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目的探讨改良全腹腔镜乙状结肠代阴道成形术治疗Mayer-Rokitansky-Kuster-Hauser syndrome(MRKH综合征)的临床疗效。方法对中国医科大学附属盛京医院2006年6月至2009年4月收治的30例患者行腹腔镜乙状结肠代阴道成形术,其中8例在腹腔镜手术中,使用内镜线型切割闭合器切断乙状结肠移植肠段的近端和远端后,先经会阴于尿道膀胱与直肠之间造穴,经穴道将乙状结肠近端拉出,置入抵钉座荷包缝合包埋后送还腹腔内,自肛门插入腔内圆型吻合器,端端吻合乙状结肠,再将带血管蒂的移植肠段牵入穴道,完成阴道成形(改良组)。22例行腹腔镜辅助经腹壁下横切口于腹壁外处理肠管的乙状结肠代阴道手术(对照组)。对两组术式的可行性、手术参数进行对比,术后随访采用自尊量表调查的方式。结果 30例术后乙状结肠吻合口均无感染及肠瘘发生,形成的阴道术后均无狭窄,阴道深度为11~13cm,阴道外口均似正常阴道,无术中和术后并发症的发生。改良组手术时间为(165.6±21.9)min,对照组(209.5±46.9)min(P<0.05);改良组术中失血量为(87.5±11.6)mL,对照组为(157.7±42.5)mL(P<0.05);自尊量表调查评分改良组平均为38分,对照组平均为36分(P>0.05)。结论改良组经阴道造穴肠吻合手术方法是可行和安全的,使肠吻合过程操作简便,具有腹壁上不留辅助切口瘢痕,避免腹壁切口感染的优点,缩短了手术时间,手术效果较理想。
Objective To investigate the clinical effect of modified total laparoscopic sigmoid colon vaginoplasty in the treatment of Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH syndrome). Methods Thirty patients underwent laparoscopic sigmoid colon vaginoplasty from Shengjing Hospital of China Medical University from June 2006 to April 2009, of which 8 patients underwent laparoscopic surgery with an endoscopic linear incision closure device The sigmoid colon after the proximal and distal bowel transplantation, the first through the perineum between the urethra and the rectum between the hole, the acupuncture will pull the sigmoid colon proximal, into the nail seat pockets after sutured and returned to the abdominal cavity, since The anus was inserted into the circular stapler of the cavity, the end of the sigmoid colon was anastomosed, and then the bowel graft with vascular pedicle was pulled into the acupoint to complete the vaginoplasty (modified group). Twenty-two patients underwent laparoscopy assisted transvaginal sigmoid colon vaginal surgery (control group). The feasibility of two surgical procedures, surgical parameters were compared, postoperative follow-up using self-esteem scale survey. Results All the 30 cases had no infection and fistula occurred in the anastomosis of the sigmoid colon. No vaginal stenosis occurred after vaginal surgery. The depth of the vagina was 11 ~ 13 cm. The external vaginal orifice was normal vagina. No intraoperative and postoperative complications occurred . The mean operative time was (165.6 ± 21.9) min in the improved group and 209.5 ± 46.9 (min) in the control group (87.5 ± 11.6 mL vs 157.7 ± 42.5 mL vs P <0.05). The self-esteem scale improved the average score of the study group by 38 points and the control group with an average score of 36 points (P> 0.05). Conclusion The transvaginal approach for anastomosis of the anastomosis in the modified group is feasible and safe. The operation of intestinal anastomosis is simple and convenient. It has the advantages of not supporting the incision scar on the abdominal wall and avoiding the incision of the abdominal incision. It can shorten the operation time and achieve satisfactory result.