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目的探讨腹腔镜下腹膜代阴道成形术与乙状结肠代阴道成形术对无阴道患者的疗效差异。方法对38例2010年1月至2014年12月西南医院妇产科收治的无阴道患者术前随机化完全区组设计进行腹腔镜下腹膜代阴道成形术(17例)和乙状结肠代阴道成形术(21例),对比分析2组患者的围手术期情况及术后随访疗效。结果腹膜代阴道成形术组手术时间、术中出血量、术后肛门排气及进食时间优于乙状结肠代阴道成形术组(P<0.01),但乙状结肠代阴道成形术组阴道长度优于腹膜代阴道成形术组(P<0.01),腹膜代阴道成形术组需术后长时间放置阴道模具。2组患者均未发生手术并发症,阴道通畅、红润,有6例乙状结肠代阴道患者阴道分泌物较多,但对性生活满意程度和阴道成形效果差异无统计学意义(P>0.05)。结论腹腔镜下腹膜代阴道成形术与乙状结肠代阴道成形术均可取得良好的预期疗效,腹腔镜腹膜代阴道成形术后放置模具扩张阴道更严格,但手术创伤小于乙状结肠代阴道成形术,手术各自的优势可实现先天性无阴道患者的个体化治疗。
Objective To investigate the effect of laparoscopic peritoneal vaginoplasty and sigmoid colon vaginoplasty on non-vaginal patients. Methods 38 patients from January 2010 to December 2014 in the Department of Obstetrics and Gynecology of Southwest Hospital were enrolled in the randomized complete block design of non-vaginal patients underwent laparoscopic peritoneal vaginoplasty (17 cases) and sigmoid colon vaginoplasty (21 cases). The perioperative status and postoperative follow-up results of two groups were compared. Results The operation time, intraoperative blood loss, postoperative anal exhaust and feeding time were better than that of the sigmoid colon vaginoplasty group (P <0.01), but the vaginal length of the sigmoid colon vaginoplasty group was better than that of the peritoneum Vaginal surgery group (P <0.01), peritoneal vaginoplasty group need to be placed after a long time vaginal mold. No complications were found in both groups. Vaginal patency and rosy vaginal discharge were found in 6 patients. Vaginal secretions were found in 6 patients with sigmoid colon and vaginal discharge, but there was no significant difference in satisfaction with sexual life and vaginoplasty (P> 0.05). Conclusion Laparoscopic peritoneal vaginoplasty and sigmoid colon vaginoplasty can achieve good expected results. Laparoscopic peritoneal vaginoplasty is more strict than vaginal dilatation and vaginal plasty, but the surgical trauma is less than sigmoid colon vaginoplasty. The advantages of congenital non-vaginal patients can achieve individualized treatment.