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題名 | Secondary Reconstruction of Vaginal Agenesis with Bilateral Island Singapore Flaps--Case Report and Review of the Literature=使用新加坡皮瓣於先天性陰道發育不全的二次重建--病例報告及文獻回顧 |
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作者 | 劉恩瑋; 黃宗君; 施秉庚; 陳信翰; 張長正; 陳宏基; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 28:3 2019.09[民108.09] |
頁次 | 頁218-226 |
分類號 | 416.413 |
關鍵詞 | 先天性陰道發育不全; 新加坡皮瓣; Congenital vaginal agenesis; Vaginal stenosis; Singapore flap; Pudendal thigh flap; |
語文 | 英文(English) |
中文摘要 | 背景:先天性陰道發育不全是一罕見的疾病,通常在女性初經後開始有症狀。相關的治療是相當具有挑戰性的,即使已有許多不同種類的整形重建手術已被提出,至今仍然難以達成普羅共識,最重要的原因就是重建後陰道管腔的再狹窄。目的及目標:我們報告一個先天性陰道發育不全經手術重建後陰道管腔再狹窄的案例。該病患在青春期初期接受首次重建手術,並於手術後持續使用陰道擴張器但仍面臨因疤痕組織形成為主因而導致前述狀況。此案例以雙側「新加坡皮瓣」進行二次重建手術並持續追蹤四十個月,藉由探討此段期間內疾病治療的過程、症狀改善進度與相關併發症,以期未來能嘉惠更多相關疾病患者。材料及方法:一位有正常第二性徵的18歲女性被診斷為原發性無月經。儘管在五年前經過首次重建手術後持續使用陰道擴張器,病患仍表現出反覆的泌尿道感染合併經血阻塞。此次以雙側「新加坡皮瓣」進行二次重建手術。結果:成功使用雙側「新加坡皮瓣」重建陰道與子宮間的連續性,病患也免於反覆性經血阻塞與泌尿道感染。在追蹤的四十個月期間,也沒有陰道管腔再狹窄的狀況發生,臨床結果成功。結論:「新加坡皮瓣」是以陰唇皺摺(labial crural fold)為中心的區域形大腿內陰皮瓣,複雜型的陰道發育不全或是陰道狹窄可以使用此皮瓣來重建以得到良好的功能性結果與外觀,對於接受保守治療失敗的患者,也不失為一理想的替代方案。主要的好處有手術後不需持續使用陰道擴張器、感覺保留以及疤痕不明顯等,反之,主要的缺點則是重建後的陰道偶有皮脂腺分泌以及毛髮生長。 |
英文摘要 | Background: Congenital vaginal agenesis is a rare anomaly and typically becomes symptomatic after menarche. Treatment is challenging and can require exceptional reconstructive surgery, many reconstruction options have been reported, however, there is not yet a consensus regarding an ideal method because narrowing of the reconstructed vaginal canal is common during follow-up after operation. Aim and Objectives: We present a case of remarkable stenosis of the lower part of the vagina after vaginal reconstruction for congenital vaginal agenesis, regardless of vaginal dilatation since her early adolescence post-operatively. Secondary vaginal reconstruction was performed and we are presenting her peri- /post-operatively forty-month long follow-up condition. Materials and Methods: An 18-year-old adolescent girl has primary amenorrhea but normal secondary sexual characteristics. She presented with recurrent urinary tract infection and obstruction of menstrual blood repeatedly regardless of non-surgical management with vaginal dilatation after initial primary pull-through vaginaplasty. Bilateral island Singapore flaps were used for secondary reconstruction. Results: Uterovaginal continuity was established in our patients, resulting in normal menstruation. The length and width of the neovagina was 9 cm and 3.7 cm respectively 40 months post operatively without restenosis of vagina. Conclusion: It is feasible to achieve successful secondary vaginal reconstruction and an uterovaginal communication in patients with vaginal stenosis and a functional uterus by using bilateral island Singapore flaps. The main advantages are that no essential postoperative dilatation is required, preserving sensation, and the inconspicuous scar. The minor disadvantages are the presence of some sebaceous vaginal secretion and hair in the vaginal lining. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。