乙状结肠和口腔黏膜在MRKH患者阴道再造中的应用效果分析

摘要

目的:比较腹腔镜乙状结肠法和口腔黏膜法在先天性无阴道综合征(Mayer-Rokitansky-Küster-Hauser syndrome,MRKH综合征)患者阴道再造术中的应用.方法:选择2008年4月至2012年6月就诊于北京大学第三医院成形外科并接受手术治疗的MRKH综合征患者共21例为研究对象,分别采用腹腔镜下带血管蒂乙状结肠法和口腔黏膜微粒移植法阴道再造法,分析比较两组的手术时间、术中出血量、术后阴道短缩或狭窄情况、内壁黏膜情况及阴道湿润程度评分.结果:腹腔镜辅助下带血管蒂乙状结肠组11例,术后18个月阴道外口无狭窄,无缩短,内壁黏膜完整、红润,腹壁可见4处穿刺孔遗留的较小瘢痕,无明显增生样改变;口腔黏膜微粒移植组10例,术后3个月随访,再造阴道内30%无黏膜微粒覆盖,经换药后大部分区域在术后6个月可通过周围黏膜爬行覆盖,术后18个月8例患者再造阴道存在3~5cm的短缩.乙状结肠组手术时间(160±18)min大于口腔黏膜组(90±15)min,差异具有统计学意义(P<0.01);乙状结肠组术中出血量(100±20)ml大于口腔黏膜组(50±8)ml,差异具有统计学意义(P<0.01);再造阴道狭窄和短缩程度方面,口腔黏膜组(4±1.1)cm较乙状结肠组(2±0.4)cm严重,差异具有统计学意义(P<0.05);乙状结肠组再造阴道湿润度评分(7.6±0.6)分优于口腔黏膜组(5.5±0.8)分,差异具有统计学意义(P<0.05).结论:与口腔黏膜微粒移植法比较,腹腔镜下带血管蒂乙状结肠阴道再造术功能重建效果更为理想.%Objective To compare the effect between laparoscopic sigmoid colon graft and buccal mucosa graft in vaginoplasty for patients with MRKH syndrome. Methods From April 2008 to June 2012, there were altogether 21 patients with MRKH syndrome, receiving vaginoplasty in department of plastic surgery of peking university third hospital. Twenty-one patients with MRKH syndrome have received treatments and are divided into two groups, with one group receiving laparoscopically assisted vascularized sigmoid colon graft and the other group receiving buccal micro-mucosa graft for vaginoplasty. Analyze and compare the time span of these two surgery methods, the bleeding volume in surgery, the degree of narrowing and shortening of the vagina after surgery, the state of mucous membranes and the evaluation of moist degree of the reconstructed vagina. Results There are eleven patients receiving laparoscopically assisted vascularized sigmoid colon graft. After 18 months of follow-up, there was no stenosis in the external orifice of the vagina, no shortening, complete and bright internal mucosal wall, and little scar on the abdominal wall of the 4 puncture holes. Ten cases were treated with oral mucosal microparticle grafting. After 3 months of follow-up, no vaginal reconstruction within 30% micro mucosa covered by dressing after most of the region in 6 months after operation through the mucous membrane around the crawling coverage, 18 months after surgery, 8 patients had vaginal reconstruction shortened 3-5cm. The laparoscopically assisted vascularize sigmoid colon graft for vaginoplasty takes more time than the buccal micro-mucosa graft does (160±18min VS 90±15min, P<0.01). The bleeding state in the laparoscopically assisted vascularize sigmoid colon graft surgery is heavier than that in buccal micro-mucosa graft surgery(100±20ml VS 50±8ml, P<0.01). The degree of narrowing and shortening of the vagina reconstructed by buccal micro-mucosa graft is more serious than that reconstructed by laparoscopically assisted vascularize sigmoid colon graft ( 4±1.1cmVS 2±0.4cm,P<0.05). The evaluation of moist degree of the vagina reconstructed by laparoscopically assisted vascularize sigmoid colon graft is better than that reconstructed by buccal micro-mucosa graft (7.6±0.6points VS 5.5±0.8points, P<0.05). Conclusion Compare to buccal micro-mucosa graft, the laparoscopically assisted vascularized sigmoid colon graft is a relatively ideal surgery method for a better reconstructed vaginal function effect in vaginoplasty.