摘要
目的探讨提高阴股沟皮瓣再造阴道的成功率、降低血循环障碍的可能性、避免大阴唇和阴道口明显畸形的治疗方法。方法1998年6月-2004年5月共收治15例患者行阴道再造术。其中男性易性癖2例;女性先天性无阴道13例。年龄23～31岁,平均26.2岁。术前以超声多普勒血流探测仪探及阴道与肛门间水平距中线约3cm处的动脉音,以腹股沟为轴在大阴唇外侧设计大小为12.0cm×5.5cm皮瓣,使动脉穿支位于皮瓣的内下角,皮瓣掀起后在蒂部行部分横断,以利皮瓣移位。造穴后将皮瓣引入形成阴道衬里,蒂部适当修整,对位缝合形成阴道外口。供区直接缝合。结果再造阴道后皮瓣全部成活。14例伤口Ⅰ期愈合;1例男性患者术后阴道后壁近顶部伤口裂开约2cm,对症处理后愈合。供区均Ⅰ期愈合。患者均获随访,随访时间6个月～3年。再造阴道深度可达10cm左右,宽度能容纳2指。1例女性患者术后20个月发现阴道内毛发较为茂密,未行处理。其余患者阴道内壁光滑完整。2例女性患者自述有性生活,应用润滑剂后比较满意。结论经改良的阴股沟皮瓣血运可靠,用于阴道再造时移位方便,阴道口外形满意。
Objective To increase the success rate of vaginal reconstruction with pudendal-thigh flap, reduce the chance ofhemocirculatory disorder and relieve the deformity of greater lip of pudendum and vaginal orifice. Methods From June 1998 to May 2004, 15 patients, 2 males with transsexualism and 13 females with vaginal absence, aged 23-31 years old （26.2 on average）, received vaginal reconstruction. Arterial perforator was detected at 3 cm laterally away from the mid-point between the vaginal orifice and the anus. The flap of 12.0 cm × 5.5 cm was designed at the lateral of the greater lip of pudendum, with the groin as the axis. After the flap was elevated beneath the deep fascia, the fascial pedicle was partially severed from lateral to medium, keeping the perforator intact into the flap. Then the flap was transferred through the tunnel to the socket. The inner layer and the orifice were formed. Results All flaps survived, and the contour of the vulva was satisfactory. Among the 15 patients, 14 patients＇ incisions obtained healing by first intention, and only 1 male with transsexualism was discovered to suffer from rectovaginal fistula at the remote juncture of the two flaps at 7 days after the operation. By taking out all the gauze and cleaning the feces, the fistula healed automatically. All patients were followed up for 6 months-3 years. The reconstructed vagina was about 10 cm deep and 2 fingers wide. One female＇s vagina was found pilous at 20 months after the operation, and no special treatment was given. The other patients＇ vaginal inner walls were smooth and complete. Two female patients had the experience of sexual intercourse and felt satisfied after using lubricant. Conclusion The modified pudendal-thigh flap has reliable blood supply and makes the transferring during vaginal reconstruction more convenient and the contour of the vulva more satisfactory.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2008年第12期1415-1417,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
阴股沟皮瓣
改良
穿支动脉
阴道再造
Pudendal-thigh flap Modified Arterial perforator Vaginal reconstruction
