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目的分析在腹腔镜或达芬奇手术系统辅助下乙状结肠或回肠移植阴道再造术后肠管发生不同程度回缩的原因、处理方法并进行随访观察。方法回顾分析3例典型阴道再造术后肠管回缩病例,就术后肠管回缩发生原因、处理方法以及术后随访情况进行讨论。结果 1例患者术后因肠管回缩约5.0 cm,遗留创面较大,行双侧阴股沟皮瓣修复;2例患者肠管回缩程度轻微为2.0~3.0 cm,经换药处理后创面呈肠管上皮化愈合。6个月后随访,患者外阴形态良好,再造阴道长度大于12.0 cm,可容纳直径约3.2 cm柱状假体,阴道无挛缩狭窄;肠镜检查提示肠黏膜炎症表现,局部增生。结论肠系膜长短、肠系膜动脉分支以及保留血管分支的位置是影响术后肠管回缩的重要因素。
Objective To analyze the reason, treatment and follow-up of bowel tube retraction to varying degrees after vaginal reconstruction with laparoscopic or da Vinci surgical system assisted by sigmoid colon or ileum transplantation. Methods Retrospective analysis of 3 cases of typical cases of intestinal retraction after vaginal reconstruction, the reasons for postoperative bowel retraction, treatment and follow-up were discussed. Results One patient had a bowel retraction of about 5.0 cm postoperatively and a large residual wound. The bilateral vaginal furrows flap was repaired. The degree of bowel retraction was 2.0-3.0 cm in 2 patients. After wound healing, Intestinal epithelial healing. 6 months after follow-up, the patient’s vulva shape is good, the reconstruction of the vagina length greater than 12.0 cm, can accommodate a diameter of about 3.2 cm columnar prosthesis, vaginal no contracture stenosis; colonoscopy prompted intestinal mucosal inflammation, local hyperplasia. Conclusion The length of mesentery, mesenteric artery branches and the location of vascular branches are the important factors that affect the intestinal retraction.