脱细胞同种异体真皮与口腔黏膜及自体皮肤混合微粒移植再造阴道

发布时间：2019-01-28 23:08

【摘要】：目的探讨在口腔黏膜及自体皮肤混合微粒移植基础上联合脱细胞同种异体真皮再造阴道的疗效。方法 2006年7月-2013年6月,收治67例先天性无阴道患者。其中47例采用单纯口腔黏膜及自体皮肤混合微粒(对照组)再造阴道,20例联合脱细胞同种异体真皮(试验组)。两组患者年龄比较差异无统计学意义(t=0.233,P=0.816)。比较两组再造阴道深度、周径、容积,创面上皮化时间及脱离模具时间,以及术后有性生活患者的女性性功能量表(FSFI)评分。结果两组手术时间、术中出血量比较,差异均无统计学意义(t=—1.922,P=0.059;t=0.398,P=0.692)。两组患者术后均获随访,随访时间11~38个月,平均16.08个月;其中试验组15例、对照组29例有性生活。对照组4例、试验组2例出现术后出血,但再造阴道未出现狭窄。两组创面上皮化时间比较,差异无统计学意义(t=—1.938,P=0.057),但试验组术后脱离模具时间显著短于对照组(t=7.020,P=0.000)。随访观察见再造阴道湿润、光滑、富有弹性,内无毛发生长。末次随访时,两组再造阴道深度、周径及容积比较,差异均无统计学意义(P0.05)。除对照组1例患者FSFI评分23分、诊断为性功能不良外,其余患者性功能均正常。两组FSFI评分以及各项评分比较,差异均无统计学意义(P0.05)。结论在口腔黏膜及自体皮肤混合微粒移植基础上联合脱细胞同种异体真皮再造阴道,具有创伤小、外观及性功能恢复正常,且口腔供区无破坏的优点。脱细胞同种异体真皮能提供可靠支架结构,有效抵抗腔穴挛缩,弥补了混合微粒再造术后需长期佩戴模具的不足。
[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.
【作者单位】：中国协和医科大学中国医学科学院整形外科医院整形十科;
【分类号】：R713.3

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