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目的探讨对于青春期先天性阴道闭锁合并有正常子宫患者,采用腹腔镜手术辅助治疗,保留生育及生殖功能的可行性。方法回顾我科2008年2月至2015年12月收治的21例青春期先天性阴道闭锁合并有正常子宫患者病例及随访资料,均采用腹腔镜辅助下的游离切断部分盆底韧带及人工阴道前庭结合的方法进行治疗。分析患者基本手术情况、月经来潮、性生活等情况。结果本组患者中Ⅰ型阴道闭锁12例,Ⅱ型阴道闭锁9例,患者在腹腔镜辅助下完成手术,均保留子宫成功。平均手术时间67.1(44~129)min,术中平均出血67.4(20~200)m L,术后平均住院时间6.4(4~11)d,无损伤膀胱、直肠等手术并发症。术后随访患者19例,2例失访,随访时间为4~62个月。19例患者均月经来潮,4例患者(1例先天性阴道完全闭锁,3例先天性阴道中下段闭锁)术后性生活满意。结论青春期先天性阴道闭锁合并有正常子宫患者的治疗方法棘手有限,腹腔镜辅助下的手术治疗有望成为治疗的有效方法之一。
Objective To investigate the feasibility of laparoscopic surgery for adjuvant treatment of adolescent congenital vaginal atresia with normal uterus and to retain the reproductive and reproductive functions. Methods The data of 21 cases of adolescent congenital vaginal atresia complicated with normal uterus and their follow-up data were retrospectively reviewed from February 2008 to December 2015 in our department. All patients underwent laparoscopic resection with partial resection of the pelvic floor ligament and artificial vaginal vestibule Method of treatment. Analysis of patients with basic surgical conditions, menstrual cramps, sexual life and so on. Results In this group, 12 cases were type Ⅰ vaginal atresia and 9 cases were type Ⅱ vaginal atresia. The patients underwent laparoscopic surgery with complete succession of the uterus. The average operation time was 67.1 (44-129) min. The mean intraoperative bleeding was 67.4 (20-200) m L and the average postoperative hospital stay was 6.4 (4-11) days. No complications such as bladder and rectum were found. Nineteen patients were followed up and two were lost to follow-up. The follow-up time ranged from 4 to 62 months. Nineteen patients had menstrual cramps. Four patients (one with complete congenital vaginal atresia and three with congenital vaginal atresia) had satisfactory sex life after operation. Conclusion Adolescent congenital vaginal atresia combined with normal uterine patients with difficult treatment methods, laparoscopic surgery with the help of surgery is expected to be an effective method of treatment.