先天性无阴道综合征生物补片法阴道成形术的手术方法介绍和临床结局

目的先天性无阴道(Mayer-Rokitansky-Küster-Hauser)综合征手术治疗方法繁多,探讨及评价生物补片法阴道成形术的手术疗效及临床结局。方法选自2006～2011年北京协和医院应用生物材料人工脱细胞真皮(acelluar dermal matrix allograft,ADM)]人工阴道成形术的MRKH综合征患者53例,进行术后随访,以及术后随诊超过6月的患者采用女性性功能指数(female sexual function index,FSFI)问卷来了解性生活情况。对照组选择同期健康体检、年龄因素匹配的患者进行FSFI问卷。结果采用Mann-Whitney U检验统计分析。结果 53例患者均没有出现膀胱或直肠损伤、盆腔血肿等并发症,术后随诊时间为(21.1±10.4)月。术后3月的解剖学成功率为100%。功能学评价方面,所有患者对自身体像满意。术后有性生活者32例进行FSFI问卷,MRKH患者FSFI总分为(26.7±3.9),在性欲、性唤起、湿润感、性高潮、性生活满意度、疼痛感这些方面的分值,与正常对照组比较均没有统计学差异(24.6±9.3),P>0.05]。结论生物补片法人工阴道成形术手术简便易行,安全有效,值得推广

The anatomic and sexual outcomes in patients with MRKH system undergone vaginoplasty using tissue - engineered biomaterial mesh

Objective To evaluate the anatomic and sexual outcomes in patients undergoing vaginoplasty using tissue- engineered biomaterial mesh. Methods This prospective study included 53 patients with Mayer - Rokitansky- Ktister- Hauser （MRKH） syndrome admitted to Peking Union Medical College Hospital. Patients underwent vaginoplasty with tissue - engineered biological material （ acellular dermal matrix）. Follow - up wasperformed at 4 weeks, 12 weeks, 6 months, and then yearly. The other age -matched women who underwent heahh examinations during the same time period were selected as a health control group and answered Female Sexual Function Index （FSFI） questionnaires for the purpose of comparing sexuality. Anatomic success was defined by a vaginal length~〉8 cm and a width allowing the easy introduction of two fingers. Sexual outcomes were assessed at the 6 - month follow - up according to body image perception and FSFI questionnaires validated for the Chinese speaking population. Results No severe intra - operative complications occurred. No mesh - related infection, rejeetion, or detachment was recorded. During a mean follow - up of （21.1 ± 10. 4） months, the anatomic success rate was 100%, and all of the patients were satisfied with their body image. Among the 15 patients （44%） who answered the FSFI questionnaire, the mean total FSFI score was （26. 7 ± 3.9 ）, which was similar to that of the control gronp （24. 6 ±9.3）, P =0. 65）]. The similarity was also observed in six separate domains of the functional aspect of female sexuality. Conclusion Vaginoplasty with tissue - engineered hiomaterial mesh is a safe, effective, minimally invasive cosmetic procedure that provides near normal sexual function for patients with vaginal aplasia.