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[摘要]目的:探讨自体微粒口腔黏膜移植在先天性无阴道成形术中的疗效。方法:对12例术前确诊为先天性无阴道患者,岛状切取口腔黏膜约16cm2,将其剪碎成直径约0.3~0.5mm 的微粒;直肠与尿道之间造穴,平均长约10cm,直径约4.2cm,腔穴中置入支架,将微粒黏膜移植于再造阴道腔穴顶部和四周。术后放置模具6月,并每日抽动扩张至瘢痕软化。结果:手术时间为50~80min,口腔创面无疼痛,2天创面愈合,口腔无畸形及功能异常。均获随访4~12个月,再造阴道深7.5~9.8cm,平均8.5cm,直径3.2~4.3cm,平均3.8cm。黏膜光滑红润,弹性好,近阴道外口处阴道壁可见皱襞,病理检查示复层鳞状上皮。外阴外观正常,无瘢痕。术后5例已婚,性交时均未出现疼痛,1例出血;其余患者无性生活,使用仿真模具, 均未出现疼痛、出血。结论:微粒口腔黏膜移植阴道成形术, 创伤小,恢复快、疗效可靠,阴道黏膜逼真, 口腔及外阴形态无破坏,但术后需要依赖模具支撑,远期效果需长期随访观察。
[关键词]先天性无阴道; 口腔黏膜; 微粒黏膜移植; 阴道再造
[中图分类号]R713 [文献标识码]A [文章编号]1008-6455(2014)12-0955-04
Abstract:Objective To investigate the effect of autologous buccal micro-mucosa graft on the vaginal reconstruction in patients with the congenital absence of vagina. Methods In this study, 12 patients were definitely diagnosed with congenital absence of vagina. Island-shaped buccal mucosa was resected into 16 cm2 in size, and then was minced into 0.3mm to 0.5 mm fractions. A cavity was generated between the rectum and urethra with the mean 10 cm in length and 4.2cm in diameter. Subsequently, a stent was implanted into this cavity, and then buccal micro-mucosa graft was transplanted into the top and surroundings of the cavity. The postoperative mold was kept for three months, during which daily tic expansion was necessary to soften scar. Results The operation duration was about 50~80 mins. The donor sites in the mouth healed well within 3 days, without the pain and deformity. All cases were followed up for 4~12 months. The depth of neovagina was 7.5to 9.8cm (mean 8.5cm) with the width 3.2~4.3cm (mean 3.8cm). The lining was pink-colored and smooth, and characterized as good flexibility. Vaginal folds can be observed via the vaginal orifice, and histopathologically identified as nonkeratinizing squamous stratified mucosa. The perineal area was not disturbed. Importantly, five patients were married and satisfied with their sexual life without pain, of whom only one with vaginal bleeding. The others had no sexual life and were still treated by simulation mold, while no pain and bleeding can occur. Following postoperative 6 months, only one case developed shortened vaginal. Conclusion Autologous buccal micro-mucosa graft is suggested as an easy, minimally invasive and realistic method in the vaginal reconstruction, with rapid recovery and no damage to the oral and genital morphology. However the patients with the vaginal reconstruction were still dependent on the mold support, in addition, long-term follow-up was also needed to further identify its long-term effect. Key words:congenital absence of vagina; buccal mucosa;micro-mucosa graft;vaginal reconstruction.
阴道是女性月经血排出、胎儿娩出及女性性生活的重要器官。先天性无阴道的患者几乎全部因发育后不来月经就诊。该病的发生率在1/4 000~1/5 000[1-2]。治疗的关键是阴道重建,解决性生活问题。目前,临床上大多数阴道再造采用局部皮瓣、肠袢、腹膜、脱细胞真皮替代等组织移植,均有其缺点。也有报道采用口腔黏膜移植再造阴道有很好的疗效。2013 年2月~2013年11月,笔者科室应用自体微粒口腔黏膜游离移植再造阴道12 例,疗效满意,现将结果报道如下。
1 资料和方法
1.1 一般资料:本组12例女性患者,年龄15~31 岁,平均为23 岁,均为先天性无阴道。入院检查:患者乳房、外阴发育良好,阴蒂及尿道外口正常;阴道前庭部可见浅凹陷,无处女膜。肛诊时均未触及子宫或宫颈,激素水平正常。染色体检查均为46,XX。超声检查示两侧均有正常卵巢,无子宫或仅有始基子宫。
1.2 手术方法
1.2.1 口腔黏膜取材及微粒黏膜制备:0.5% 聚维酮碘溶液消毒口腔,确定腮腺导管开口,并亚甲兰标记位置防止手术损伤。于两侧颊部及上下唇部黏膜下局部注射肾上腺素盐水,岛状切取黏膜,总面积约16cm2,创面电凝止血,外敷碘仿纱布。将切取的黏膜用眼科剪剪成直径约0.3~0.5mm的微粒,混合少量生理盐水后备用。
1.2.2 阴道成形: 手术在经鼻腔气管插管全身麻醉下进行,取截石位,尿道内置入3腔气囊导尿管并留置导尿。术者左手或右手食指伸入直肠内,紧贴直肠前壁做导引,于阴道前庭阴道外口的陷窝或浅凹处,注射肾上腺素盐水10ml,X型切开黏膜长约2cm,引导插入直径1.6mm钝头多孔注水针深约10cm,在不同的深度及两侧注射150ml肾上腺素生理盐水膨胀液。将自行设计的剥离器在深入肛门、直肠的左手或右手示指引导下从小号到大号探入,在尿道后壁和直肠前壁间钝性分离造穴至所需深度9~11cm,宽4.2cm。顶端向两侧分离,增加其宽度,彻底止血。
1.2.3微粒黏膜移植: 将制备的微粒黏膜均匀散布于7个大小为5cm×2cm的明胶海绵条上,再造阴道腔穴顶端置入带有微粒黏膜的明胶海绵一块,然后置入套有侧孔避孕套的中空可调硅橡胶管支架,将铺有口腔微粒黏膜的明胶海绵条置入到阴道壁与支架之间,微粒黏膜侧向阴道壁,阴道再造穴腔的上、下、两侧壁各2条,扁形硅橡胶中心填入纱布,边填入纱布,边扩张支架使其直径达到最大,外敷纱布,固定尿管。
1.3 术后处理:术后常规应用抗生素5天。聚维酮碘溶液擦拭外阴、尿道外口附近及缝线处;术后第3天换药,更换支架内纱布,第6 天换药,取出模具内纱布条及模具,用淡碘冲洗腔穴后,更换带有避孕套硬模具,同时拔除尿管。以后每间隔2天更换模具冲洗腔穴1 次,直到腔穴创面完全被黏膜覆盖即可出院。20天后,每日用扩张棒缓慢抽动式扩张3次,每次15min, 直到瘢痕软化。若患者术后3个月内结婚,连续佩戴模具至婚前;如3个月内未结婚,则间断佩戴模具至婚前,并每日用扩张棒抽动扩张1~2次。
2 结果
术中出血30~50ml。阴道成形术手术时间为50~80min,口腔创面无疼痛、2天创面愈合,口腔无畸形及功能异常。均获随访4~12个月,再造阴道深7.5~9.8cm,平均8.5cm,直径3.2~4.3cm,平均3.8cm。黏膜光滑红润,弹性好,近阴道外口处阴道壁可见皱襞,病理检查示复层鳞状上皮。外阴外观正常,无瘢痕。术后5例已婚,性生活满意,性交时均未出现疼痛,仅1例出血,处理后1个月后痊愈;其余患者无性生活,使用仿真模具或自制模具,每日自行用模具扩张棒抽动扩张1~2次, 均未出现疼痛、出血。
3 讨论
先天性无阴道系双侧副中肾管发育不全或双侧副中肾管尾端发育不良所致。几乎均合并无子宫或始基子宫,输卵管及卵巢一般发育正常,极个别有发育正常的子宫, 故青春期时因宫腔积血出现周期性腹痛或无月经出现而就诊。先天性无阴道患者承受巨大生理、心理压力,目前治疗主要为阴道再造术,以解决患者的性生活问题,提高患者的生活质量。
阴道成形术术式较多,如:皮瓣皮片法 [3]、组织工程医用补片阴道成形术[4]、腹腔镜腹膜代阴道成形术[5],取得了满意的疗效,但目前仍没有理想的统一术式。理想的人工阴道应有自然的角度、合适的深度和宽度,柔软、润滑、清洁、有弹性、满意的性生活,理想的术式应创伤小、效果好、安全简便、少挛缩或不挛缩、不破坏外阴形态,不遗留供区显著瘢痕,能再造一个解剖上、功能上都接近正常的阴道。因此,未来的发展会更加倾向于微创和组织工程材料的应用。
口腔黏膜阴道成形术是近年来又一种新的阴道重建技术[6-8]。一种方法是取口腔内颊黏膜覆盖阴道腔穴,为先天性无阴道患者再造阴道,术后经过随访,重建阴道深度及宽度均良好,有黏液分泌,性生活满意,且口腔供区瘢痕不明显;另一种方法[9]报道应用剪成微粒状的口腔粘膜及小阴唇皮肤联合游离移植成功完成阴道再造,也取得了较好的效果。本组病例采用岛状切取口腔黏膜,制成微粒黏膜移植再造阴道,也取得了较好的效果。口腔供区创面极小,无需缝合,术后很快愈合,不留瘢痕,重建阴道的外观、功能、感觉患者均满意。
黏膜为正常阴道壁的覆盖组织,应用黏膜作为再造阴道腔壁衬里从组织学方面更贴近正常的阴道组织,理论上最具优势,形成的阴道在生理功能方面更接近正常阴道。应用微粒口腔黏膜阴道再造有明显的优势,取材方便、取材量少,岛状切取黏膜,创面不必缝合,愈合快,2天后创面新生新的黏膜,完全覆盖创面,完全愈合后创面无瘢痕。而且在阴道再造术中,关键的环节阴道造穴手术方法简单,快捷,出血少。造穴时,在肛内手指引导下,在尿道后壁和直肠前壁间插入钝头多孔注水针,深度约10cm,在不同的深度及两侧注射150ml肾上腺素盐水膨胀液。再用不同大小的剥离器分离造穴至所需深度和宽度,所用时间10min左右,造穴手术安全、快捷,不会造成尿道、膀胱及直肠的损伤。且术后外阴部无瘢痕,外阴形态正常,患者易接受。术后功能恢复迅速 [10]。 先天性无阴道的手术时机, 多数学者认为在婚前2~3个月手术, 也有学者认为在18 岁性成熟后及时手术, 否则会影响患者性心理及性格发育。治疗方式选择应个体化,要遵循不破坏外阴结构、一次手术成功及为患者隐私保密原则[11]。本组1例术后6月短缩至7.5cm,为最年轻的患者,分析原因为不能坚持使用模具,这与年龄明显有关。年龄小,依从性差,影响术后效果。因此,笔者认为手术时机选择应个体化,患者本人有明显的要求,年龄尽可能大时手术为好。
术后性生活满意度与再造阴道解剖长度有关 [12],术后阴道解剖长度较短,尤其<7cm的患者性生活满意度较低。本组再造阴道深7.5~9.5cm,平均8.5cm,直径3.2~4.3cm,平均3.8cm。黏膜光滑红润,弹性好,术后5例已婚,性生活满意,与早期报道相符。要保持再造阴道的长度及宽度,术后护理非常重要。术后预防再造阴道挛缩是重点,阴道挛缩在20天左右开始,3个月达高峰,这一时期必须要求有阴道模具的持续支撑,而且每日用扩张棒抽动式扩张3次,每次15min,直到瘢痕开始软化。同时对患者进行性知识及心理辅导。未婚者,瘢痕软化后,使用软弹模具,外套避孕套,减轻患者不适感,利于长久佩带,也便于更换及冲洗再造阴道,且不影响黏膜成活。并建议使用仿真阴道模具自行扩张阴道。保证手术远期效果。
微粒口腔黏膜再造阴道的手术方法简便,效果可靠,损伤小,外形满意,术后护理方便。手术时间短,风险低,是很好的阴道再造手术方法。远期效果需要进一步的长期随访。
[参考文献]
[1]Akn S.Experience with neovaginal construction using the full-thickness skin graft in vaginal agenesis[J].Ann Plast Surg,2004,52(4): 391-396.
[2]Morcel K,Camborieux L,Programme de Recherches sur les Aplasies Müllériennes,et al. Mayer-Rokitansky-Kü ster-Hauser(MRKH) syndrome[J].Orphanet J Rare Dis,2007,2: 13.
[3]李晓格,李世荣,曹川,等.两种阴道再造术的疗效分析[J].中国美容医学,2012,21(12):2164-2165.
[4]朱兰,周慧梅,郎景和. 组织工程医用补片在人工阴道成形术中的应用[J].中国实用妇科与产科杂志,2006,22(12):953-954.
[5]康志宏,郝敏.腹腔镜下腹膜代阴道成形术21 例临床分析[J].中国微创外科杂志,2012,12(8):707-709.
[6]Lin WC,Chang CY,Shen YY,et al.Use of autologous buccal mucosa for vaginoplasty: a study of eight cases[J].Hum Reprod,2003,18(3):604-607.
[7]Yesim,Ozgenel G,Ozcan M.Neovaginal construction with buccal mucosal grafts[J].Plast Reconstr Surg,2003,111(7):2250-2254.
[8]李巍,刘长松,王涛,等. 口腔黏膜和阴唇皮肤微粒移植用于阴道再造的初步经验[J]. 中国美容医学,2013,22(1):144-146.
[9]Zhao M,Li P,Li S,et al.Use of autologous micromucosa graft for vaginoplasty in vaginal agenesis[J].Ann Plast Surg,2009,63(6):645-649.
[10]Simman R,Jackson IT,Andrus L. Prefabricated buccal mucosa-lined flap in an animal model that could be used for vaginal reconstruction[J].Plast Reconstr Surg, 2002,109(3): 1044-1049.
[11]李海萍, 罗光楠,廖 莳.先天性无阴道综合征临床研究进展[J].生殖与避孕,2012,32(4):264-268.
[12]Liu X,Liu M,Hua K,et al.Sexuality after laparoscopicper itonea l vaginoplasty in women with Mayer-Rokitansky- Küster-Hauser syndrome[J]. Minimally Invasive Gynecol, 2009, 16(6):720-729.
[收稿日期]2014-04-22 [修回日期]2014-05-24
编辑/李阳利
[关键词]先天性无阴道; 口腔黏膜; 微粒黏膜移植; 阴道再造
[中图分类号]R713 [文献标识码]A [文章编号]1008-6455(2014)12-0955-04
Abstract:Objective To investigate the effect of autologous buccal micro-mucosa graft on the vaginal reconstruction in patients with the congenital absence of vagina. Methods In this study, 12 patients were definitely diagnosed with congenital absence of vagina. Island-shaped buccal mucosa was resected into 16 cm2 in size, and then was minced into 0.3mm to 0.5 mm fractions. A cavity was generated between the rectum and urethra with the mean 10 cm in length and 4.2cm in diameter. Subsequently, a stent was implanted into this cavity, and then buccal micro-mucosa graft was transplanted into the top and surroundings of the cavity. The postoperative mold was kept for three months, during which daily tic expansion was necessary to soften scar. Results The operation duration was about 50~80 mins. The donor sites in the mouth healed well within 3 days, without the pain and deformity. All cases were followed up for 4~12 months. The depth of neovagina was 7.5to 9.8cm (mean 8.5cm) with the width 3.2~4.3cm (mean 3.8cm). The lining was pink-colored and smooth, and characterized as good flexibility. Vaginal folds can be observed via the vaginal orifice, and histopathologically identified as nonkeratinizing squamous stratified mucosa. The perineal area was not disturbed. Importantly, five patients were married and satisfied with their sexual life without pain, of whom only one with vaginal bleeding. The others had no sexual life and were still treated by simulation mold, while no pain and bleeding can occur. Following postoperative 6 months, only one case developed shortened vaginal. Conclusion Autologous buccal micro-mucosa graft is suggested as an easy, minimally invasive and realistic method in the vaginal reconstruction, with rapid recovery and no damage to the oral and genital morphology. However the patients with the vaginal reconstruction were still dependent on the mold support, in addition, long-term follow-up was also needed to further identify its long-term effect. Key words:congenital absence of vagina; buccal mucosa;micro-mucosa graft;vaginal reconstruction.
阴道是女性月经血排出、胎儿娩出及女性性生活的重要器官。先天性无阴道的患者几乎全部因发育后不来月经就诊。该病的发生率在1/4 000~1/5 000[1-2]。治疗的关键是阴道重建,解决性生活问题。目前,临床上大多数阴道再造采用局部皮瓣、肠袢、腹膜、脱细胞真皮替代等组织移植,均有其缺点。也有报道采用口腔黏膜移植再造阴道有很好的疗效。2013 年2月~2013年11月,笔者科室应用自体微粒口腔黏膜游离移植再造阴道12 例,疗效满意,现将结果报道如下。
1 资料和方法
1.1 一般资料:本组12例女性患者,年龄15~31 岁,平均为23 岁,均为先天性无阴道。入院检查:患者乳房、外阴发育良好,阴蒂及尿道外口正常;阴道前庭部可见浅凹陷,无处女膜。肛诊时均未触及子宫或宫颈,激素水平正常。染色体检查均为46,XX。超声检查示两侧均有正常卵巢,无子宫或仅有始基子宫。
1.2 手术方法
1.2.1 口腔黏膜取材及微粒黏膜制备:0.5% 聚维酮碘溶液消毒口腔,确定腮腺导管开口,并亚甲兰标记位置防止手术损伤。于两侧颊部及上下唇部黏膜下局部注射肾上腺素盐水,岛状切取黏膜,总面积约16cm2,创面电凝止血,外敷碘仿纱布。将切取的黏膜用眼科剪剪成直径约0.3~0.5mm的微粒,混合少量生理盐水后备用。
1.2.2 阴道成形: 手术在经鼻腔气管插管全身麻醉下进行,取截石位,尿道内置入3腔气囊导尿管并留置导尿。术者左手或右手食指伸入直肠内,紧贴直肠前壁做导引,于阴道前庭阴道外口的陷窝或浅凹处,注射肾上腺素盐水10ml,X型切开黏膜长约2cm,引导插入直径1.6mm钝头多孔注水针深约10cm,在不同的深度及两侧注射150ml肾上腺素生理盐水膨胀液。将自行设计的剥离器在深入肛门、直肠的左手或右手示指引导下从小号到大号探入,在尿道后壁和直肠前壁间钝性分离造穴至所需深度9~11cm,宽4.2cm。顶端向两侧分离,增加其宽度,彻底止血。
1.2.3微粒黏膜移植: 将制备的微粒黏膜均匀散布于7个大小为5cm×2cm的明胶海绵条上,再造阴道腔穴顶端置入带有微粒黏膜的明胶海绵一块,然后置入套有侧孔避孕套的中空可调硅橡胶管支架,将铺有口腔微粒黏膜的明胶海绵条置入到阴道壁与支架之间,微粒黏膜侧向阴道壁,阴道再造穴腔的上、下、两侧壁各2条,扁形硅橡胶中心填入纱布,边填入纱布,边扩张支架使其直径达到最大,外敷纱布,固定尿管。
1.3 术后处理:术后常规应用抗生素5天。聚维酮碘溶液擦拭外阴、尿道外口附近及缝线处;术后第3天换药,更换支架内纱布,第6 天换药,取出模具内纱布条及模具,用淡碘冲洗腔穴后,更换带有避孕套硬模具,同时拔除尿管。以后每间隔2天更换模具冲洗腔穴1 次,直到腔穴创面完全被黏膜覆盖即可出院。20天后,每日用扩张棒缓慢抽动式扩张3次,每次15min, 直到瘢痕软化。若患者术后3个月内结婚,连续佩戴模具至婚前;如3个月内未结婚,则间断佩戴模具至婚前,并每日用扩张棒抽动扩张1~2次。
2 结果
术中出血30~50ml。阴道成形术手术时间为50~80min,口腔创面无疼痛、2天创面愈合,口腔无畸形及功能异常。均获随访4~12个月,再造阴道深7.5~9.8cm,平均8.5cm,直径3.2~4.3cm,平均3.8cm。黏膜光滑红润,弹性好,近阴道外口处阴道壁可见皱襞,病理检查示复层鳞状上皮。外阴外观正常,无瘢痕。术后5例已婚,性生活满意,性交时均未出现疼痛,仅1例出血,处理后1个月后痊愈;其余患者无性生活,使用仿真模具或自制模具,每日自行用模具扩张棒抽动扩张1~2次, 均未出现疼痛、出血。
3 讨论
先天性无阴道系双侧副中肾管发育不全或双侧副中肾管尾端发育不良所致。几乎均合并无子宫或始基子宫,输卵管及卵巢一般发育正常,极个别有发育正常的子宫, 故青春期时因宫腔积血出现周期性腹痛或无月经出现而就诊。先天性无阴道患者承受巨大生理、心理压力,目前治疗主要为阴道再造术,以解决患者的性生活问题,提高患者的生活质量。
阴道成形术术式较多,如:皮瓣皮片法 [3]、组织工程医用补片阴道成形术[4]、腹腔镜腹膜代阴道成形术[5],取得了满意的疗效,但目前仍没有理想的统一术式。理想的人工阴道应有自然的角度、合适的深度和宽度,柔软、润滑、清洁、有弹性、满意的性生活,理想的术式应创伤小、效果好、安全简便、少挛缩或不挛缩、不破坏外阴形态,不遗留供区显著瘢痕,能再造一个解剖上、功能上都接近正常的阴道。因此,未来的发展会更加倾向于微创和组织工程材料的应用。
口腔黏膜阴道成形术是近年来又一种新的阴道重建技术[6-8]。一种方法是取口腔内颊黏膜覆盖阴道腔穴,为先天性无阴道患者再造阴道,术后经过随访,重建阴道深度及宽度均良好,有黏液分泌,性生活满意,且口腔供区瘢痕不明显;另一种方法[9]报道应用剪成微粒状的口腔粘膜及小阴唇皮肤联合游离移植成功完成阴道再造,也取得了较好的效果。本组病例采用岛状切取口腔黏膜,制成微粒黏膜移植再造阴道,也取得了较好的效果。口腔供区创面极小,无需缝合,术后很快愈合,不留瘢痕,重建阴道的外观、功能、感觉患者均满意。
黏膜为正常阴道壁的覆盖组织,应用黏膜作为再造阴道腔壁衬里从组织学方面更贴近正常的阴道组织,理论上最具优势,形成的阴道在生理功能方面更接近正常阴道。应用微粒口腔黏膜阴道再造有明显的优势,取材方便、取材量少,岛状切取黏膜,创面不必缝合,愈合快,2天后创面新生新的黏膜,完全覆盖创面,完全愈合后创面无瘢痕。而且在阴道再造术中,关键的环节阴道造穴手术方法简单,快捷,出血少。造穴时,在肛内手指引导下,在尿道后壁和直肠前壁间插入钝头多孔注水针,深度约10cm,在不同的深度及两侧注射150ml肾上腺素盐水膨胀液。再用不同大小的剥离器分离造穴至所需深度和宽度,所用时间10min左右,造穴手术安全、快捷,不会造成尿道、膀胱及直肠的损伤。且术后外阴部无瘢痕,外阴形态正常,患者易接受。术后功能恢复迅速 [10]。 先天性无阴道的手术时机, 多数学者认为在婚前2~3个月手术, 也有学者认为在18 岁性成熟后及时手术, 否则会影响患者性心理及性格发育。治疗方式选择应个体化,要遵循不破坏外阴结构、一次手术成功及为患者隐私保密原则[11]。本组1例术后6月短缩至7.5cm,为最年轻的患者,分析原因为不能坚持使用模具,这与年龄明显有关。年龄小,依从性差,影响术后效果。因此,笔者认为手术时机选择应个体化,患者本人有明显的要求,年龄尽可能大时手术为好。
术后性生活满意度与再造阴道解剖长度有关 [12],术后阴道解剖长度较短,尤其<7cm的患者性生活满意度较低。本组再造阴道深7.5~9.5cm,平均8.5cm,直径3.2~4.3cm,平均3.8cm。黏膜光滑红润,弹性好,术后5例已婚,性生活满意,与早期报道相符。要保持再造阴道的长度及宽度,术后护理非常重要。术后预防再造阴道挛缩是重点,阴道挛缩在20天左右开始,3个月达高峰,这一时期必须要求有阴道模具的持续支撑,而且每日用扩张棒抽动式扩张3次,每次15min,直到瘢痕开始软化。同时对患者进行性知识及心理辅导。未婚者,瘢痕软化后,使用软弹模具,外套避孕套,减轻患者不适感,利于长久佩带,也便于更换及冲洗再造阴道,且不影响黏膜成活。并建议使用仿真阴道模具自行扩张阴道。保证手术远期效果。
微粒口腔黏膜再造阴道的手术方法简便,效果可靠,损伤小,外形满意,术后护理方便。手术时间短,风险低,是很好的阴道再造手术方法。远期效果需要进一步的长期随访。
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[收稿日期]2014-04-22 [修回日期]2014-05-24
编辑/李阳利