Eighty-six cases of laparoscopic vaginoplasty using an ileal segment

Background The surgical management of the absence of the vagina is a complex problem and constitutes a significant technical challenge. As the laparoscopy has been an important tool for the treatment of uterovaginal anomalies, we evaluated the feasibility of laparoscopic vaginoplasty using an ileal segment retrospectively. Methods Totally 86 patients who underwent laparoscopic vaginoplasty using an ileal segment in Beijing Anzhen Hospital during February 2004 to July 2007 were enrolled in this study. Of the 86 patients, 70 （81.4%） underwent primary operations and 16 （18.6%） secondary operations. Nineteen （22.1%） patients underwent total laparoscopic vaginoplasty and 67 （77.9%） patients underwent laparoscope-assisted vaginoplasty. The operation time, cost of hospitalization, and hospital duration were compared between the two laparoscopic groups. The Student＇s t test and the Mann-Whitney test were used to examine the differences. Results All the surgeries were successfully completed with no any intraoperative complication. There were three major surgical complications in the postoperative period： one case of intra-abdominal hemorrhage, one case of meatal stenosis and one case of intestinal obstruction. The mean follow-up period of this series was 18 months. Seventy-eight patients were satisfied with their sexual lives after the surgeries except 5 women complaining of vaginal stenosis and 3 with no sexual partner during the follow-up. Significant differences were obtained between total laparoscopic and laparoscope-assisted vaginoplasty groups, such as the operation time, cost of hospitalization, and hospital duration （P 〈0.01）. There were no significant differences in sexual function between the two groups. Conclusions The laparoscopic vaginoplasty using an ileal segment is satisfactory for cosmetic, functional, and anatomic results. Vaginoplasty with an ileal segment, performed by either total laparoscopic or laparoscope-assisted techniques, has a high success rate for a functional vagina.     

LaMa minora skin flap vaginoplasty using tissue expansion

Objective This is to introduce a method for vagina reconstruction using the expanded labia minora flap. Methods Two tissue expanders were implanted in the labia minora bilaterally and expanded slowly over 4 weeks. In the operation, the expanded labial tissue was advanced as a bipedicle flap to line the reconstructed vagina. Five patients were treated with this methcxi. Postoperative stent placement and dilation resulted in a vaginal canal exceeding 8 cm in depth. Results During the follow-up of 6 months to 2 years, four of the five patients got married. The vulva exhibited almost indistinguishable appearance. The reconstructed vagina had sensory and secretary functions. Its morphology and depth well meet the physiological demand. Conclusion The modified method of tissue expansion vaginoplasty using the labia minora bipedicle flap is a good option for vagina surgery. The reconstructed vagina possesses the anatomical and physiological resemblance. 11 refs,3 figs.     

Laparoscopic and gasless laparoscopic sigmoid colon vaginoplasty in women with vaginal agenesis

Background  In the past several decades we have seen multiple advances in the reconstruction for girls born with vaginal agenesis. This study aimed to evaluate the technical feasibility, anatomical and functional outcomes of one-stage laparoscopic and gasless laparoscopic vaginoplasty with sigmoid colon for the patients of vaginal agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome).

Methods  We did a retrospective review of a total of 150 women with Mayer-Rokitansky-Kuster-Hauser syndrome treated at Beijing Anzhen Hospital, Capital Medical University from March 2006 to August 2010. The patients were divided into the CO₂ pneumoperitoneum laparoscopic group and the abdominal wall lift of gasless laparoscopic group. Sigmoid colon vaginoplasty approaches were performed in all of the patients. The surgical techniques, perioperative results, complications, anatomical and functional outcomes of vaginoplasty were recorded.

Results  All procedures were performed successfully. Significant differences in the operative time and intraoperative blood loss existed in the laparoscopic vaginoplasty group compared with the gasless laparoscopic vaginoplasty group. The patients who underwent sigmoid colon vaginoplasty had good cosmetic results without the problem of excessive mucus production. The postoperative complications were minimal. During a mean follow-up of 15.6 months, no stenosis or shrinkage was encountered. The subjective sexual satisfaction rate with the surgical outcomes in all patients was 83.3%.

Conclusions  Laparoscopic or gasless laparoscopic vaginoplasty with sigmoid colon are effective and feasible approaches for women with congenital vaginal agenesis. The procedures have satisfactory anatomical and functional results.

     

Obstetric outcome of women with uterine anomalies in China

Background Congenital uterine anomalies are associated with the highest incidence of reproductive failure and obstetric complications. This study aimed to summarize the clinical characteristics and prenatal outcome of pregnancy in women with congenital uterine malformations. Methods This retrospective study evaluated the fertility and obstetric outcome of 116 inpatients with uterine malformations with pregnancy in Peking University Third Hospital from June 1998 to June 2009. A total of 270 randomly selected pregnant women with a previously confirmed normally shaped uterus as a control group. Student＇s t test and analysis of variance （ANOVA） were used to compare means for normally distributed variables. The analysis was carried out using the SPSS. Results Among 21 961 deliveries in Peking University Third Hospital, 116 （0.45%） were in women with uterine anomalies. A septate uterus was present in 43 （37.1%） and the uterus didelphys in 28 （24.2%） of the 116 women identified. Bicornuate uterus, arcuate and unicomate uterus were observed in 12 （10.3%）, 18 （15.5%） and 15 （12.9%） patients, respectively. Patients with uterine anomalies had significantly higher rates of malpresentation （38.8%）, preterm delivery （19.8%）, and cesarean section （78.5%） compared with the group of women with a normal uterus. Patients with uterine anomalies had significantly lower mean birth-weight neonates and a significantly higher incidence of small for gestationalage （SGA） neonates; women with uterus didelphys more frequently required infertility treatment than patients with other uterine anomalies （P 〈0.001）. The rate of malpresentation was significantly higher in patients with septated uterus in comparison with patients with uterus unicorns （P 〈0.05）. Conclusions Women with congenital uterinemal formation usually have higher incidence of complications during pregnancy and delivery. A septate uterus appears to be associated with poorer obstetric outcomes.     

Comparison of main lactobacillus species between healthy women and women with bacterial vaginosis

Background The normal microbial flora of the vagina plays an important role in preventing genital and urinary tract infections in women. Thus an accurate understanding of the composition and ecology of the ecosystem is important to understanding the etiology of these diseases. This study aimed to compare the characteristics of main lactobacillus species between healthy women and women with bacterial vaginosis （BV） by quantitative culture and PCR methods. Main lactobacillus species include L. crispatus , L. gasseri, L. jensenii and L. iners.
Methods A total of 150 Women attending Gynecology Outpatient Clinic of Beijing Friendship Hospital, were diagnosed as having BV because three or more of the following criteria were met （standard of Amsel＇s composite criteria）： homogeneous discharge, elevated vaginal pH （pH 〉4.5）, production of amines, and presence of ＂clue＂ cells. Those with less than three of the criteria were considered as healthy. Simultaneously, smears were made of vaginal fluid and Gram stained, then were assessed qualitatively as normal （grade Ⅰ）, intermediate （grade Ⅱ）, or consistent with BV （grade Ⅲ）. Gardnerella vaginalis were identified by using Vitek 2 Compact and PCR methods. Lactobacillus species were identified by PCR methods. Gardnerella vaginalis and lactobacilli colony counts were determined by calculating the most number of colonies of each species in the appropriate plates （colonies between 10 and 300）, corrected by the dilution of the sample in the plates, and multiplied by 10 （to account for plating 100 μl）, in order to get colony forming units per milliliter of vaginal secretion.
Results BV was diagnosed in 31% （46/150） patients using the composite criteria, the remainder being regarded as healthy. The majority of patients with BV had a smear assessed as grade Ⅲ （91%, 42/46） and minority of them had a smear assessed as grade Ⅱ（9%, 4/46）. The majority of healthy women had a smear assessed as grade Ⅰ （64%, 67/104）. Smears assessed as grade Ⅱwere found （36%, 37/104） among patients diagnosed as healthy, with less than three of the composite criteria. L. crispatus was cultured from 94% of healthy women and 83% of women with BV, with the former colonies count average value of 106 and the latter of 103. L. gasseri, L. iners, and L. jensenfi were cultured from 85%, 68% and 43% of healthy women; and 28%, 89% and 44% of BV women, respectively.
Conclusions The quantities of four lactobacillus species except L. jensenii had a significant difference between healthy women and women with BV. Our results provide support for the negative association between L. iners and L. gasseri. Although L. crispatus were existent both in healthy and BV positive women＇s vagina, the numbers of L. crispatus were significantly different for the dominant number in healthy women. Smears of vaginal fluid and Gram stain play an important guiding role in bacteria culture.     

Transcatheter closure of perimembranous ventricular septal defects:single centre experience in China

Ventricular septal defect (VSD) is one of the most common congenital heart malformation. As an isolated lesion, it accounts for 20%-30% of patients with congenital heart disease.1 Eighty percent of these defects are perimembranous involving the membranous septum and the adjacent area of muscular septum. At least 80% of these defects are small and close spontaneously,2,3 the larger defects often persist to cause significant shunt and right ventricular hypertension. Although conventiona…     

脉管性疾病592例临床分析

Background  Vascular anomalies are common and multidisciplinary involved diseases. The greatest impediment to their treatment in the past was their confusing terminology and clinical heterogeneities. This hospital-based retrospective study assessed some clinical characteristics, diagnosis, therapies and outcomes of patients with vascular anomalies in southeast China.

Methods  A total of 592 vascular anomalies patients (patients with intracranial tissues or viscera involved were excluded), admitted to the First Affiliated Hospital of Sun Yat-sen University from January 2006 to September 2009, were enrolled in the study. Data for clinical characteristics, diagnosis, therapies and outcomes were collected and analyzed.

Results  Of the 592 patients, the male:female ratios in the vascular tumor group (n=187) and the vascular malformation group (n=405) were 1:1.49 and 1:1.06 respectively, with no significant difference between them. The mean onset age of the vascular tumor group was significantly younger than that of the vascular malformation group (Ρ <0.001). The head and neck were the most commonly (31.4%) involved areas in vascular anomalies. A total of 23.8% of the patients with vascular anomalies had definite symptoms caused by the vascular lesions. In the vascular tumor group, 94.1% of them were infantile hemangiomas. Venous malformation was the most common (41.0%) subtype of vascular malformations. Surgical therapy was undertaken in 94.2% of the patients with vascular anomalies. Of the 519 patients available for the 16-58 month follow-up, 322 patients (62.0%) were cured, 108 patients (20.8%) were markedly improved, 57 patients (11.0%) were partially improved, and 32 patients (6.2%) were uncured.

Conclusions  Vascular anomalies are clinically heterogeneous. While the outcome is generally favorable, further effort should be made to determine the appropriate terminology and management.

     

A Clinicopathological Study on Aortic Valves in Children

In order to investigate the clinicopathological characteristics of aortic valve disease in children, all the native surgically excised aortic valves obtained between January 2003 and December 2005 were studied macroscopically and microscopically. The patients’ medical records were reviewed and the clinical information was extracted. According to preoperative echocardiography, intraopera- tive assessment, and postoperative pathology, combined with clinical symptoms and signs, aortic valve diseases were divided into three categories: aortic stenosis (AS), aortic insufficiency (AI), and aortic stenosis with insufficiency (AS-AI). The etiology was determined according to the macro- scopic, microscopic and clinical findings. The results showed that among 70 aortic valves, patient age ranged from 6 to 18 years, with a mean of 15.4 years, and there were 56 boys and 14 girls (male: fe- male=4:1). Forty-four children only had pure aortic valve disease, and the other 26 children had aor- tic valve disease associated with other heart valve diseases. There were 5 cases of AS (7.14%), 60 cases of AI (85.71%) and 5 cases of AS-AI (7.14%). The causes were congenital aortic valve mal- formation (32 cases, 45.71%), rheumatic disease (28 cases, 40%), infective endocarditis (7 cases, 10%), Marfan syndrome (2 cases, 2.86%), and undetermined (1 case, 1.43%). It was concluded that the common causes of aortic valve disease in order of frequency in children were congenital aortic valve malformation, rheumatic disease, infective endocarditis, and Marfan syndrome. AI was more common in children with aortic valve disease. Compared with adult patients, congenital bicuspid aor- tic valve in children was often AI. Histologically, the leaflets of congenital bicuspid aortic valve were mainly myxomatous, fibrosis and calcification less seen. AI was frequently found in rheumatic dis- ease, mostly associated with other heart valve diseases. Macroscopic and microscopic examinations together with clinical information, echocardiographic findings and operative details were important in evaluating the etiology of aortic valve disease.     

PREGNANCY AND ITS OUTCOME IN WOMEN WITH MALFORMED UTERUS

To analyze the clinical characteristics of fertility and pregnancy in women with congenital uterine malformations and explore optimal treatments to improve the prognosis.Methods. A retrospective study was conducted on the fertility and obstetric outcome in 153 patients with uterine malformations treated in our hospital from January 1984 to December 1998. Twenty - seven cases with other kinds of genital and/or urinary anomalies but with normal uterus during the same period were enrolled as the control group.Results. The infertility rate was 26. 6% (34/128), the miscarriage rate 44. 3% (86/194), premature birth rate 9. 3% (18/194), abnormal fetal presentation rate 28. 4% (29/102), the cesarean section rate 61. 8% (63/102), and the perinatal mortality rate 11. 8% (12/102).Conclusion. Women with congenital uterine malformation usually have higher incidence of infertility and complications during pregnancy and delivery. Bicornuate and septate uterus can be associated with poor obstetric outcome.     

Mediastinal enteric cysts in children

Objective The aim of this study is to discuss the etiology, clinical diagnosis and therapy of enteric cysts in the mediastinum. Methods Seventeen children with mediastinal enteric cysts in the last 20 years were studied retrospectively. Results There were one esophageal intramural cyst and 16 enteric cysts. Two of 16 cases had combined esophageal with gastric duplication. Most patients presented with symptoms of respiratory distress. Twelve patients had associated with vertebral anomalies. The cystic nature of these lesions were confirmed by ultrasound in 12 cases and MRI in 4. Eight patients who had 99Tm Tc scan showed hot spots in the posterior mediastinum. Conclusion Most patients present with symptoms of respiratory distress and vertedbral anomalies. Ultrasonography and MRI may be helpful in confirming the cyctic nature of these lesions. 99TmTc scan is the most effective method for differentiating from other mediastinal cysts. 11 refs.     

先天性阴道斜隔综合征的超声图像特征

目的 验证阴道斜隔综合征是否均伴有闭锁阴道侧的肾脏缺如.方法 对妇产科17年间所有经超声检查诊断为阴道斜隔综合征的病例进行分析.2001年前以回顾性方式收集病例,2001年后以前瞻性方式收集病例.结果 共诊断该综合征41例,其中38例为双子宫、双宫颈、双阴道,一侧阴道完全或不完全闭锁;2例为残角子宫;1例为双角子宫、一侧阴道不完全闭锁.41例均伴有一侧肾脏缺如,对侧肾脏不同程度地代偿性增大.结论 先天性阴道斜隔综合征畸形并不少见,均伴有闭锁阴道侧的肾脏缺如和对侧肾脏的代偿性增大,超声检查应列为该病的首选方法.     

先天性无阴道26例临床分析

目的 探讨先天性无阴道的临床特点及治疗方法.方法 回顾性分析2010年6月至2015年6月在我院诊治的26例先天性无阴道患者的临床资料.结果 16例前庭隐窝深度小于3 cm的患者行腹腔镜腹膜代阴道成形术均成功,平均手术时间(76±16) min,中位出血量30 ml.术后1例患者阴道出血给予缝合止血,术后阴道深度8～10cm,1例失访,已有性生活者14例,性生活满意者13例.10例前庭隐窝深度大于3cm的患者行阴道模型顶压法均成功,平均治疗时间(90±10)d,术后阴道深度7～10cm,1例失访,性生活满意者7例.术后两组平均随访3～ 60个月,两组阴道长度、性生活的满意度差异无统计学意义.结论 腹腔镜腹膜代阴道成形术和阴道模型顶压法均为安全有效的方法,对于前庭隐窝深度大于3cm的患者,可首选阴道模型顶压法.     

部分小阴唇皮瓣网状移植人工阴道成形术治疗先天性阴道闭锁 或先天性无阴道9例

目的探讨部分小阴唇皮瓣网状移植人工阴道成形术治疗先天性无阴道或阴道完全闭锁的临床效果及优越性。方法对2011年5月至2017年9月收治的先天性阴道闭锁合并宫颈闭锁或先天性无阴道病人9例,设计并施行部分小阴唇皮瓣网状移植人工阴道成形术或宫颈成形术,对手术效果进行评估。结果9例手术均顺利,出院前阴道深度均达到7~9 cm。远期随访:9例病人阴道宽度与深度均满意;5例保留子宫的月经周期正常,术后均无腹痛发生;7例已结婚,婚后性生活均满意。结论部分小阴唇皮瓣网状移植人工阴道成形术是治疗先天性阴道闭锁或先天性无阴道病人的首选手术方式之一。     

超声多普勒检查对幼少女下生殖道肿物的诊断效能

目的 探讨分析幼少女下生殖道肿物临床特点及超声特征,预测超声多普勒检查在相关疾病上的诊断效能,以期指导临床相关诊疗策略。方法 回顾性收集2010年3月—2021年5月在四川大学华西第二医院治疗并确诊的幼少女下生殖肿物患者39例。分析39例幼女下生殖道肿物的疾病种类,相关临床特征、超声表现、术后记录及病理资料。分析与临床诊断符合率,探讨超声检查对幼少女下生殖道发育异常的诊断价值。结果 39例生殖道肿物中恶性肿瘤者10例,其中子宫2例,宫颈8例;良性病变者2例,均来源于外阴;下生殖道发育异常者27例,其中阴道斜隔综合征15例,阴道闭锁6例,处女膜闭锁2例,阴道横隔1例,先天性无阴道1例,副中肾管囊肿2例。结论 对于下生殖道肿瘤,超声检查可凭借包块大小、性质、血流信号等参数对包块良恶性进行初步评估,在基础体检、普查、临床随诊中有意义,亦可指导相关临床策略     

Longitudinal vaginal septum 'obstructive variety'--a challenge for gynaecologist

The cases which have been presented here have varied presentations but all the three patients in the series had acyclical abdominal pain. Since the uterus is functional there is collection of blood in the pouch formed due to the vaginal septum. This is a potential site for infection and could result in foul smelling discharge. Failure of fusion of lower ends of mullerian ducts that form vagina results in longitudinal vaginal septum. The septum may be partial or complete. The clinical syndrome of double uterus with vaginal obstruction (unilateral, partial or complete) and ipsilateral renal agenesis (same as of the side of obstruction) is rare. This combination is suggestive of embryologic arrest occuring at 8 weeks of pregnancy that simultaneausly affected the mullerian and metanephric ducts.     

Frank压迫法阴道成形术治疗先天性无阴道

目的探讨Frank压迫法阴道成形术治疗先天性无阴道的临床效果。方法观察Frank法治疗159例先天性无阴道患者的治疗时间和随访治疗效果。结果159例患者全部治疗成功,所需时间最长7个月,最短10 d,62例已结婚,随访性生活满意。结论对于阴道前庭部弹性好,阴道外口处有0.5 cm以上陷凹的先天性无阴道患者,用Frank压迫法阴道成形术简便、安全、有效,有2 cm以上阴道者,疗效更佳。     

小阴唇瓣联合阴道前庭瓣阴道成形术

目的探讨以小阴唇瓣联合阴道前庭瓣行阴道再造的方法和临床价值。方法对该科1985～2004年采用小阴唇瓣联合阴道前庭瓣的手术方法治疗先天性无阴道17例患者的临床资料和随访结果分析总结。结果经术后6个月～2年随访,再造阴道可容两指,深度8cm以上,具有感觉和分泌功能,性生活满意。结论小阴唇瓣联合阴道前庭瓣阴道成形术是诸多阴道再造方法中较为理想的方法,其再造阴道接近解剖及生理状态。     

先天性阴道闭锁8例临床分析

目的探讨先天性阴道闭锁的临床特点及治疗。方法回顾分析湘西自治州人民医院近10年收治的8例先天性阴道闭锁合并有功能子宫的临床资料,包括临床表现、手术方式及预后。结果8例Ⅱ型先天性阴道闭锁,均采用保留子宫并阴道成形手术,其中3例合并先天性宫颈闭锁,阴道成形结合开腹手术。随访1～101个月,其中4例成功;2例反复3次出现阴道上段黏连闭锁行黏连分离术,1年后因子宫腺肌病、卵巢巧克力囊肿,痛经难忍行子宫切除术;2例因外省路途遥远失访。结论先天性阴道闭锁保留功能性子宫的手术是可行的,治疗虽较为困难,术后坚持带模具,可保留其生理与生殖功能。     

沂蒙山区女性盆底功能障碍性疾病手术治疗的临床研究

目的：探讨沂蒙山区女性盆底功能障碍性疾病阴道前后壁“桥”式修补加阴道旁修补加改良阴道纵隔成形术的临床应用价值。方法总结分析采用阴道前后壁“桥”式修补加阴道旁修补加改良阴道纵隔成形术治疗子宫脱垂合并阴道前壁和/或后壁脱垂患者42例,为观察组,并与同期采用阴式子宫全切加传统阴道前后壁修补治疗子宫脱垂合并阴道前壁和/或后壁脱垂患者36例,为对照组,进行比较。结果观察组42例均取得满意效果。观察组术中出血量及手术时间低于对照组（ P＞0.05）,观察组术后住院日少于对照组（P＜0.05）。两组均无排尿困难及尿潴留,术后随访2年。观察组术后1个月复查阴道深度长于对照组,差异有统计学意义（ P＜0.05）。术后随访观察组无复发,对照组复发4例,复发率11.1％,与观察组相比,差异有统计学意义（ P＜0.05）。结论阴道前后壁“桥”式修补加阴道旁修补加改良阴道纵隔成形术能有效治疗女性盆底功能障碍性疾病。经济实用,特别适合贫困地区。     

超声诊断女性生殖器发育异常的价值

目的探讨超声在诊断女性生殖器发育异常的价值。方法对134例生殖器发育异常患者的病例资料进行回顾性分析。结果 134例患者169个部位发育异常,其中外阴阴道发育异常54例,占39.1%（54/169）;子宫未发育或者发育不全22例,占13.1%（22/169）;子宫发育异常93例,占55.0%（93/169）。169个异常部位中超声发现异常141个,占84.3%（141/169）,其中外阴阴道发育异常40例,检出率74.1%（40/54）;子宫未发育或者发育不全22例,检出率90.9%（20/22）;子宫发育异常81例,检出率87.9%（81/93）,与手术确诊例数比较具有统计学意义（χ2=27.664,P〈0.000）。结论超声技术对女性生殖器发育异常的诊断及分型中有较高价值。