【摘要】：目的探討在口腔黏膜及自體皮膚混合微粒移植基礎(chǔ)上聯(lián)合脫細(xì)胞同種異體真皮再造陰道的療效。方法 2006年7月-2013年6月,收治67例先天性無陰道患者。其中47例采用單純口腔黏膜及自體皮膚混合微粒(對照組)再造陰道,20例聯(lián)合脫細(xì)胞同種異體真皮(試驗組)。兩組患者年齡比較差異無統(tǒng)計學(xué)意義(t=0.233,P=0.816)。比較兩組再造陰道深度、周徑、容積,創(chuàng)面上皮化時間及脫離模具時間,以及術(shù)后有性生活患者的女性性功能量表(FSFI)評分。結(jié)果兩組手術(shù)時間、術(shù)中出血量比較,差異均無統(tǒng)計學(xué)意義(t=—1.922,P=0.059;t=0.398,P=0.692)。兩組患者術(shù)后均獲隨訪,隨訪時間11~38個月,平均16.08個月;其中試驗組15例、對照組29例有性生活。對照組4例、試驗組2例出現(xiàn)術(shù)后出血,但再造陰道未出現(xiàn)狹窄。兩組創(chuàng)面上皮化時間比較,差異無統(tǒng)計學(xué)意義(t=—1.938,P=0.057),但試驗組術(shù)后脫離模具時間顯著短于對照組(t=7.020,P=0.000)。隨訪觀察見再造陰道濕潤、光滑、富有彈性,內(nèi)無毛發(fā)生長。末次隨訪時,兩組再造陰道深度、周徑及容積比較,差異均無統(tǒng)計學(xué)意義(P0.05)。除對照組1例患者FSFI評分23分、診斷為性功能不良外,其余患者性功能均正常。兩組FSFI評分以及各項評分比較,差異均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論在口腔黏膜及自體皮膚混合微粒移植基礎(chǔ)上聯(lián)合脫細(xì)胞同種異體真皮再造陰道,具有創(chuàng)傷小、外觀及性功能恢復(fù)正常,且口腔供區(qū)無破壞的優(yōu)點。脫細(xì)胞同種異體真皮能提供可靠支架結(jié)構(gòu),有效抵抗腔穴攣縮,彌補(bǔ)了混合微粒再造術(shù)后需長期佩戴模具的不足。
[Abstract]:Objective to investigate the effect of combined acellular dermal allograft for vaginal reconstruction on the basis of oral mucosal and autologous skin mixed micrografts. Methods from July 2006 to June 2013, 67 patients with congenital absence of vagina were treated. Among them, 47 cases were reconstructed vagina with oral mucous membrane and autogenous skin mixed particles (control group), and 20 cases were combined with acellular allogenic dermis (experimental group). There was no significant difference in age between the two groups (t = 0.233, P = 0.816). The depth, circumference, volume, wound epithelization time and time of detaching mould of the reconstructed vagina were compared between the two groups, and the female sexual function scale (FSFI) score of the patients with sexual life after operation was compared. Results there was no significant difference in the time of operation and the amount of blood loss between the two groups (t = -1.922, P = 0.059, P ~ (0.692). The two groups were followed up for 11 ~ 38 months with an average of 16.08 months, including 15 cases in the experimental group and 29 cases in the control group. There were 4 cases in the control group and 2 cases in the experimental group, but no stenosis was found in the reconstructed vagina. There was no significant difference in wound epithelialization time between the two groups (t _ (1.938) P _ (0.057), but the time of mold detachment in the experimental group was significantly shorter than that in the control group (t _ (7.020) P ~ (+) ~ (0.000). It was observed that the reconstituted vagina was moist, smooth, elastic and hairless. At the last follow-up, there was no significant difference in the depth, circumference and volume of reconstructed vagina between the two groups (P0.05). The sexual function was normal except for the 23 points of FSFI score of 1 patient in the control group and the diagnosis of sexual dysfunction. There was no significant difference in FSFI scores and scores between the two groups (P0.05). Conclusion on the basis of oral mucous membrane and autogenous skin mixed microparticle transplantation combined with acellular allogenic dermis to reconstruct vagina has the advantages of less trauma normal appearance and sexual function and no damage to oral donor area. Acellular allogeneic dermis can provide reliable scaffold structure, effectively resist the contracture of cavities, and make up for the shortage of long-term wear mould after mixed particle reconstruction.
【作者單位】： 中國協(xié)和醫(yī)科大學(xué)中國醫(yī)學(xué)科學(xué)院整形外科醫(yī)院整形十科;
【分類號】：R713.3

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本文編號：2417400