以膠原蛋白生物工程海綿為支架的自體微粒皮復合口腔黏膜移植在陰道狹窄再造中的應用

楊宇 仇雄文 丁力 鄭清健 莊兢

[摘要]目的：探討以膠原蛋白生物工程海綿為支架的自體微粒皮復合口腔黏膜移植在陰道狹窄再造中的應用效果。方法：在陰道狹窄患者尿道與直腸之間形成腔穴并止血，取頰部口腔黏膜，在大小陰唇交界處取游離皮片，將兩者形成微粒并混合，采用陰道軟性模具，將混合組織鋪在膠原蛋白生物工程海綿上，并緊貼于再造的陰道腔穴內側壁上，碘仿紗條填塞固定6d后取出軟質模具，更換成硬質模具并每日進行陰道沖洗，術后繼續佩戴硬質模具6～12個月。結果：本組8例陰道狹窄患者經過術后6個月～3年的定期隨訪，并進行病理學復查，效果良好，再造陰道愈合迅速，且不易破損，不影響日常生活與工作。結論：應用以膠原蛋白生物工程海綿為支架的自體微粒皮復合口腔黏膜的游離移植進行陰道再造，方法新穎，術后創傷較小，效果良好，值得臨床推廣應用。

[關鍵詞]陰道狹窄；微粒皮；口腔黏膜；膠原蛋白生物工程海綿

[中圖分類號]R622 [文獻標志碼]A [文章編號]1008-6455（2018）05-0049-03

The Application of Grafting Autologous Granular Skin Mixed with Oral Mucosa and Placed on a Collagen Sponge in Reconstruction Surgery Treating Vaginal Stenosis

YANG Yu，QIU Xiong-wen，DING Li，ZHENG Qing-jian，ZHUANG Jing

（Department of Plastic Surgery， Fujian Province Hospital，Fuzhou 350001，Fujian，China）

Abstract： Objective This essay is aimed to explore the application effect of grafting autologous granular skin which is mixed with oral mucosa and placed on a collagen sponge in reconstruction surgery treating vaginal stenosis. Methods By using conventional method， a cavity linking to cervix was formed between urethra and rectum. Mixed suspension of granular tissues， which was made of oral mucosa acquired from buccal division along with autologous granular skin obtained from the junction of labia minora and labia majora， was placed on collagen sponge by using self-made soft mold. Then the soft mold was putted into the reconstructed vaginal cavity， clinging to the medial wall and being fixed by filling iodoform gauzes into the cavity. Six days thereafter， the soft mold was taken away from the vaginal cavity and replaced by a hard mold which will remain in the cavity for six to twelve months with daily vaginal douching after surgery. Results 8 cases of vaginal stenosis were followed up for six months to three years after surgery. The results of pathological review prove that satisfied effects have been achieved. The reconstructed vaginas have healed quickly and are not easy to be torn. The daily life and work of the patients will not be affected by the operation. Conclusion The free graft of autologous granular skin which is mixed with oral mucosa and placed on a collagen sponge is a novel method in reconstruction surgery treating vaginal stenosis. It leads to better results with less wound， and is worth of extension.

Key words： vaginal stenosis； granular skin； oral mucosa； collagen sponge

在臨床工作中，時常遇到因陰道狹窄，無法進行正常夫妻生活的患者，為了正常的婚姻生活，她們往往迫切希望進行陰道再造。如果這些患者的子宮、卵巢等發育正常，是可以進行正常的孕育過程而享受天倫之樂的，如何采用最小的代價重建與生理狀態相似的陰道，并盡力保護患者隱私，是整形外科醫師關注的一個富有挑戰性的課題。