两种阴道成形术式的对比分析

摘要

Objective:To compare the clinical value of the artificial vaginoplasty with pudendal-thigh skin flap transplantation and modified Vechietti vaginoplasty through Retzius gap,and explore the latter puncture path and safety. Methods:Eighteen patients with congenital absence of uterus and vagina were treated with vaginoplasty using pudendal-thigh skin flap transplantation ( skin flap transplantation group,9 cases) and modified Vechietti vaginoplasty through Retzius gap( modified group,9 cases) . The operation time, blood loss, hospital stay, complications and postoperative effects between two groups were compared. Results:All operations were successful. In skin flap transplantation group,except for 1 case lost following-up,8 cases were followed up for 3 months to 2 years. Mild vulvae shape change and 1 case with artificial vagina secondary infection in skin flap transplantation group were found. The modified group were followed up for 4 months to 2. 5 years,no vulvae shape change and complications were found. The appropriate width and depth of vagina,lubricated and elastic mucosa and harmonious sexual life in two groups were confirmed. Compared with the skin flap transplantation group,the shorter operation time,less blood loss and shorter hospital stay were found in modified group,the differences of two groups were statistical significance(P<0. 01). Conclusions:The modified Vechietti vaginoplasty through Retzius gap is minimally invasive,simple and safe,which is worth clinical promotion.%目的：对比阴股皮瓣移植人工阴道成形术及经Retzius间隙改良Vechietti阴道成形术的临床应用价值，探讨经Retzius间隙改良Vechietti阴道成形术的穿刺路径和手术安全性。方法：对18例先天性无子宫无阴道患者行阴道成形术，其中阴股皮瓣移植人工阴道成形术(皮瓣移植组)9例，经Retzius间隙改良Vechietti阴道成形术(改良组)9例。比较2组手术时间、出血量、住院时间、手术并发症及术后效果。结果：18例手术均获成功，皮瓣移植组术后随访8例，失访1例，随访时间3个月至2年，术后外阴形态轻度改变，有1例人工阴道继发感染；改良组9例术后均随访，随访时间4个月至2.5年，术后外阴形态无改变，无1例并发症发生。两种方法成形术后阴道宽度及深度均满意，黏膜润滑、弹性可，已婚者性生活满意。改良组手术时间短，出血量少，住院时间短，与皮瓣移植组比较差异均有统计学意义(P<0.01)。结论：经Retzius间隙改良Vechietti阴道成形术更趋微创、操作简单，对患者损伤更小。只要掌握手术技巧，该术式是安全的，值得临床推广。