球海绵体肌瓣重叠法阴道缩窄术治疗产后阴道松弛

目的探讨一种有效的阴道缩窄整形术的方法.方法经阴道口皮肤黏膜交界处切开,剥离阴道黏膜,分离出撕裂的球海绵体肌,形成肌瓣.将肌瓣折叠缝合,然后纵行缝合阴道黏膜,并形成阴道黏膜隆突.结果本组11例患者均采用球海绵体肌重叠缝合法行阴道缩窄术,9例患者术后随访3个月至2年,夫妻性生活的质量均有明显提高,效果满意.结论经此手术后可以矫正阴道松弛,提高患者性生活质量,效果确切.     

球海绵体肌法治疗产后阴道松弛症

目的：探讨一种实用有效的治疗产后阴道松弛症的方法和效果。方法：采用经阴道口后壁皮肤与粘膜交界处切开,剥离随访膜,分离出撕裂的球海绵体,形成肌瓣。将肌瓣折叠缝合,纵形缝合阴道粘膜,使形成隆突,保留阴道粘膜。结果：本组20例患者均采用球海绵体肌肌瓣重叠缝合法行阴道缩窄术。18例患者术后6个月～3年随访,性生活质量均有明显提高,效果较满意。结论：本术式可以治疗阴道松弛症,能明显提高患者性生活质量,效果确切,方法简单,是一种治疗产后阴道松弛症的较好方法。     

球海绵体肌瓣法矫治阴道松弛症探讨

目的:为寻找一种实用有效的治疗产后阴道松弛症的手术方法和临床效果。方法:采用自体阴道分离出撕裂的球海绵体,形成肌瓣。将肌瓣折叠缝合,纵形缝合阴道黏膜,使形成隆突,保留阴道黏膜,加固阴道后壁紧缩阴道腔的手术治疗方法。结果:本组30例患者创口均I期愈合,术后随访6个月至2年,性生活质量均有明显提高,效果较满意。结论:用自体阴道球海绵体肌瓣重叠法治疗阴道松弛症,能明显提高患者性生活质量,效果确切,方法简单,是一种治疗产后阴道松弛症简单有效的方法。     

提肛肌肌瓣对合重叠缝合法治疗产后阴道松弛

目的 探讨一种有效治疗产后阴道松弛的手术方法。方法 经阴道口皮肤黏膜交界处切开，剥离阴道黏膜，分离出撕裂的提肛肌，形成两个肌瓣。将两肌瓣对合重叠拉紧缝合后缝合阴道黏膜，并形成阴道黏膜隆突。结果 1998年6月至2002年6月将此法用于2l例产后阴道松弛的患者，术后随访16例，随访3个月至2年，患者均感手术后提高了性生活质量。结论 此方法可以提高患者性生活质量，效果确切。     

球海绵体肌瓣在女性复杂性膀胱阴道瘘修补术中的应用

目的探讨球海绵体肌瓣修补女性复杂性膀胱阴道瘘的应用价值。方法女性复杂膀胱阴道瘘患者11例,均有瘘修补失败史,均经膀胱镜检查确诊,瘘口直径3.0～5.0 cm。经腹会阴途径修补,瘘口周围瘢痕组织经腹彻底切除。会阴部切口,自阴道前壁和尿道后壁之间分离至瘘口,用可吸收线缝合阴道侧瘘口。沿大小阴唇之间纵行切开,游离球海绵体肌,避免损伤会阴外动脉血供。经小阴唇底部打一隧道,将球海绵体肌瓣通过隧道,阴蒂端经膀胱瘘口缝合于子宫前壁下端,缝合膀胱裂口。结果11例患者术后均无阴道漏尿及尿失禁。随访6个月～5年,患者均无尿道狭窄,10例已婚者性生活正常。结论球海绵体肌瓣移位术操作简单,成功率高,尤其适用于修补女性复杂膀胱阴道瘘。     

阴道旁修补术联合球海绵体肌缝合治疗重度阴道松弛症

目的 探讨重度阴道松弛症的修复方法 及临床效果.方法 对48例重度阴道松弛症患者经阴道旁筋膜修补及球海绵体肌缝合,并随访术后性生活满意度、会阴外观、不自主排尿及阴道分泌物的改善效果.结果 术后随访43例,性满意度改善者40例,有效率为93%.14例对自身会阴外观不满意者术后均有明显改善;不自主排尿、阴道分泌物增多等症状有效缓解.结论 阴道旁修补术联合球海绵体肌缝合治疗重度阴道松弛症,手术安全,疗效可靠.     

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.     

自体阴道瓣"桥"式缝合治疗阴道松弛20例

目的 寻找一种有效治疗阴道前壁松弛,减少尿失禁发生的方法.方法 采用自体阴道前壁瓣作材料,"桥"式缝合加固阴道前壁,缩窄阴道腔.结果 本组共20例患者,术后随访6～12个月,尿失禁明显改善,阴道缩紧,效果满意.结论 自体阴道瓣桥式缝合法可以矫正阴道松弛,提高患者性生活的质量,治疗女性压力性尿失禁,简单有效.     

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。     

保留阴道黏膜的V-Y切口阴道紧缩成形术

目的:寻找一种既能保留阴道黏膜,又能形成外科美观的阴道缩紧成形术效果。方法:于阴道后壁皮肤与黏膜交界处设计V形切口,分离深约4cm后,显露阴道缩肌,行"8"字形或环形缝合球海绵体肌3~4针,以缩紧阴道后壁肌肉,然后褥式连续缝合剥离阴道黏膜及黏膜下组织,让保留的阴道黏膜突入阴道内,将V形切口用Y形缝合,以缩小阴道外口,形成松紧适宜美观的新阴道口。结果:本组30例患者切口均I期愈合。所有患者术后随访3个月~3年,均感术后性生活满意,有良好效果。且瘢痕不明显,会阴部外形美观。结论:该方法既操作简单、疗效确切,且外观美观,是一种阴道紧缩安全有效的好方法,值得推广应用。     

Treatment of vaginal agenesis with modified Abbé-Mclndoe technique

In a patient with vaginal agenesis reconstruction of the neovagina is very important both functionally and psychologically. The absent vagina can be constructed either by surgery or by an intermittent pressure technique defined by Frank. In this paper simple modification is presented which has good anatomical and functional results. For a young woman without a vagina the ideal operation should create a vagina in one stage and at the same time produce a cosmetically attractive scar. This goal can be achieved by the Abbé-McIndoe technique. A modification using a meshed split thickness skin graft for lining the neovagina is presented. Between 1985–1991 in our clinic, 46 patients were treated. A follow-up study has been performed and biopsies were taken from this neovagina; these showed normal vaginal mucosa.     

PLLA 在老年性阴道炎患者中的应用效果

目的 探讨聚左旋乳酸（PLLA）在老年性阴道炎患者中的应用效果。方法 选取2021年4月-2022年 3月南昌添润医疗美容门诊部收治的50例老年性阴道炎患者作为研究对象，选用PLLA作为干预因素，采用阴 道黏膜下多点注射，术后3个月观察患者阴道健康指数、阴道症状指数及阴道内pH变化。结果 治疗后阴道健 康评分为（9.84±1.69）分，高于治疗前的（6.06±2.14）分，差异有统计学意义（P＜0.05）；治疗后阴道症 状评分为（5.92±1.75）分，低于治疗前的（8.08±1.95）分，差异有统计学意义（P＜0.05）；治疗前后阴道 内pH值比较，差异无统计学意义（P＞0.05）。结论 PLLA可以改善老年性阴道炎阴道黏膜老化症状，提高阴 道健康状况，改善阴道内环境，在阴道年轻化中具有较高的临床应用价值。     

Reconstruction of vaginal agenesis by Singapore flap

Summary Various surgical methods for reconstruction of vaginal agenesis have been described in the past. One of these is the neurovascular pudendal thigh flap described by Wee and Joseph [20] after they studied the blood and nerve supply of upper thigh skin, medial groin, and perineum in fresh cadavers. This technique involves elevation of two flaps extending laterally to labia majora in the groin crease and suturing them to each other in the midline after bringing them through tunnels formed under the labia majora, thus, creating a new vagina. In our clinic, 24 cases of vaginal agenesis have been reconstructed with neurovascular pudendal thigh flaps in a period of 33 months. The patients were observed for eight months to three years following the operation, and only in three cases did necrosis of the distal flaps occur; hair grew in the vagina in five cases, and shrinkage was observed in only one case. This rather easy technique is the ideal reconstructive method in the vaginal agenesis. However, hair growth in the vagina must be prevented, since this is the main patient complaint.Presented at the 7th Congress of the European Section of the International Confederation for Plastic and Reconstructive Surgery, Berlin, Germany, June 2–5, 1993     

双菱形缝线法阴道紧缩术

目的介绍一种即微创又有效的阴道紧缩手术。方法采用打孔器在会阴处打6个小孔,将2根双向倒齿线经小孔对盆底肌肉行双菱形法缝合,收紧盆底肌肉,缩小阴道口。结果本组20例患者手术时间为30~40 min,平均35 min。出血量较少,无瘢痕形成。获随访6个月,性生活满意度较术前有所提高。结论采用双菱形缝线法阴道紧缩术,设计科学,损伤小,不遗留瘢痕,且并发症较少,是改善阴道松弛及提高患者性生活质量的简单而有效的手术方法。     

Flap techniques as an adjunct in vaginal fistulectomy

This paper reviews the method of vaginal fistulectomy as currently practiced worldwide. In addition, the tissue flap techniques available for repair of extensive injuries not amenable to primary multilayer closure are presented. Specific optional flap procedures proposed in fistula closure include: random tissue flaps, the labial fat pad (Martius graft), the bulbocavernosus muscle flap and the gracilis or rectus abdominis myocutaneous tissue flaps. The uses and advantages of each procedure and a comparison with split-thickness skin grafts are discussed.The opinions and assertions contained herein are those of the authors and are not to be construed as official or as representing the views of the Department of the Army or the Department of Defense.     

腹腔镜下经腹膜外阴道旁修补术治疗阴道前壁脱垂9例报告

目的探讨腹腔镜经腹膜外阴道旁修补术治疗阴道旁缺陷所致的阴道前壁脱垂的可行性及疗效。方法2010年7月～2011年10月行腹腔镜经腹膜外阴道旁修补术治疗阴道旁缺陷所致的阴道前壁脱垂9例（Ⅲ度4例,Ⅱ度1例,Ⅰ度4例;4例合并阴道后壁脱垂Ⅰ度）,腹腔镜下腹膜外暴露双侧盆侧壁盆筋膜腱弓（白线）及坐骨棘,阴道穹隆角缝合于同侧坐骨棘,将阴道侧壁缝合于同侧白线。需行子宫全切及阴道壁修补术的患者同时行相应手术,但行阴道壁修补时不去除阴道壁。结果同时行阴式全子宫切除及阴道前后壁修补术4例,阴式全子宫切除1例,阴道前壁修补1例。手术时间75～310 min,平均177 min。除1例术中出血500 ml外,其余患者出血量中位数60 ml（5～280 ml）。术中均无并发症发生。3例术后出现臀部及下肢痛,除1例下肢痛持续2个月外,其余患者持续5～7 d后缓解。术后住院2～11 d,平均6 d。9例术后随访6～15个月,平均8个月,7例主观治愈及客观治愈。1例术后6个月感觉阴道肿物脱出,妇科检查为子宫脱垂Ⅰ度、阴道前壁脱垂Ⅰ度;1例术后1年感觉阴道肿物脱出,妇科检查为阴道前壁脱垂Ⅰ度。所有患者术后阴道深度均〉7 cm。结论腹腔镜经腹膜外阴道旁修补术治疗阴道旁缺陷所致的阴道前壁脱垂安全、可行,能保留阴道的原有深度,近期疗效好。     

Bulbocavernosus muscle flap in the repair of complicated vesicovaginal fistula

AIM: To investigate the transposition of the bulbocavernosus muscle flap for repairing complicated vesicovaginal fistulas. METHODS: Vesicovaginal fistulas were repaired via combined abdominal and perineal approaches. Through an abdominal approach, the fistula and surrounding scar tissue were excised thoroughly. A perineal incision was made between the orifices of the urethra and the vagina, dissecting until the fistula. The vaginal defect was closed through either the abdominal or the perineal approach depending upon its position. Through the abdominal approach, the bladder defect was closed in two layers with the suture lines vertical to each other. The bulbocavernosus muscle was freed through an incision between the labium majus pudendi and the labium minus pudenda, without damaging the pudendal vascular supply. The bulbocavernosus muscle flap was tunneled beneath the labium minus pudendi, and was sutured in place on the bladder wall over the fistula repair site. RESULTS: Nine patients with complicated vesicovaginal fistulas were treated using this technique. After surgery, no symptoms of vagina leakage, urinary incontinence, or urethral stricture were reported by any of the patients, and they reported normal sexual function. CONCLUSIONS: Transposition of the bulbocavernosus muscle flap is an excellent technique with low morbidity and high success rate for repairing complicated vesicovaginal fistulas.     

Transvaginal drainage in rectum amputations

In cases of abdomino-perineal excision of the rectum, a monobloc excision of the posterior vaginal wall and the rectum is performed. The flaps thus formed are rotated and sutured to the side-walls of the cavity. The perineal fat is approximated and the skin sutured. The "new vagina" is packed. The vaginal epithelium covers in less than three weeks the posterior raw area reconstituting a normal vagina. The packing is irrigated daily with an antiseptic. Postoperative cares are more easier.