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目的了解腹腔镜腹膜阴道成形术后患者人工阴道的微生态状况,探讨腹腔镜腹膜阴道成形术后阴道微生态评价的临床意义。方法选取54例性腹腔镜腹膜阴道成形术术后回访的患者,取阴道分泌物进行微生态评价,同时检查患者的人工阴道物理功能及阴道壁组织活检。结果腹腔镜腹膜阴道成形术术后患者的人工阴道具有正常阴道的组织学特点,物理功能良好。54例患者中阴道菌群密集度为Ⅱ~Ⅲ级者48例,占88.9%;菌群多样性为Ⅱ~Ⅲ级者39例,占72.2%;优势菌为革兰阳性大杆菌者15例,占27.8%;pH≤4.5者31例,占57.4%。无病原菌感染。术后时间≥2年的23例患者阴道微生态正常者占14例(60.9%),异常者占9例(39.1%)。术后时间<2年的31例患者中阴道微生态正常者11例(35.5%),异常者20例(64.5%)。菌群异常主要包括:菌群抑制(包括未见到任何细菌)、革兰阳性短杆菌(12.3%)、革兰阳性球菌(31.5%)、革兰阴性短杆菌(9.6%)。结论 (1)先天性无阴道的患者在阴道成形术后不同程度存在菌群失调表现。表现为pH值升高,阴道内菌群多样性欠佳,正常优势菌群存在比例低。(2)手术后时间是影响腹膜阴道成形术后阴道微生态的重要因素,随着术后时间的延长,人工阴道阴道微生态正常的比例逐渐增加。(3)评价腹腔镜腹膜阴道成形术后阴道微生态环境的状况,对预防与治疗术后人工阴道感染、促进人工阴道的健康发展具有重要意义。
Objective To understand the status of artificial vaginal microecology after laparoscopic peritoneal vaginoplasty and to evaluate the clinical significance of vaginal microecology after laparoscopic peritoneal vaginoplasty. Methods Fifty-four patients who underwent laparoscopic peritoneal vaginoplasty were enrolled in this study. Vaginal secretions were evaluated for microecology. The physical function of the vagina and vaginal wall biopsy were also examined. Results Laparoscopic peritoneal vaginoplasty in patients with artificial vaginal histology has normal vaginal histological features, good physical function. Among the 54 patients, 48 cases (88.9%) had vaginal flora concentration Ⅱ ~ Ⅲ and 39 cases (Ⅱ) Ⅱ grade Ⅲ accounted for 72.2%. The dominant bacteria were gram positive bacilli in 15 cases , Accounting for 27.8%; pH≤4.5 in 31 cases, accounting for 57.4%. No pathogen infection. Twenty-three patients (≥2 years) had normal vaginal microfacies accounting for 14 (60.9%) and abnormalities (9%, 39.1%). Eleven patients (35.5%) had normal vaginal microecology and 20 (64.5%) had abnormality in 31 patients who had less than 2 years postoperative time. Microbial population abnormalities include: bacterial population inhibition (including no bacteria), Gram-positive Brevibacterium (12.3%), Gram-positive cocci (31.5%) and Gram-negative Brevibacterium (9.6%). Conclusions (1) The patients with congenital absence of vagina have different degrees of dysbacteriosis after vaginoplasty. The performance of the pH value, intravaginal flora diversity is poor, the prevalence of normal dominant flora is low. (2) The time after surgery is an important factor affecting the vaginal microflora after peritoneal vaginoplasty. With the extension of postoperative time, the proportion of normal vaginal micro-ecology in the vagina increases gradually. (3) Evaluation of the status of vaginal microenvironment after laparoscopic peritoneal vaginoplasty is of great significance in the prevention and treatment of postoperative artificial vaginal infection, and promote the healthy development of artificial vagina.