单孔腹腔镜联合阴道造穴乙状结肠代阴道成形术治疗先天性无阴道患者的可行性研究
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摘要
目的:探讨单孔腹腔镜联合阴道造穴乙状结肠代阴道成形术治疗先天性无阴道(MRKH综合征)患者的临床可行性。方法:回顾性分析河北医科大学第二医院2007年1月至2017年12月接受腹腔镜下乙状结肠代阴道成形术治疗MRKH综合征患者65例,其中单孔腹腔镜联合阴道造穴乙状结肠代阴道成形术37例(单孔腹腔镜组),腹腔镜下乙状结肠代阴道成形术28例(传统腹腔镜组)。比较两组患者术中、术后情况,并采用女性性功能量表(FSFI评分)对性生活质量进行调查分析。结果:单孔腹腔镜组的手术时间低于传统腹腔镜组,差异有统计学意义(P<0.05);术中出血量、术后住院时间、术后排气时间、术后并发症比较,差异无统计学意义(P>0.05)。两组的FSFI评分满意率比较,差异无统计学意义(P>0.05)。结论:单孔腹腔镜联合阴道造穴乙状结肠代阴道成形术是安全可行的,手术时间较传统腹腔镜短。
Objective:To investigate the clinical feasibility of transumbilical laparoendoscopic single-site surgery combined with vaginal cavitation in sigmoid colon vaginoplasty in the treatment of MRKH syndrome.Methods:The total of 65 patients with MRKH syndrome,who had accepted laparoendoscopic sigmoid colon vaginoplasty from January 2007 to December 2017 were enrolled.The clinical documents of trans-umbilical laparoendoscopic single-site combined with vaginal cavitation in sigmoid colon vaginoplasty(group A,n=37) and conventional laparoscopic sigmoid colon vaginoplasty(group B,n=28) were retrospectively analyzed.The intraoperative and postoperative conditions in both groups were compared.The female sexual function scale(FSFI score) was used to investigate and analyze the quality of sexual life.Results:The operation time of group A was shorter than that of group B.The difference was statistically significant(P<0.05).No significant difference was detectedin blood loss,hospital stay after operation or postoperative complications between the two groups(P>0.05).There was no significant difference in FSFI score between the two groups(P>0.05).Conclusions:The transumbilical laparoendoscopic single-site surgery combined with vaginal cavitation sigmoid colon vaginoplasty is feasible and safe.The operation time could be shorter compared with conventional surgery.
Objective:To investigate the clinical feasibility of transumbilical laparoendoscopic single-site surgery combined with vaginal cavitation in sigmoid colon vaginoplasty in the treatment of MRKH syndrome.Methods:The total of 65 patients with MRKH syndrome,who had accepted laparoendoscopic sigmoid colon vaginoplasty from January 2007 to December 2017 were enrolled.The clinical documents of trans-umbilical laparoendoscopic single-site combined with vaginal cavitation in sigmoid colon vaginoplasty(group A,n=37) and conventional laparoscopic sigmoid colon vaginoplasty(group B,n=28) were retrospectively analyzed.The intraoperative and postoperative conditions in both groups were compared.The female sexual function scale(FSFI score) was used to investigate and analyze the quality of sexual life.Results:The operation time of group A was shorter than that of group B.The difference was statistically significant(P<0.05).No significant difference was detectedin blood loss,hospital stay after operation or postoperative complications between the two groups(P>0.05).There was no significant difference in FSFI score between the two groups(P>0.05).Conclusions:The transumbilical laparoendoscopic single-site surgery combined with vaginal cavitation sigmoid colon vaginoplasty is feasible and safe.The operation time could be shorter compared with conventional surgery.
引文
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[12] Song T,Kim TJ,Lee YY,et al.What is the learning curve for single-port access laparoscopic-assisted vaginal hysterectomy[J].Eur J Obstet Gynecol Reprod Biol,2011,158(1):93-96.
[13] Yang L,Gao J,Zeng L,et al.Systematic review and Meta-analysis of single-port versus conventional laparoscopic hysterectomy[J].Int J Gynaecol Obstet,2016,133(1):9-16.
[14] Sandberg EM,la Chapelle CF,van den Tweel MM,et al.Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy:a systematic review and Meta-analysis[J].Arch Gynecol Obstet,2017,295(5):1089-1103.
[15] Fanfani F,Rossitto C,Gagliardi ML,et al.Total laparoendoscopic single-site surgery(LESS)hysterectomy in low-risk early Endometrial cancer:a pilot study[J].Surgical Endoscopy,2012,26(1):41-65.
[16] Boruta DM,Fagotti A,Bradford LS,et al.Laparoendoscopic single-site radical hysterectomy with pelvic lymphadenectomy:initial multi-institutional experience for treatment of invasive cervical cancer[J].J Minim Invasive Gynecol,2013,21(3):394-398.
[17] Park JY,Kim DY,Suh DS,et al.Laparoendoscopic single site versus conventional laparoscopic surgical staging for early-stage endometrial cancer[J].Int J Gynecol Cancer,2014,24(2):358-363.
[2] 刘海元,孙大为,等.《妇科单孔腔镜手术技术专家共识》解读[J/CD].中华腔镜外科杂志(电子版),2017,10(1):1-6.
[3] 中国医师协会妇产科分会妇科单孔腹腔镜手术(包括NOTES)专家技术协作组.中国大陆妇科单孔腹腔镜及NOTES手术的探索发展及现状[J/CD].中华腔镜外科杂志(电子版),2018,11(1):1-3.
[4] Bean EJ,Mazur T,Robinson AD.Mayer-Rokitansky-Küster-Hauser syndrome:sexuality,psychological effects,and quality of life[J].J Pediatr Adolesc Gynecol,2009,22(6):339-346.
[5] ACOG Committee Opinion No.728:Mullerian Agenesis:Diagnosis,management,and treatment[J].Obstet Gynecol,2018,131(1):35-42.
[6] Lambert AE,Mukati M,Shobeiri SA.Metastatic cancer in sigmoid neovagina:a case report[J].Female Pelvic Med Reconstr Surg,2013,19(1):56-57.
[7] 张大伟,张军,王焕英,等.腹腔镜带血管蒂回肠与乙状结肠移植阴道成形术的比较研究[J].中华妇产科杂志,2014,49(3):172-175.
[8] Moulton L,Jernigan AM,Carr C,et al.Single port laparoscopy in gynecologic oncology:seven years of experience at a single institution[J].American Journal of Obstetrics & Gynecology,2017,217(5):1-8.
[9] Wheeless CR Jr.A rapid,inexpensive,and effective method of surgical sterilization by laparoscopy[J].J Reproduct Med,1969,3(5):65-69.
[10] Dursun P,Gülümser C,Caglar M,et al.Laparoendoscopic single-site surgery for acute adnexal pathology during pregnancy:preliminary experience[J].J Matern Fetal Neonatal Med,2013,26(13):1282-1286.
[11] Gasparri ML,Mueller MD,Taghavi K,et al.Conventional versus single port laparoscopy for the surgical treatment of ectopic pregnancy:a Meta-analysis[J].Gynecol Obstet Invest,2018,83(4):329-337.
[12] Song T,Kim TJ,Lee YY,et al.What is the learning curve for single-port access laparoscopic-assisted vaginal hysterectomy[J].Eur J Obstet Gynecol Reprod Biol,2011,158(1):93-96.
[13] Yang L,Gao J,Zeng L,et al.Systematic review and Meta-analysis of single-port versus conventional laparoscopic hysterectomy[J].Int J Gynaecol Obstet,2016,133(1):9-16.
[14] Sandberg EM,la Chapelle CF,van den Tweel MM,et al.Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy:a systematic review and Meta-analysis[J].Arch Gynecol Obstet,2017,295(5):1089-1103.
[15] Fanfani F,Rossitto C,Gagliardi ML,et al.Total laparoendoscopic single-site surgery(LESS)hysterectomy in low-risk early Endometrial cancer:a pilot study[J].Surgical Endoscopy,2012,26(1):41-65.
[16] Boruta DM,Fagotti A,Bradford LS,et al.Laparoendoscopic single-site radical hysterectomy with pelvic lymphadenectomy:initial multi-institutional experience for treatment of invasive cervical cancer[J].J Minim Invasive Gynecol,2013,21(3):394-398.
[17] Park JY,Kim DY,Suh DS,et al.Laparoendoscopic single site versus conventional laparoscopic surgical staging for early-stage endometrial cancer[J].Int J Gynecol Cancer,2014,24(2):358-363.