复杂性阴道畸形的影像学诊断与外科治疗策略

目的探讨复杂性阴道畸形的辅助诊断及手术治疗方法。方法回顾性分析13例复杂性阴道畸形患者的临床资料与治疗结果。结果通过术前骨盆平片、造影、经肛B超及CT等检查可基本明确阴道损伤情况,根据阴道损伤发生的位置及损伤程度的不同,选择经耻骨前路、会阴或两者联合入路,运用游离植皮、皮瓣游离移植、阴道粘膜推进瓣、断端对断吻合、"Z"成形等方法进行修复,除1例发生阴道直肠瘘外,其余病例均取得满意治疗效果。结论术前对阴道损伤程度及相邻器官解剖关系的准确把握是决定手术入路、手术修复方法及治疗效果的关键因素。

The Surgical Treatment of Complicated Vaginal Deformity

Objective To investigate the surgical methods of treating complicated vaginal deformity. Methods A retrospective study was carried out on the clinical materials and results of 13 patients suffered from complicated vaginal deformity. Results Different surgical approaches such as trans-pubic, transperineal or both approach was applied according to the position of the atresia, meanwhile, different surgical methods such as skin graft, free flap transplantation, vaginal mucous flap advancement, direct anastomosis of the two ends, "Z" plasty were used to repair the vagina according to the different defect of the vagina, except for 1 case complicated with vagino-rectus fistula, all the other cases achieved satisfactory results. Conclusions The accurate judgment of the severity of the vaginal injury and the understanding of the changed anatomy around the injured vagina was the key points to the success of the surgical treatment of complicated vaginal deformity.