以胶原蛋白生物工程海绵为支架的自体微粒皮复合口腔黏膜移植在阴道狭窄再造中的应用

杨宇 仇雄文 丁力 郑清健 庄兢

[摘要]目的：探讨以胶原蛋白生物工程海绵为支架的自体微粒皮复合口腔黏膜移植在阴道狭窄再造中的应用效果。方法：在阴道狭窄患者尿道与直肠之间形成腔穴并止血，取颊部口腔黏膜，在大小阴唇交界处取游离皮片，将两者形成微粒并混合，采用阴道软性模具，将混合组织铺在胶原蛋白生物工程海绵上，并紧贴于再造的阴道腔穴内侧壁上，碘仿纱条填塞固定6d后取出软质模具，更换成硬质模具并每日进行阴道冲洗，术后继续佩戴硬质模具6～12个月。结果：本组8例阴道狭窄患者经过术后6个月～3年的定期随访，并进行病理学复查，效果良好，再造阴道愈合迅速，且不易破损，不影响日常生活与工作。结论：应用以胶原蛋白生物工程海绵为支架的自体微粒皮复合口腔黏膜的游离移植进行阴道再造，方法新颖，术后创伤较小，效果良好，值得临床推广应用。

[关键词]阴道狭窄；微粒皮；口腔黏膜；胶原蛋白生物工程海绵

[中图分类号]R622 [文献标志码]A [文章编号]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，时常遇到因阴道狭窄，无法进行正常夫妻生活的患者，为了正常的婚姻生活，她们往往迫切希望进行阴道再造。如果这些患者的子宫、卵巢等发育正常，是可以进行正常的孕育过程而享受天伦之乐的，如何采用最小的代价重建与生理状态相似的阴道，并尽力保护患者隐私，是整形外科医师关注的一个富有挑战性的课题。