Davydov描述的治疗先天性阴道发育不全的腹膜阴道成形术:腹腔镜腹腔镜转位(Davydov)技术及其发展

作     者：Dargent D Marchiol P Giannesi A 侯巍 

出 版 物：《世界核心医学期刊文摘（妇产科学分册）》 (Core Journal in Obstetrics/Gynecology)

年 卷 期：2005年第1卷第5期

页      面：35-36页

学科分类：1002[医学-临床医学] 100211[医学-妇产科学] 10[医学] 

主　　题：腹膜阴道成形术 Davydov 发育不全 腔镜 腹腔镜手术 膀胱阴道瘘 剖腹术 术后并发症 会阴缝合 唇成形术 

摘      要：Introduction. -The laparoscopic Davydov is described. The data concerning the surgery and the postoperative course are reported at the same time as the data concerning the anatomical and sexological results. Patients and methods. -The s urgery includes three steps: (i) cleavage under laparoscopic guidance, (ii) peri toneovestibular stitch by perineal approach, (iii) making the vaginal vault with the laparoscope. The cleavage can be performed in front of the fascia interpose d between the bladder and the rectum or behind it. A nymphoplasty can be added t o the colpopoeisis. Results. -Between February 1996 and March 2003 we operated on 28 patients affected by congenital vaginal agenesis using the laparoscopic Da vydov technique. Two peroperative complications occurred (urinary tract injuries during the first step: laparoscopic management) and two postoperative complicat ions (intraperitoneal migration of the mould and vesicovaginal fistula managed s uccessfully with the laparoscope for the first one and trough laparotomy for the second one). Four reoperations (incision and dilation) were necesssary. The len gth of the neovagina was, at the last assessment, 7.2 ±1.3cm. The Female Sexual Function Index was 26,5±5.6 vs. 27.9 ±4.5 in a control cohort. In the patient s whose cleavage was performed behind the fascia (13 cases vs. 15) no complicati on occurred, no re-operation was necessary, the length of the neovagina was 7,0 ±0,7cm and the FSFI was 26,3 ±5,9. Discussion and conclusion. -The laparoscop ic Davydov is, if the dorsal approach is used for the cleavage, an easy to make operation (operating time: 90 ±.29 minutes) with a short hospital stay. The pos toperative care is simple (vaginal mould useless). Heterosexual activity with pe nile penetration can start early (6 to 8 weeks). The level of satisfaction is hi gh. Laparoscopic Davydov procedure may be considered a good alternative to the m ore complex ones (as Vecchietti’s technique) or to the more dangerous ones (s