前庭黏膜聯(lián)合陰股帶蒂皮瓣移植治療先天性陰道閉鎖患者性生活質(zhì)量的研究

葉暉 劉燕 程英祝

【摘要】目的：探討前庭黏膜聯(lián)合陰股帶蒂皮瓣移植治療先天性陰道閉鎖臨床價(jià)值，并分析其對(duì)患者術(shù)后性生活質(zhì)量的影響。方法：選擇2010年1月至2015年2月我院收治的先天性陰道閉鎖患者80例，按照隨機(jī)數(shù)字法分為兩組，各40例，觀察組進(jìn)行前庭黏膜聯(lián)合陰股帶蒂皮瓣移植，對(duì)照組使用單純游離皮片移植治療，選擇大腿內(nèi)側(cè)皮片進(jìn)行移植。比較兩組術(shù)后1個(gè)月和6個(gè)月時(shí)陰道長(zhǎng)度、寬度，術(shù)后瘢痕形成影響美觀、毛發(fā)生長(zhǎng)及性交無(wú)分泌物情況、性功能質(zhì)量，及術(shù)后使用模具時(shí)間及開(kāi)始性生活時(shí)間。結(jié)果：觀察組術(shù)后1個(gè)月和術(shù)后6個(gè)月其陰道長(zhǎng)度均長(zhǎng)于對(duì)照組相應(yīng)時(shí)間（P<0.05），寬度則寬于對(duì)照組相應(yīng)時(shí)間（P<0.05），觀察組瘢痕形成影響美觀、毛發(fā)生長(zhǎng)及性交無(wú)或少分泌物的比例顯著少于對(duì)照組（P<0.05），觀察組性欲望、性興奮、性高潮、疼痛、陰道潮濕和性滿意度6項(xiàng)得分均顯著高于對(duì)照組（P<0.05），觀察組總分高于對(duì)照組（P<0.05），觀察組術(shù)后使用模具時(shí)間短于對(duì)照組，開(kāi)始性生活時(shí)間早于對(duì)照組（P<0.05）。結(jié)論：前庭黏膜聯(lián)合陰股帶蒂皮瓣移植治療先天性陰道閉鎖術(shù)后恢復(fù)快，手術(shù)并發(fā)癥少，能顯著改善患者術(shù)后性功能，提高生活質(zhì)量。

【關(guān)鍵詞】前庭黏膜；陰股帶蒂皮瓣移植；先天性陰道閉鎖

Clinical value of vestibular mucosa combined with shares pedicle flap pedicle for congenital vaginal atresiaYE Hui， LIU Yan， CHENG Yingzhu. Department of Obstetrics，Baoji City Traditional Chinese Medicine Hospital， Baoji 721001， Shaanxi， China

【Abstract】Objectives： To investigate the clinical value of vestibular mucosa combined with shares pedicle flap pedicle for congenital vaginal atresia. Methods： 80 patients with congenital vaginal atresia from January 2010 to February 2015 in our hospital were chosen and randomly divided into two groups， each of 40 cases. The observation group received vestibular mucosa combined with shares pedicle flap pedicle， and the control group received free skin graft treatment. Postoperative vaginal length， width， scar formation， appearance， hair growth and secretions， the quality of sexual function and postoperative period using a mold and beginning sexual life 1 month and 6 months after treatment were compared. Results： The vaginal length and width of observation group 1 month and 6 months after was longer and wider than control group respectively （P<0.05）. The incidence of scarring affecting appearance， hair growth and secretions in observation group was significantly less than control group （P<0.05）. The scores of sexual desire， sexual arousal， orgasm， pain， vaginal moisture and sexual satisfaction in observation group were significantly higher than control group （P<0.05）， so as the total score （P<0.05）. The time of using mold was shorter than control group， and that of starting having sex was earlier than control group （P<0.05）. Conclusions： Vestibular mucosa combined with shares pedicle flap pedicle for congenital vaginal atresia has rapid recovery and fewer complications， which can significantly improve postoperative sexual function and quality of life.

【Key words】Vestibular mucosa； Shares pedicle flap pedicle； Congenital vaginal atresia

【中圖分類號(hào)】R713.3【文獻(xiàn)標(biāo)志碼】A

先天性的陰道發(fā)育異常，尤其是陰道閉鎖，發(fā)病率雖然較低，但其嚴(yán)重影響患者生活質(zhì)量，尤其是陰道閉鎖患者[1]，甚至因此而失去生育功能，給患者及其家庭帶來(lái)巨大生理與心理壓力，成為影響社會(huì)和諧的因素之一[2]。針對(duì)陰道閉鎖患者手術(shù)治療方法多樣，不同術(shù)式將產(chǎn)生不同治療效果，且對(duì)患者術(shù)后性生活質(zhì)量產(chǎn)生影響。陰道前庭黏膜含有的前庭球可以感受心理和局部的刺激及來(lái)自陰蒂刺激產(chǎn)生的連鎖反應(yīng)，出現(xiàn)充血隆起等性興奮表現(xiàn)[3]。前庭大腺則在性興奮時(shí)分泌黃白色液體，起到滑潤(rùn)作用[4]。且前庭黏膜組織結(jié)構(gòu)與陰道黏膜相同，已經(jīng)成為人工陰道造成移植的首選移植物。……