乙状结肠代阴道成形术后30年阴道侧旁脱垂一例

doi:10.12280/gjfckx.20250089

摘要/Abstract

摘要：

阴道闭锁是一种较为少见的先天性生殖道发育异常，为泌尿生殖窦未参与形成阴道下段所致。不同手术方式可能导致的并发症有所不同，国内外关于术后长期并发症及处理的相关文献报道较少。新疆维吾尔自治区人民医院收治了1例阴道闭锁Ⅱ型患者行保留子宫的乙状结肠代阴道成形术后30年阴道侧旁脱垂，经多学科团队讨论后行阴道成形术+腹腔镜下左侧卵巢囊肿剥除术，手术顺利，术后8个月患者随访效果好。通过该病例探讨生殖道畸形行乙状结肠代阴道成形术的长远期并发症，提高对该类患者的认识和诊治水平。

关键词: 阴道闭锁, 泌尿生殖系统畸形, 子宫脱垂, 手术后并发症, 乙状结肠代阴道成形术

Abstract:

Vaginal atresia is a relatively rare congenital malformation of the reproductive tract, which is caused by the failure of the urogenital sinus to participate in the formation of the lower segment of the vagina. Different surgical methods may lead to different complications, and there is limited long-term data on postoperative complications and management at home and abroad. A patient with type Ⅱ vaginal atresia who has undergone sigmoid colon vaginoplasty with uterine preservation was treated at the People′s Hospital of Xinjiang Uygur Autonomous Region. Thirty years after the surgery, the patients presented with paravaginal prolapse. After discussion by a multi-disciplinary team, the patient underwent vaginal reconstruction surgery and laparoscopic left ovarian cystectomy. The surgery was successful, and the patient had a good follow-up result 8 months after the surgery. This case aims to explore the long-term complications of sigmoid colon vaginoplasty for genital tract malformations and improve the understanding, diagnosis and treatment of such patients.

Key words: Vaginal atresia, Urogenital abnormalities, Uterine prolapse, Postoperative complications, Sigmoid colon vaginoplasty

米合日尼沙·买买提, 努尔古再丽·麦合木提, 木克代斯·买买提艾力. 乙状结肠代阴道成形术后30年阴道侧旁脱垂一例[J]. 国际妇产科学杂志, 2025, 52(4): 477-480.

Miherinisha·Maimaiti , Nuerguzaili·Maihemuti , Mukedaisi·Maimaitiaili . A Case of Paravaginal Prolapse 30 Years after Sigmoid Colon Vaginoplasty[J]. Journal of International Obstetrics and Gynecology, 2025, 52(4): 477-480.

图/表 3

图1 患者盆腔MRI图注：A 矢状位T2加权成像（T2 weighted imaging，T2WI）压脂像；B 矢状位T2WI未压脂像；箭头所示为阴道中段向下脱出的结肠代阴道及脂肪

图2 手术前及术中局部图注：A 脱出的结肠代阴道；B 术中见结肠脂肪；C 环形切除延长结肠后缝合；D 切除的结肠组织

图3 术后8个月随访局部图注：A 阴道形状；B 局部外观

参考文献 21

[1]	刘新民. 现代妇产科疾病诊断与治疗[M]. 北京: 人民卫生出版社, 2004:77-89.
[2]	朱兰, 郎景和, 宋磊, 等. 关于阴道斜隔综合征、MRKH综合征和阴道闭锁诊治的中国专家共识[J]. 中华妇产科杂志, 2018, 53(1):35-42. doi: 10.3760/cma.j.issn.0529-567x.2018.01.008.
[3]	Moegni F, Meutia AP, Kouwagam AD, et al. Secondary pyosalpinx after reconstructive surgery of vaginal agenesis patient with bilateral hematosalpinx: A case report[J]. Int J Surg Case Rep, 2021, 85:106166. doi: 10.1016/j.ijscr.2021.106166.
[4]	冷金花, 郎景和, 连利娟, 等. 阴道闭锁16例临床分析[J]. 中华妇产科杂志, 2002, 37(4):217-219.
[5]	Rink RC, Adams MC. Feminizing genitoplasty: state of the art[J]. World J Urol, 1998, 16(3):212-218. doi: 10.1007/s003450050055. pmid: 9666547
[6]	Burgu B, Duffy PG, Cuckow P, et al. Long-term outcome of vaginal reconstruction: comparing techniques and timing[J]. J Pediatr Urol, 2007, 3(4):316-320. doi: 10.1016/j.jpurol.2006.09.008. pmid: 18947763
[7]	王勇, 梁子建, 陈运培, 等. 乙状结肠重建阴道术治疗小儿阴道畸形的疗效分析[J]. 临床小儿外科杂志, 2019, 18(7):583-587. doi: 10.3969/j.issn.1671-6353.2019.07.013.
[8]	Ekinci S, Karnak I, Ciftci AO, et al. Sigmoid colon vaginoplasty in children[J]. Eur J Pediatr Surg, 2006, 16(3):182-187. doi: 10.1055/s-2006-924301. pmid: 16909357
[9]	O′Connor JL, DeMarco RT, Pope JC 4th, et al. Bowel vaginoplasty in children: a retrospective review[J]. J Pediatr Surg, 2004, 39(8):1205-1208. doi: 10.1016/j.jpedsurg.2004.04.003. pmid: 15300528
[10]	Bouman MB, van Zeijl MC, Buncamper ME, et al. Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function[J]. J Sex Med, 2014, 11(7):1835-1847. doi: 10.1111/jsm.12538.
[11]	Garcia-Roig M, Castellan M, Gonzalez J, et al. Sigmoid vaginoplasty with a modified single Monti tube: a pediatric case series[J]. J Urol, 2014, 191(Suppl 5):1537-1542. doi: 10.1016/j.juro.2013.08.073.
[12]	Johnston GW. Vaginoplasty in excision of the rectum[J]. Proc R Soc Med, 1974, 67(1):56-57. doi: 10.1177/003591577406700131. pmid: 4821600
[13]	Van der Sluis WB, Bouman MB, Buncamper ME, et al. Revision Vaginoplasty: A Comparison of Surgical Outcomes of Laparoscopic Intestinal versus Perineal Full-Thickness Skin Graft Vaginoplasty[J]. Plast Reconstr Surg, 2016, 138(4):793-800. doi: 10.1097/PRS.0000000000002598. pmid: 27673515
[14]	Georgas K, Belgrano V, Andreasson M, et al. Bowel vaginoplasty: a systematic review[J]. J Plast Surg Hand Surg, 2018, 52(5):265-273. doi: 10.1080/2000656X.2018.1482220. pmid: 30039726
[15]	Drusany Starič K, Distefano R, Norčič G. Sigmoid neovagina prolapse treated with Altemeier procedure: case report and systematic review of the literature[J]. Int Urogynecol J, 2023, 34(11):2647-2655. doi: 10.1007/s00192-023-05603-4.ˇˇˇ pmid: 37490063
[16]	Elgandashvili D, Kalantarov A, Gugeshashvili T. Mayer-rokitansky-kuster-hauser syndrome. Laparoscopic sigmoid vaginoplasty for the treatment of vaginal agenesis-single center experience in georgia. Case report[J]. Georgian Med News, 2024(354):129-138. pmid: 39580840
[17]	Delshad S, Delshad B, Mogheimi P. Postoperative outcomes of sigmoid colon vaginoplasty for vaginal agenesis: A randomized controlled trial[J]. Ann Med Surg(Lond), 2022, 78:103833. doi: 10.1016/j.amsu.2022.103833.
[18]	Jin X, Liu S, Wang N, et al. Tubal replacement of cervix for treatment of type Ⅱ vaginal atresia complicated with cervical dysplasia: a case report[J]. J Int Med Res, 2024, 52(8):3000605241272532. doi: 10.1177/03000605241272532.
[19]	Meece MS, Weber LE, Hernandez AE, et al. Major complications of sigmoid vaginoplasty: a case series[J]. J Surg Case Rep, 2023, 2023(6):rjad333. doi: 10.1093/jscr/rjad333.
[20]	Yadav M, Hayashi T, Krisna R, et al. Laparoscopic sacrocolpopexy in a patient with vault prolapse of the sigmoid stump after vaginoplasty in Mayer-Rokitansky-Küster-Hauser syndrome: A case report[J]. Case Rep Womens Health, 2021,30:e00313. doi: 10.1016/j.crwh.2021.e00313.
[21]	Pennesi CM, English EM, Bell S, et al. Prevalence of urinary, prolapse, and bowel symptoms in Mayer-Rokitansky-Küster-Hauser syndrome[J]. Am J Obstet Gynecol, 2021, 225(1):70.e1-70.e12. doi: 10.1016/j.ajog.2021.02.020.