腹壁悬吊式腹腔镜辅助乙状结肠阴道成形术在治疗先天无阴道的临床应用

目的通过气腹腹腔镜和腹壁悬吊式腹腔镜2种条件下进行乙状结肠阴道成形术的对比研究,评价腹壁悬吊式腹腔镜辅助乙状结肠阴道成形术的安全性和可行性。方法对83例先天性无阴道女性实施腹腔镜乙状结肠阴道成形术,其中悬吊组31例,气腹组52例,比较2组手术时间、术中出血量和术后肛门排气时间。结果全部手术均成功,无中转开腹病例。悬吊组手术时间（151.0±26.6）min,较气腹组（170.2±32.1）min明显缩短（t=2.806,P=0.006）;悬吊组术中出血量（94.5±46.5）ml,较气腹组（127.1±76.0）ml明显减少（t=2.157,P=0.034）;悬吊组术后肛门排气时间为（2.5±0.7）d,与气腹组（2.3±0.7）d无统计学意义（t=-1.259,P=0.212）。结论腹壁悬吊式腹腔镜辅助乙状结肠阴道成形术在手术通路的建立、腹腔内外操作的转换以及腹腔镜监视下完成阴道造穴全过程等方面较气腹腹腔镜有明显的优势,使手术变得更安全、更简捷。

Abdominal Wall Lifting in Laparoscopic-assisted Sigmoid Colon Vaginoplasty for Congenital Absence of the Vagina

Objective To investigate the feasibility,safety,and effectiveness of laparoscopic-assisted sigmoid colon vaginoplasty with abdominal wall lifting for congenital absence of the vagina.Methods We performed laparoscopic-assisted sigmoid colon vaginoplasty in 83 patients,among which abdominal wall lifting was used in 31 cases,and pneumoperitoneum was employed in 52 patients.The operation time,bloods loss and evacuation time after the surgery were recorded and compared between the two groups.Results The operations were successfully completed in both the groups.No patient was converted to open surgery.The mean operation time in the abdominal wall lifting group was significantly shorter than that in the pneumoperitoneum group [（151.0±26.6）min vs.（170.2±32.1）min;t=2.806,P=0.006] and the blood loss of the abdominal wall lifting group was significantly less than that in the pneumoperitoneum group [（94.5±46.5）ml vs.（127.1±76.0）ml;t=2.424,P=0.018].The evacuation time in the abdominal wall lifting group was（2.5±0.7）days,which was similar to that in the pneumoperitoneum group [（2.3±0.7）days,t=-1.259,P=0.212].Conclusions Laparoscopic-assisted sigmoid colon vaginoplasty with abdominal wall lifting is superior to pneumoperitoneum in surgery channel building,procedure transformation between extra-and intra-abdominal spaces.It is an effective approach for women with congenital absence of the vagina.