腹腔镜带血管蒂回肠与乙状结肠移植阴道成形术的比较研究

摘要

目的 比较腹腔镜带血管蒂回肠与乙状结肠移植阴道成形术的临床效果.方法 回顾性分析2004年1月至2009年12月在北京安贞医院妇产科接受腹腔镜带血管蒂回肠与乙状结肠移植阴道成形术的105例患者的临床资料,其中腹腔镜带血管蒂回肠移植阴道成形术48例(回肠组),腹腔镜带血管蒂乙状结肠移植阴道成形术57例(乙状结肠组),比较两组手术时间、术中出血量、排气时间、术后住院时间、并发症及成形人工阴道情况.结果 105例患者手术均获得成功.手术时间乙状结肠组为(159±18) min,回肠组为(141 ±22) min,两组比较,差异有统计学意义(P=0.000);术后排气时间乙状结肠组为(68±8)h,回肠组为(36 ±9)h,两组比较,差异也有统计学意义(P =0.000);术后住院时间乙状结肠组为(11.1±1.3)d,回肠组为(9.8±2.0)d,两组比较,差异有统计学意义(P=0.004);术中出血量乙状结肠组为(83±14) ml,回肠组为(42±6) ml,两组比较,差异也有统计学意义(P =0.000).两组均无术中并发症发生,术后并发症4例,其中乙状结肠组粘连性不全肠梗阻2例,回肠组尿道口狭窄、人工阴道直肠瘘各l例.术后随访6 ～ 62个月,人工阴道均可容两指松,长12 ～ 15 cm,分泌物为少量乳白色水样液或黏液,无明显异味.有性生活者55例,均满意.人工阴道口狭窄6例,回肠组5例,乙状结肠组1例.结论 腹腔镜带血管蒂回肠与乙状结肠移植阴道成形术均是有效的阴道成形方法,后者手术时间较长,术中出血较多,但术后人工阴道口挛缩、狭窄的发生率有降低趋势.%Objective To study the clinical effect of laparoscopic vaginoplasty using pedicled ileal and sigmoid colon segment.Methods From January 2004 to December 2009,105 cases undergoing laparoscope-assisted vaginoplasty using a vascularized pedicled intestinal flap were studied retrospectively.Operation time,blood loss in operating,bowel movement after operation,postoperation hospital duration,side effect,and artificial vagina were compared between two surgical management.Results The vaginoplasty were preformed successfully in all 105 cases.There were 48 patients treated by aparoscopeassisted ileal vaginoplasty and 57 patients treated by laparoscope-assisted sigmoid colon vaginoplasty.The values of the operation time [(141 ±22) minutes versus (159 ± 18) minutes,P =0.000],blood loss in operating [(42 ±6) ml versus (83 ± 14) ml,P =0.000],bowel movement after operation (36 ±9) hours versus (68 ±8)hours(P =0.000),and postoperation hospital duration [(9.8 ±2.0) days versus (11.1 ± 1.3) days,P =0.004] in the sigmoid colon vaginoplasty group were longer or higher than those in ileal vaginoplasty group (P ＜ 0.05).No intraoprative complication occurred.There were four postoperative complications:2 cases with intestinal obstruction in sigmoid colon vaginoplasty group,1 case with urethral orifice stenosis and 1 case with vaginal-rectal fistula in ileal vaginoplasty group.At follow-up of 6-62 months,all artificial vaginas had a capacity of over two fingers in wideness and 12-15 cm in length.Vaginal discharges resembled a milky white water or mucus without odour.Fifty-five patients with sexual intercourse reported satisfactory results.Six patients complained vaginal stenosis:5 patients in ileal vaginoplasty group and 1 patient in sigmoid colon vaginoplasty group.Conclusions Laparoscope-assisted vaginoplasty using pedicled ileum or sigmoid colon segment are both the effective ways in forming vagina.The latter management takes more time and blood loss while operating,yet the incidence of vaginal opening contracture appeared to be decreasing trend.