保留完整阴道粘膜的阴道紧缩术

阴道紧缩术是性快感强化手术之一，传统的方法是将阴道后壁的粘膜菱形切除。但此术式术后存在许多弊端，笔者自1998年以来，采用保留完整阴道粘膜的阴道紧缩术，治疗28例患者，术后效果满意，现报道如下。     

小切口保留完整粘膜阴道紧缩术

目的:探究阴道缩窄的最佳手术方式。方法:采用小切口并保留完整阴道粘膜的术式,对阴道后壁多层缝合,使阴道外1/3及阴道口得以收紧。结果:将此法应用于105例阴道松弛患者,手术全部成功,术后随访0.5～3年,效果满意。结论:小切口保留完整粘膜阴道紧缩术在收紧阴道肌肉的基础上,着重于对阴道外1/3及阴道口的收紧,更符合生理特性,提高性生活质量,效果确切。     

改良的阴道紧缩术治疗阴道松弛临床观察

目的探讨更安全有效的治疗阴道松弛的阴道紧缩手术方法。方法对132例因阴道松弛导致性生活质量下降,要求行阴道紧缩手术的患者进行改良的阴道缩紧术。手术对松弛的阴道前壁和后壁的肌肉及筋膜进行切实有效修复,同时修复会阴裂伤。对合并张力性尿失禁的患者,根据尿道中断吊床学说理论,在修复前壁时于尿道中段加强缝合肌肉筋膜1针;对合并便秘患者,在后壁修复时加强缝合肛提肌3针;前后壁修复时最大限度保护阴道黏膜。结果术后2～7年,随访118例对术后改善性生活满意度、张力性尿失禁、便秘及阴道排气4项内容进行问卷调查,收到满意的临床效果。结论手术方法设计专业,疗效确切,患者满意度高,适合有经验的专科医师采用。     

阴道后壁环肌紧缩术治疗产后阴道松弛症

目的：探讨一种有效治疗产后阴道松弛症的手术方法。方法：对阴道后壁撕裂松弛的肌肉由内向外采用水平褥式紧缩缝合法,缩小阴道直径;由深至浅,采用纵向紧缩缝合法,缩小阴道口并延长会阴体。结果：将此法用于56例产后阴道松弛症患者,手术全部成功。术后随访6～12个月,患者无不适感,术后效果满意。结论：阴道后壁环肌紧缩术治疗产后阴道松弛症,既达到解剖上的缩窄,同时也达到功能的康复,效果确切。     

保留阴道黏膜阴道紧缩术97例报告

目的 介绍一种保留阴道黏膜的阴道紧缩术方法.方法 于阴道口处女膜痕外5 mm处行切口,不切除阴道黏膜,紧缩阴道侧后壁肌肉,连续褥式缝合剥离阴道黏膜及黏膜下组织,将保留的阴道黏膜及黏膜下组织突入阴道.结果 本组共97例患者,术后随访3个月至6年,均感术后性生活满意,效果良好.结论 该手术方法操作简单,疗效确切、可靠,值得临床推广应用.     

粘膜下阴道紧缩术围术期的护理

现代女性比较注意自己性生活的质量,因分娩、产伤等因素导致阴道松弛,影响性生活,造成婚姻家庭不和谐,所以行阴道紧缩术是解决松弛的有效方法。我科2003年1月~2004年4月为13例患者行粘膜下阴道紧缩术,通过加强围术期的护理,取得了满意效果,现将护理体会介绍如下:1临床资料1.1一般资料:13例患者均已婚已育,年龄26~41岁。其中陈旧性会阴裂伤、阴道侧切术后9例,先天性阴道松弛4例。1.2手术方法:常规会阴区域备皮,取膀胱截石位,行阴道后壁局部麻醉。在阴道后壁皮肤与粘膜交界处粘膜侧做长约4.5cm弧形切口,于阴道粘膜下剥离阴道后壁粘膜全长的1/2…     

不损伤粘膜的阴道紧缩术29例

本文报道的方法不切开阴道粘膜 ,势必给手术暴露及操作带来一定的困难 ,对合并有直肠膨出者 ,将不利于直肠前筋膜较高位置的缝合 (而不是阴道后壁肌肉 )从而可能影响手术效果。粘膜游离过多可能会引起阴道后壁皱壁过大和粘膜下血肿。     

双环法阴道紧缩术

目的 介绍一种简单有效的阴道紧缩手术方法。方法 应用3—0丝线或可吸收线，对自觉阴道松弛的患者行黏膜下肌层内连续缝合，环状收缩打结，使阴道黏膜及肌层皱缩隆起，缩小阴道内腔。结果本组患者手术时间20～30min，平均25min。术中无明显出血、手术感染及直肠瘘的发生。术后阴道内无瘢痕。阴道后壁形成数条不规则皱襞。术后随访6个月，性生活较术前满意率达90．9％（10／11）。结论 双环法阴道紧缩术不损伤阴道黏膜，阴道内不遗留瘢痕，损伤小，并发症少，是改善阴道松弛患者性生活质量较为简单有效的方法。     

双环法阴道紧缩术

目的介绍一种简单有效的阴道紧缩手术方法。方法应用3-0丝线或可吸收线,对自觉阴道松弛的患者行黏膜下肌层内连续缝合,环状收缩打结,使阴道黏膜及肌层皱缩隆起,缩小阴道内腔。结果本组患者手术时间20～30min,平均25min。术中无明显出血、手术感染及直肠瘘的发生,术后阴道内无瘢痕,阴道后壁形成数条不规则皱襞。术后随访6个月,性生活较术前满意率达90.9%(10/11)。结论双环法阴道紧缩术不损伤阴道黏膜,阴道内不遗留瘢痕,损伤小,并发症少,是改善阴道松弛患者性生活质量较为简单有效的方法。     

自体脂肪颗粒移植治疗阴道松弛

目的:探讨自体脂肪颗粒移植治疗阴道松弛。方法:2008年3月～2012年6月对38例轻中度阴道松弛,采用自体脂肪颗粒移植治疗,观察局部有无结节和囊肿,阴道插入松紧度,以及性生活满意度等评价标准,并根据随防结果决定是否需再次手术。结果:38例患者分别经l～2次脂肪颗粒注射充填治疗,均达较满意效果。其中29例患者经1次注射,9例中度松弛者经2次注射。结论:自体脂肪颗粒移植治疗阴道松弛所需时间短,操作方便简单,损伤小,术后随访证实恢复快、效果良好。     

V-Y切口阴道紧缩成形术

目的 介绍注重外形美观的阴道V-Y切口紧缩术.方法 于阴道后联合皮肤黏膜交界处设计V形切口;按设计切开皮肤,钝性分离深约4 cm后,暴露球海绵体肌(阴道缩肌),提起两侧壁的肌肉,测试括约肌的紧张度;以"8"字形或环形缝合球海绵体肌及阴道括约肌3、4针.将V形切口予以Y形缝合,缩小、提高阴道外口,形成宽度适宜的新阴道口.自2003年2月至2008年6月,对23例患者行阴道紧缩成形术.结果 所有患者的切口均I期愈合,且术后瘢痕不明显,会阴外形较美观.术后随访23例患者6个月至5年,性生活效果较术前明显改善者12例,较改善者6例,无改善者5例.结论 V-Y切口阴道紧缩成形术是一种改良的且安全、有效的手术方法.     

An ambispective observational study in the safety and efficacy of posterior colporrhaphy with composite Vicryl-Prolene mesh

There is increasing evidence to show that the use of surgical meshes reduces recurrence rates of hernia repair and anterior vaginal wall prolapse. The aim of this study was to determine the safety and efficacy of posterior colporrhaphy with mesh in patients with posterior vaginal prolapse. An ambispective observational study involving 90 patients was conducted with retrospective chart review and prospective subjective and objective assessments at the end of a 1-year study period. Apart from 2 of 90 (2.2%) minor hematoma incidents, there was no other major perioperative morbidity. Prevalence of common prolapse complaints of vaginal lump sensation, constipation, defecation difficulty and dyspareunia all improved significantly postoperatively (p<0.001). Surgical correction was achieved in 27 of 31 (83.9%) at 6 months and beyond. There was no mesh infection but minor vaginal mesh protrusion was found in 7 of 90 (7.8%) patients at 6–12 weeks and 4 of 31 (12.9%) patients at 6 months and beyond. All these were treated easily with trimming without the need of mesh removal. We conclude that posterior colporrhaphy with mesh is effective in treating posterior vaginal prolapse in short term.Editorial Comment: This study reflects the authors experience in using a Vicryl-Prolene mesh, Vypro II, for treatment of rectocele in 90 patients. No serious operative or postoperative complications occurred. The most common minor complication was vaginal mesh protrusion, with a 9 of the 90 being found with this problem; all but 1 of these were resolved with a simple clinic procedure. In a group of 31 patients followed for at least 6 months, the authors note a 16% recurrence rate of rectocele. In a questionnaire given after the surgeries, comparing pre-op and post-op symptoms, 63–79% of the respondents felt improved, depending on the symptom. The authors feel that vaginal colporrhaphy with Vicryl-Prolene mesh will prove to be more efficacious than the existing popular approaches, including site-specific defect repair. Clearly, randomized controlled studies with longer follow-up comparing this method with other colporrhaphy techniques will be needed to validate this assumptionAn erratum to this article can be found at     

Long‐term follow‐up of anterior vaginal repair: A comparison among colporrhaphy,colporrhaphy with reinforcement by xenograft,and mesh

Aims

To assess the long‐term complications and outcomes in patients treated for pelvic organ prolapse (POP) with transvaginal anterior colporrhaphy (AC) alone, transvaginal naterior AC with reinforcement by using porcine Xenograft (AC‐P) (Pelvisoft® Biomesh), and transvaginal anterior repair with polypropylene mesh (AC‐M).

Methods

This was a retrospective analysis of 109/123 consecutive patients, who underwent cystocele repair: 42 AC, 19 AC‐P, and 48 AC‐M. Subjective outcomes included validated questionnaires as well as questions that had not been previously validated. Objective outcomes have been evaluated considering failure the anterior vaginal wall recurrence >2 stage POP‐Quantification. Statistical analysis included the chi‐square or Fisher exact test.

Results

The mean follow‐up was 94.80 ± 51.72 months (19‐192 months). In all groups, the patient's personal satisfaction was high. There was no evidence of difference in outcome based on whether a biological graft was or was not performed, or whether synthetic mesh was used to reinforce the repair. Data showed a higher rate of complications in the AC‐M group (P < 0.05) that could explain the lower subjective satisfaction of these patients.

Conclusions

This study evaluated long‐term outcomes to anterior vaginal repair over a period of more than 5 years in all the groups. Our data show that anterior vaginal repair with mesh and xenograft did not improve significantly objective and subjective outcomes. Rather, prosthetic device use leads to higher rate of complications.     

Transvaginal posterior colporrhaphy combined with laparoscopic ventral mesh rectopexy for isolated Grade III rectocele: a prospective study of 27 patients

Aim The aim of this study was to evaluate prospectively transvaginal posterior colporrhaphy (TPC) combined with laparoscopic ventral mesh rectopexy (LVR) in patients with a symptomatic isolated rectocele. Method Patients with these complaints underwent dynamic and static MRI. All consecutive patients with a Grade III (4 cm or more) rectocele and without internal/external rectal prolapse, enterocele and external sphincter damage were operated on. The patients completed the Obstructed Defecation Syndrome (ODS) score and the Cleveland Clinic Incontinence Score (CCIS). All tests were repeated after treatment. Dynamic disorders of the pelvic floor detected by MRI were recorded. Results In 27 patients [median age 67 (46–73) years], TPC combined with LVR was feasible. Complications were limited to port site infection in two patients. Sexual discomfort (n = 8) due to prolapse diminished in six (75%) patients and in one (4%) de novo dyspareunia developed after treatment. The median follow‐up was 12 (10–18) months. The median CCIS was 12 (10–16) before treatment and 8 (7–10) after (P < 0.0001). The median ODS score was 19 (17–23) before and 6 (3–10) after treatment (P < 0.0001). There was no change in urinary symptoms. Conclusion TPC combined with LVR for obstructed defaecation and faecal incontinence in patients with Grade III rectocele significantly relieves the symptoms of these disorders.     

梯形缝合法阴道紧缩术应用探讨

目的:探究阴道缩窄术的最佳手术方式。方法:采用梯形缝合法即对阴道后壁呈梯形样三层缝合使阴道下1/3段及阴道口肌肉紧缩的手术方式。结果:治疗30例,阴道松弛症状均取得了良好的矫治效果。结论:梯形缝合法将直肠筋膜、阴道周围缩紧加强的同时,更着重于加强阴道外1/3段,特别是近阴道口肌肉的力量使其更加符合生理特性,提高性生活的质量。该法是治疗阴道松弛症较好的手术方法。     

小阴唇皮瓣法治疗阴道闭锁

目的：探讨小阴唇皮瓣法在先天性阴道闭锁的临床应用。方法：选择适宜的13例先天性阴道闭锁患者,根据阴道缺损的量设计应用部分或完全小阴唇皮瓣进行部分或全阴道再造。结果：所有手术获得成功,再造阴道均通畅,湿润,光滑有弹性,有功能性子宫的病人月经正常,性生活满意,并有3例获正常妊娠分娩。结论：选择小阴唇发育良好的病例应用小阴唇皮瓣法再造阴道,其方法简便,损伤小,无外显瘢痕,费用少,值得在临床选择推广应用。