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目的 :总结使用全腹腔镜和腹腔镜辅助下乙状结肠阴道成形术各成功治疗1例Mayer Rokitansky Kuster Hauser综合征 (MRKH综合征 )的经验。方法 :全腹腔镜下使用腔镜闭合切割器切断乙状结肠的近端和远端。自肛门插入腔内圆型吻合器 ,将降结肠与直肠吻合。经会阴于尿道膀胱与直肠之间造穴。将带血管蒂的乙状结肠牵入穴道 ,完成阴道成形。腹腔镜辅助下阴道成形中 ,腔镜闭合切割器切断乙状结肠的远端后 ,于左下腹壁做一辅助切口 ,将近端乙状结肠经此切口拉出至腹腔外。切断乙状结肠近端 ,将乙状结肠的远端开口缝合 2层 ,使之成盲端。近侧端开口置入吻合器之钉钻 ,再行荷包缝合送回腹腔 ,用吻合器行肠吻合。其余步骤同全腹腔镜手术步骤。术后根据临床检查或磁共振成像测量新成形阴道的长度和宽度。结果 :全腹腔镜手术新成形的阴道长 18cm ,宽 4cm。腹腔镜辅助手术新形成的阴道长 19cm ,宽 4cm。两例新形成的阴道黏膜湿润 ,呈粉红色。无术中和术后并发症的发生。结论 :经腹腔镜乙状结肠移植段的长度完全能达到开腹手术的要求。与开放手术比较 ,全腹腔镜乙状结肠代阴道手术在腹壁上不留手术瘢痕 ,美容效果理想。而腹腔镜辅助下阴道成形 ,虽腹壁留有小手术疤痕 ,但操作简便 ,手术时间短 ,手术费用低
OBJECTIVE: To summarize the experience of one successful Mayer Rokitansky Kuster Hauser syndrome (MRKH syndrome) using total laparoscopy and laparoscopic-assisted sigmoid vaginoplasty. Methods: Total laparoscopic endoscopic stapler was used to close the proximal and distal sigmoid colon. Since the anus into the cavity circular stapler, the descending colon and rectum anastomosis. The perineal urethra bladder and rectum between the points. The pedunculated sigmoid colon acupoints to complete the vagina. Laparoscopic assisted vaginoplasty, endoscopic closure cut off the distal end of the sigmoid colon, in the left lower abdominal wall to do an auxiliary incision, the proximal sigmoid colon through this incision to the outside of the abdominal cavity. The proximal colon of the sigmoid colon is severed, and the distal sigmoid colon is sutured 2 layers to make a blunt end. The proximal end of the opening into the stapler of the nail drill, purse suture and then back to the abdominal cavity, stapling line anastomosis. The remaining steps with the whole laparoscopic surgical procedures. The length and width of the newly formed vagina were measured postoperatively based on clinical examination or magnetic resonance imaging. Results: The new shape of the total laparoscopic vaginal length 18cm, width 4cm. Laparoscopic surgery newly formed vaginal length 19cm, width 4cm. Two newly formed vaginal mucosa moist, pink. No intraoperative and postoperative complications occurred. Conclusion: The length of laparoscopic sigmoid colon graft can reach the requirement of open surgery completely. Compared with open surgery, total laparoscopic sigmoid colon surgery vaginal surgery without leaving the scar in the abdominal wall, the cosmetic effect is ideal. Laparoscopic assisted vaginal formation, although the abdominal wall leaving a small surgical scar, but easy to operate, the operation time is short, low operation costs