腹腔镜与腹腔镜辅助乙状结肠代阴道术治疗MRKH综合征

目的 :总结使用全腹腔镜和腹腔镜辅助下乙状结肠阴道成形术各成功治疗1例Mayer Rokitansky Kuster Hauser综合征 (MRKH综合征 )的经验。方法 :全腹腔镜下使用腔镜闭合切割器切断乙状结肠的近端和远端。自肛门插入腔内圆型吻合器 ,将降结肠与直肠吻合。经会阴于尿道膀胱与直肠之间造穴。将带血管蒂的乙状结肠牵入穴道 ,完成阴道成形。腹腔镜辅助下阴道成形中 ,腔镜闭合切割器切断乙状结肠的远端后 ,于左下腹壁做一辅助切口 ,将近端乙状结肠经此切口拉出至腹腔外。切断乙状结肠近端 ,将乙状结肠的远端开口缝合 2层 ,使之成盲端。近侧端开口置入吻合器之钉钻 ,再行荷包缝合送回腹腔 ,用吻合器行肠吻合。其余步骤同全腹腔镜手术步骤。术后根据临床检查或磁共振成像测量新成形阴道的长度和宽度。结果 :全腹腔镜手术新成形的阴道长 18cm ,宽 4cm。腹腔镜辅助手术新形成的阴道长 19cm ,宽 4cm。两例新形成的阴道黏膜湿润 ,呈粉红色。无术中和术后并发症的发生。结论 :经腹腔镜乙状结肠移植段的长度完全能达到开腹手术的要求。与开放手术比较 ,全腹腔镜乙状结肠代阴道手术在腹壁上不留手术瘢痕 ,美容效果理想。而腹腔镜辅助下阴道成形 ,虽腹壁留有小手术疤痕 ,但操作简便 ,手术时间短 ,手术费用低

Laparoscopic and laparoscopically assisted rectosigmoid colpopoiesis in two patients with Mayer-Rokitansky-Kuster-Hauser syndrome

Objective:To summarize the experience of treating two patients with Mayer-Rokitansky- Kuster-Hauser symdrome by the total laparoscopic and the laparoscopically assisted rectosigmoid colpopoiesis.Methods:For the total laparoscopic technique,the proximal and distal oral level of sigmoid colon was chosen and severed with endoscopic linear cutters respectively,allowing for a segment of 20cm in length.The stump of the rectum and the proximal colon was anastomosed using curved intraluminal stapler.After the space between the bladder and the rectum was detached,the isolated sigmoid transplant reached the perineum. For the laparoscopically assisted technique,once the distal oral level of sigmoid colon was severed with endoscopic linear cutters,a small incision was made on the left lower abdominal wall through which the proximal sigmoid colon was drawn out of the abdominal cavity.The distal oral of the sigmoid plant was sutured as a cul-de-sac.The anvil of the intraluminal curved stapler was put in and the purse-string suture was made in proximal oral of the descending colon.The remaining procedures were the same as those of total laporoscopic techniques.The length and width of the neovagina were evaluated and measured by clinical examination or by magnetic resonance imaging(MRI).Results:The mucosa of the neovagina of both cases was pinkish and had a moist surface.The neovagina of total laporoscopic technique was 18cm in length and 4cm in diameter,and of the laporoscopically assisted,19cm and 4cm,respectively.No intraoperative or postoperative complications were observed.Conclusoins:The length of the bowel transplant harvested laparoscopically is equal to that achieved with conventional surgery.Compared with laparotomy,total laparoscopic colpopoiesis has various advantages,including its minimally invasive nature and excellent cosmetic result.While there is a small incision (3cm) on the the lower abdominal wall for the laporoscopically assisted colpopoiesis,this technique has the advantages of less time-consuming,less cost and easy to perform.