Wang Yong,Liang Zijian,Chen Yunpei,et al.Clinical treatment of vaginal replacement with sigmoid colon in children[J].Journal of Clinical Pediatric Surgery,2019,18(07):583-587.[doi:10.3969/j.issn.1671-6353.2019.07.013]
乙状结肠重建阴道术治疗小儿阴道畸形的疗效分析
- Title:
- Clinical treatment of vaginal replacement with sigmoid colon in children
- Keywords:
- Urogenital Abnormalities; Surgery; Plastic
- 分类号:
- R729;R656.9;R699.7
- 摘要:
- 目的 探讨乙状结肠重建阴道术治疗小儿阴道畸形的可行性，并总结手术技巧及治疗经验。方法 回顾性分析2013-2017年在广州市妇女儿童医疗中心接受阴道重建术患儿的临床资料。其中一穴肛4例，先天型阴道闭锁1例。接受手术时年龄6个月至3岁10个月，体重6~20 kg。结果 一穴肛重建手术时间为265~510 min，术中出血量10~50 mL，重建阴道长度6~8 cm，术后患处可见少量分泌物，无异味、狭窄、脱垂，未见明显瘢痕组织。1例先天型阴道闭锁患儿手术时间为335 min，术后阴道伤口无异味、脱垂，稍狭窄，术后1个月出现盆腔积液，膀胱镜检查结果提示成形阴道愈合良好，子宫及阴道交界处可见脓性分泌物，诊断为肠道分泌物积聚，予以生理盐水冲洗，术后一年复查未见明显异常。结论 乙状结肠重建阴道术治疗小儿阴道畸形的术后并发症发生率低，治疗小儿阴道畸形安全、有效，但仍需大量的病例积累及长期随访研究。
- Abstract:
- Objective To explore the feasibility of vaginal reconstruction with sigmoid colon in children.Methods A total of five children underwent vaginoplasty during 2013-2017.The mean operative age was 21 months and the mean weight 13kg.The initial diagnosis was persistent cloaca (n=4) and congenital vaginal atresia (n=1).Surgery was performed via a simultaneous abdomino-perineal approach.Neovaginal cavity was dissected and sigmoid segment mobilized and transected down to the base of sigmoid arteries.The segment was guided in an iso-peristaltic way through a neovaginal tunnel on to perineum.Distal staple line was opened and sutured to perineum.Results In cloaca cases,operative duration was from 265 to 510 min and intraoperative blood loss 10 to 50 ml.Except for minimal secretion,there was no odor,stenosis or prolapse.Wound healing was excellent.There was no obvious scar tissue.Vaginal length for reconstruction was 6-8 cm.The operative duration of congenital vaginal atresia was 335 min.There was neither odor nor prolapse.Only mild stenosis was present.Pelvic effusion recurred at 1 month post-operation.Cystoscopy indicated an excellent healing of vaginal anastomosis.Suppurative secretion appeared at the junction of uterus and vagina.New vagina was flushed daily until a disappearance of pelvic fluid.Re-examination at 1 year revealed no obvious abnormality.Conclusion With a low incidence of complications,sigmoid colon reconstruction is both safe and effective for children with vaginal malformation.However,a large number of cases are required for long-term follow-up studies.
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备注/Memo
收稿日期:2018-12-15。
基金项目:诱导多能干细胞治疗肠道神经损伤的实验研究（编号：2017070010369）
通讯作者:王勇,Email:summer660@163.com