会阴体重建阴道紧缩术临床应用研究.docVIP

会阴体重建阴道紧缩术临床应用研究[摘要]目的：分析会阴体重建阴道紧缩术的方法及临床作用。方法：手术采用阴道口入路，立体分段缝合、紧缩盆底肌相关段、重建会阴体结构。术后10天拆线、2月后开始性生活。结果：自2006年8月～2008年7月，应用本文术式完成治疗阴道松弛患者 92 例，无血肿及感染等临床并发症，伤口愈合良好。随访41例，最短者术后9个月，最长者术后16个月。均述肛缩有力，阴道收缩能力、阴道壁张力增强，性生活质量明显提高。结论：应用会阴体重建阴道紧缩术治疗产后会阴体损伤、阴道松弛，针对性强，设计合理，操作简便，效果明显。 [关键词]会阴体；阴道松弛；阴道紧缩术 [中图分类号]R713.3[文献标识码]A[文章编号]1008-6455（2008）10-1441-03 Analyzingtheapplication ofperinealbodyreconstructiontorepairvaginalrelaxation ZHOU Chuan-de,LI Qiang,TANG Yong,CHEN Wen,LI Feng-yong,YANG Zhe,LI Yang-qun (The Tenth Plastic Department of Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China) Abstract:ObjectiveAnalyzing the method and effectiveness of perineal body reconstruction to repair vaginal relaxation.MethodsWe took incision at the vaginal orifice, sutured different layers in three-dimension to tighten the relative muscles which formed pelvic floor and reconstructed perineal body. Stiches were taken out 10 days after operation, and sexual life was restored 2 months later.ResultsFrom Aug.2006 to Jul.2008, 92 cases were repaired by our method. All the incisions healed without any hematoma and infection. 41 patients were followed up (ranged from 9 months to 16 months), and they all described the stronger contraction force of anus and vagina and were all satisfied with their sexual lives. Conclusions Perineal body reconstruction is a direct, feasible and simple approach to repair the injuried perineal body and vaginal relaxation postpartum. Key words: perineal body; vaginal relaxation; vaginal contraction 女性会阴体位于肛门与阴道前庭后端之间，肛提肌及众多小块功能性肌肉均附着于此，具有加固盆底承托盆内脏器的作用，分娩时极易受损[1-2]；同时雌激素水平、受体下降也会导致盆底肌松弛[3]，乃至出现尿失禁、盆底器官膨出等症状。性生活质量显著下降是多数要求妇科整形患者的主诉之一。自2006年8月～2008年7月，我们对92例妇科整形患者实施了以会阴体重建为目的的阴道紧缩术。 1临床资料 1.1 一般资料：本组计92例，年龄26～54岁，平均40岁。89例为1～3胎阴道分娩，3例为人工流产。阴道分娩者78例行侧切，11例未经侧切，膀胱截石位会阴体临床形态检查发现，两者无显著差异。患者主要整形外科情况为：会阴区塌陷，阴道-会阴间直线距离缩短、前庭松散、凹向后下。阴道外段容3横指余，侧壁松弛，缩肛乏力；后壁分离形成沟隙，缩肛时显著，阴道壁主动、被动弹力下降。3例人工流产患者主要表现