
Department of Pediatric Surgery, Russian State Medical University, Russian Children's Clinical Hospital, Moscow.
J Urol. 1998 Dec;160(6 Pt 1):2194-6. doi: 10.1097/00005392-199812010-00083.
High vaginal stricture is a rare abnormality of traumatic origin, which in most cases is associated with urethral injury. Because to our knowledge there are no previous reports of surgical management of this condition, we describe our experience with plastic surgery performed via a posterior sagittal approach using local tissue in girls with posttraumatic vaginal stricture.
We performed vaginoplasty using a posterior sagittal pararectal approach in 6 girls 5 to 14 years old with posttraumatic high vaginal stricture. Five patients had urethral stricture and urethrovaginal fistula. In 5 cases bladder neck closure and the Mitrofanoff procedure were done.
There were no complications in any patients during the immediate postoperative period. Followup studies 1 to 3 years later in all girls revealed a fully patent vaginal anastomosis.
Principles of reconstruction that must be followed if a positive result is to be obtained include concurrent vaginoplasty and suture of the urethrovaginal fistula with separation of the suture line, complete excision of scars in the segments being joined, use of meeting flaps to lengthen the anastomotic line as much as possible, and prevention of ischemia and inflammation in the anastomotic region.
高位阴道狭窄是一种罕见的创伤性异常，在大多数情况下与尿道损伤有关。据我们所知，此前尚无关于该病症手术治疗的报道，因此我们描述了通过后矢状位入路使用局部组织对创伤后阴道狭窄女童进行整形手术的经验。
我们对6名5至14岁创伤后高位阴道狭窄女童采用后矢状位直肠旁入路进行阴道成形术。5例患者伴有尿道狭窄和尿道阴道瘘。5例患者进行了膀胱颈闭合术和米氏术。
术后即刻所有患者均未出现并发症。1至3年后对所有女童的随访研究显示阴道吻合口完全通畅。
若要取得良好效果，必须遵循的重建原则包括同时进行阴道成形术和尿道阴道瘘缝合且缝线分离、完全切除吻合部位的瘢痕、尽可能使用对合皮瓣延长吻合线以及防止吻合区域缺血和炎症。
