改良的侧对侧缝合阴道断端在腹式全子宫切除术中的临床应用

目的：为了增强全子宫切除术后盆底的支持力，减少术中出血，降低术后阴道残端出血和肉芽组织增生的发生率。方法：在Ｗａｔｓｏｎ氏侧对侧缝合阴道断端的基础上进行一些改进，使关闭阴道残端与加固主韧带的缝合一次成形。结果：与同期常规的全子宫切除术比较，改良的侧对侧缝合法减少了术中出血和降低了术后阴道残端出血与肉芽组织增生的发生率，并基本保留了阴道穹隆的解剖形态，克服了传统前后缝合法无法保留前后穹窿和Ｗａｔｓｏｎ氏侧对侧法无地保留侧穹窿的弊端。结论：改良后的侧对侧缝合阴道残端不仅继承了Ｗａｔｓｏｎ氏侧对侧缝合加固盆底支撑，减少术中失血的优点，同时简化了操作过程，使残端切口缩短，所形成术后穹窿更符合解剖。     

Female urethral and bladder neck injury after rape: an appraisal of the surgical management

The aim of this study was to discuss the surgical management of urethral and bladder neck injury after urethral coitus during rape. A 21-year-old lady presented with total urinary incontinence of 1-year duration after being raped. On examination, she had urethral laceration and a patulous urethra and bladder neck suggesting urethral coitus during the rape. Her introitus and vagina were however normal. She had repair of her urethral laceration and plication of her urethra and bladder neck via a vaginal approach. She regained her continence and voids without any residual urine. Urethral coitus is rare. Urethral coitus in the presence of a normal introitus and vagina is very rare. The urethral and bladder neck injury resulting from this can be satisfactorily corrected by urethral and bladder neck plication via a vaginal approach with the vaginal incisions positioned to forestall suture line apposition, which may lead to wound failure.     

Vaginal rhabdomyoma

Three cases of vaginal rhabdomyoma are reported. Their macroscopic and microscopic appearances with ultrastructural features are described. Aetiological aspects and differential diagnoses are discussed. Simple excision of these rare, benign lesions is curative.     

Progesterone receptors in human oestrogen target tissues

The levels of specific oestrogen and progesterone receptors have been measured in myometrial, endometrial and vaginal tissues obtained from 18 women between the ages of 28–73 yr.High speed cytosols of the three tissues were incubated at four different concentrations of specific ligands: E₂ for the oestrogen receptor (ERc) and Org-2058 for the progesterone receptor (PgRc). Separation of bound and free hormones was done by dextran-coated charcoal; data were analysed according to Scatchard.In the myometrium and endometrium both PgRc and ERc were found. In the vaginal tissues obtained from the same patients only ERc was present. There was no evidence of specific progesterone receptors in the vagina. Both clinical and histological findings indicate that the vagina is an oestrogen-sensitive organ. Therefore, it is surprising that progesterone receptors, which are considered to be a specific response of oestrogen target tissue, are absent in the human vagina.This finding suggests that the induction of the progesterone receptors is not a specific response to oestrogen stimulation in the human vagina.     

Sarcoma botryoides of the vagina

A case of sarcoma botryoides of uagina in a 2 yr old girl is reported. The relevant literature is briefly reviewed.     

Treatment for unsuccessful tension-free vaginal tape operation by shortening pre-implanted tape

PURPOSE: We studied the efficacy of shortening the pre-implanted suburethral tape in patients with recurrent urodynamic stress incontinence after a TVT operation. MATERIALS AND METHODS: A total of 14 women, including 6 with ISD, were treated for recurrent urodynamic stress incontinence after the initial TVT operation by performing the shortening procedure under local anesthesia. Urodynamics, a 1-hour pad test, introital ultrasonography of the urethra and a cotton swab test were done before the procedure and 1 year postoperatively. RESULTS: All 14 patients completed the shortening procedure. Mean patient age was 47.2 years (range 43 to 66). Mean time between initial TVT and the shortening procedure was 4 months (range 3 to 14). Ten patients (71.4%) were objectively cured and treatment failed in 4 (2 with ISD and 2 with a fixed urethra). Mean operative time was 17 minutes (range 10 to 25). No intraoperative surgical complications were observed. The 1-hour pad test showed a decrease from a median of 9.0 gm to 1.0. Median postoperative hospital stay was 1 day (range 1 to 4). Spontaneous voiding with adequate post-void residual urine was noted in all patients before discharge home. CONCLUSIONS: Shortening a pre-implanted TVT tape for the treatment of recurrent urodynamic stress incontinence is a safe, effective and minimally invasive option requiring only a short hospital stay. However, ISD and an immobile urethra seem to be risk factors for failure. Long-term followup is needed to determine if this surgery achieves long-lasting results.     

Pelvic organ support and prevalence by Pelvic Organ Prolapse-Quantification (POP-Q) in Korean women

PURPOSE: We evaluated pelvic organ support and the prevalence of pelvic organ prolapse in Korean women using the Pelvic Organ Prolapse-Quantification system as the assessment tool. MATERIALS AND METHODS: The study population consisted of 713 women 18 to 72 years old who were seen for annual Papanicolaou testing and pelvic examinations. Pregnant patients and patients who had delivered within the previous 6 weeks were not recruited. All pelvic examinations were performed by a single examiner. The patient was examined in the dorsal lithotomy position in a pelvic examination chair positioned at a 15-degree angle. All 9 measurements except total vaginal length were taken with the patient performing the maximal Valsalva maneuver. RESULTS: Mean patient age was 41.6 years (range 18 to 72), mean weight +/- SD was 55.8 +/- 7.4 kg (range 40 to 83), mean height was 158.7 +/- 5.4 cm (range 138 to 177), mean body mass index was 22.3 +/- 8.1 kg/m2 (range 15.7 to 32) and median parity was 2 (range 0 to 6). Mean scores for the position of the cervix and posterior fornix, and total vaginal length were -5.0, -6.6 and 7.0 cm, respectively. In the 713 women with a uterus the incidence of anterior vaginal, uterine and posterior vaginal prolapse was 27.6%, 2.0% and 25.4%, respectively. The overall distribution of pelvic organ prolapse quantification system stage was stages 0 to 4 in 68.3%, 19.9%, 11.2%, 0.6% and 0.0% of patients, respectively. CONCLUSIONS: Vaginal size in Korean women differs from that in Western women. The prevalence of any degree of prolapse was approximately 31.7%. Korean women were at relatively higher risk for anterior and posterior vaginal prolapse than for uterine prolapse.     

Neurofibroma with rhabdomyomatous differentiation: Benign 'Triton' tumour of the vagina

The benign 'Triton' tumour is a neural tumour with benign rhabdomyomatous differentiation: it must be distinguished from the better known malignant counterpart. We describe the first case outside the peripheral soft tissues and the first to be studied ultrastructurally. It also represents the second lesion identified in an adult patient.     

自制模型在腹腔镜下腹膜阴道成形术中的应用

目的 探讨自制阴道模型在腹腔镜下腹膜阴道成形术的临床应用价值.方法 于2008年4月～2010年3月该院共实施腹腔镜下腹膜阴道成形术13例,在术中均使用由塑料注射器改制成的自制阴道模型,并对术式进行了改进.结果 13例手术均取得成功,术后均获随访,随访时间2个月～1.5年,无术后并发症发生.成形之阴道宽敞,黏膜粉红色、润滑、弹性好,外阴外观无改变,性生活满意.结论 自制阴道模型取材方便、制作简单、价格低廉,适合成形后的人工阴道.经改进后的术式可有效减少并发症.     

CM-Dil标记对骨髓间充质干细胞的影响及其在大鼠阴道重建模型中的示踪

目的探讨骨髓间充质干细胞（bone marrow stem cells,BMSCs）氯甲基苯甲酰胺（chloromethyl-benzamidodialkylcarbocyanine,CM-DiI）标记的效果及其标记后在大鼠阴道重建模型中的示综。 方法全骨髓贴壁培养法培养大鼠BMSCs。用不同浓度的CM-Dil标记液标记BMSCs,观察不同浓度标记下BMSCs的标记效率和增殖能力。BMSCs与小肠黏膜下基质（small intestinal submucosa,SIS）复合后构建大鼠阴道重建模型,观察干细胞在重建阴道的示综。 结果CM-DiI标记后各浓度的标记效率都可达98%以上,但荧光强度随浓度的增加而变强。2.5 μmol/L及5 μmol/L标记后的生长曲线与对照组无明显区别,10 μmol/L及20 μmol/L标记后生长曲线较对照组稍降低。BMSCs移植后主要分布在阴道深层组织中,术后3个月仍可见橙黄色的BMSCs。 结论CM-DiI标记对干细胞活性影响小,5 μmol/L可能是最佳的标记浓度,BMSCs移植后3个月仍可见橙黄色的BMSCs,可用于后期进一步研究。