罗湖术式在阴道闭锁治疗中的应用及热点问题探讨

先天性阴道闭锁临床表现复杂,北京协和医院把阴道闭锁分为阴道下段闭锁(Ⅰ型)和阴道完全闭锁(Ⅱ型),准确的分型有利于选择恰当的治疗方案。对于阴道闭锁Ⅱ型,"罗湖三式"通过闭锁宫颈切除+腹腔镜腹膜阴道成形(罗湖二式)+子宫人工阴道吻合术的组合,成功解决了阴道闭锁Ⅱ型保留生育功能的难题。对于阴道闭锁Ⅰ型中闭锁位置较高的病例,"罗湖四式"通过腹腔镜下闭锁阴道切开+腹膜阴道成形术(罗湖二式)的结合,也成功保留了患者的子宫。充分的术前影像学检查有助于对阴道闭锁的类型进行正确诊断,协助制定合理的治疗方案,而且应该选择合适的手术时机以避免患者延误治疗。术后利用阴道模具进行短时间定期扩张以保持人工阴道的通畅,合并严重子宫内膜异位症者可加用药物治疗。阴道闭锁保留子宫术后的远期妊娠结局有待观察。

Application of Luohu Technique for Patients with Congenital Vaginal Atresia and Relevant Inconclusive Questions

The clinical manifestations of female congenital vaginal atresia were complicated. A classification was developed by Peking Union Medical Hospital, type Ⅰ: partical atresia, type Ⅱ: completed atresia, which should help in congenital vaginal atresia diagnosis and treatment. Trachelectomy and uterus-neovagina anastomosis (LuohuⅢtechnique) was used to treated patients with type Ⅱ vaginal atresia, which can relieve symptoms and restore fertility. Laparoscopic vaginal section and vaginoplasty with hyphemia cyst wall and peritoneum (LuohuⅣtechnique) was used to treated patients with typeⅠvaginal atresia, which surgically restored a patent outflow tract and preserved fertility. Preoperative imaging examination was of great importance to classification of congenital vaginal atresia and to the choice of treatment. Selecting the appropriate timing of operation in the treatment play a key role. Patients were instructed to dilate the neovagina each day for a period with vaginal mould. Medical intervention was used in patients with endometriosis. Its long-term performance in pregnancy and labor need to be assessed in the further.