部分小阴唇皮瓣和阴股局部皮瓣网状移植人工阴道及宫颈成形术治疗先天性宫颈闭锁合并阴道完全闭锁的远期效果评价

发布时间：2018-03-03 01:16

本文选题：宫颈闭锁　切入点：阴道闭锁　出处：《安徽医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:评价部分小阴唇皮瓣和阴股局部皮瓣网状移植人工阴道及宫颈成形术后远期效果。方法:回顾性分析1984年3月至2015年8月期间,在阜阳市人民医院就诊的先天性宫颈闭锁合并阴道完全闭锁患者的临床资料。以施行部分小阴唇皮瓣以及阴股局部皮瓣网状移植人工阴道及宫颈成形术的先天性宫颈闭锁合并阴道完全闭锁患者为研究对象,分析两种术式的手术情况,随访患者术后至今的人工阴道及宫颈的解剖情况、并发症及生育情况,同时选用FSFI量表和SF-36健康调查表,通过电话随访评价患者术后性功能状态、生活质量。同时随机选择年龄匹配的健康有性生活的妇女作为对照组研究对象。结果:1.先天性宫颈闭锁合并阴道完全闭锁患者共20例,11例患者同意施行部分小阴唇皮瓣网状移植人工阴道及宫颈成形术(A组),9例患者接受阴股局部皮瓣网状移植人工阴道及宫颈成形术(B组)。2.术后随访结果:(1)解剖:A组患者人工阴道长8cm-11cm,平均9.20cm±1.21cm,宽约3cm;B组患者人工阴道长约8cm-10cm,平均9.12cm±1.60cm,宽约3cm。(2)性功能:A组、B组和对照组在FSFI总分以及性兴趣、性唤起、阴道润滑、性高潮、性满意度、性交痛6个方面,三者之间相互比较,P值均大于0.05,差异无统计学意义。(3)生活质量:A组、B组以及对照组在心理健康这个维度上有显著性差异,其中A组和对照组,B组和对照组之间相比较有显著性差异,而A组和B组之间P0.05,无显著性差异。而在sf-36其他七个维度方面,三组之间无显著性差异。4.5例患者自然受孕成功,均在孕37周前后行剖宫产,子女体健,尚未发现畸形者。1例患者在孕3个月先后经历2次自然流产。剩余部分患者因未到生育阶段故需继续随访。结论:部分小阴唇皮瓣和阴股局部皮瓣网状移植人工阴道及宫颈成形术操作简单、手术损伤小,并发症少,且能达到解剖学成功与正常女性的性功能状态。并且,两种手术对患者生活质量影响不大,但手术是否影响精神健康需进一步研究。因手术例数有限,有待于更大样本的支持。
[Abstract]:Objective: to evaluate the long-term effects of partial labial labia flap and local clavicular flap on artificial vagina and cervicoplasty. Methods: the period from March 1984 to August 2015 was retrospectively analyzed. Clinical data of patients with congenital cervix atresia combined with complete vaginal atresia in Fuyang people's Hospital. Cervical atresia with complete vaginal atresia was studied. The anatomic status, complications and fertility of the artificial vagina and cervix were analyzed. FSFI scale and SF-36 health questionnaire were used to evaluate the sexual function of the patients by telephone follow-up. Quality of life. At the same time, healthy and sexually active women matched with age were randomly selected as control group. Results 1. 20 patients with congenital cervix atresia and complete vaginal atresia were selected as control group. A total of 11 patients with congenital cervix atresia and complete vaginal atresia agreed to take part of small yin. Labial flap mesh graft artificial vagina and cervicoplasty group A (n = 9) received vaginal graft with vaginal local flap and cervicoplasty group B (n = 2). Follow-up results showed that the length of artificial vagina in group A was 8 cm ~ 11 cm (mean 9.20 cm 卤1.21 cm), and that in group A was 8 cm ~ 11 cm (mean, 9.20 cm 卤1.21 cm). The length of artificial vagina in group B was about 8 cm to 10 cm (mean 9.12 cm 卤1.60 cm, width about 3 cm. 2) the total score of FSFI and sexual interest in group B and control group were 3 cm to 10 cm, respectively. Sexual arousal, vaginal lubrication, orgasm, sexual satisfaction, intercourse pain, There were significant differences in the dimension of mental health between group A and group B and control group. There was significant difference between group A and control group B and control group, but there was no significant difference between group A and group B. in the other seven dimensions of sf-36, there was no significant difference among the three groups. All of them underwent cesarean section before and after 37 weeks of gestation, and their children were in good health. In the third month of pregnancy, 1 cases of deformities had experienced 2 spontaneous abortions. The rest of the patients needed to be followed up because they had not reached the reproductive stage. Conclusion: partial labial labia flap and local skin flap of vulva and femoris are artificial grafts. Vaginal and cervical angioplasty is simple, The surgical injury is small, the complication is few, and can achieve the anatomical success and the normal female sexual function state. Moreover, the two kinds of surgery have little influence on the patient's quality of life, but whether the operation affects the mental health needs further study. Support is expected from a larger sample.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R713

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