将 AlloDerm 用于一名泄殖腔患者的阴道部分置换术的新方法:病例报告

Veronica I. Alaniz , Kelly Harris , Kellie Woodfield , Julie Friedman , Vatche Melkonian , Andrea Bischoff
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引用次数: 0

摘要

导言在泄殖腔重建过程中,如果原生阴道无法到达会阴部,就会考虑用肠移植来替代阴道。其风险包括需要进行翻修手术、产生粘液、结肠炎以及罕见的发育不良。鉴于这些问题,人们正在考虑采用其他阴道重建手术。病例介绍 一名 17 个月大的女婴,病史复杂,患有慢性肾脏病 (CKD) 5 期,通过后矢状切口对 4.5 厘米的泄殖腔进行了修复。虽然直肠在脱离张力后得到了充分的移动,但阴道在脱离张力后距离会阴仍有 4 厘米。由于使用乙状结肠替代阴道需要对这名病情复杂的患儿进行探查性开腹手术,因此决定使用 AlloDerm 移植材料进行阴道成形术。两块 2 × 4 厘米的 AlloDerm 被纵向放置,以形成阴道前后壁。然后固定侧壁和周围的脂肪,并创建阴道内口。术后三个月进行了阴道镜检查,证实移植物完好无损,长约 2-3 厘米,与原生阴道吻合通畅。对于不适合进行结肠阴道成形术的泄殖腔患者来说,这是一种很有前景的阴道替代选择。今后还需要进行研究,以评估这种移植物用于青春期前阴道成形术的长期效果。
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Novel use of AlloDerm for partial vaginal replacement in a patient with cloaca: A case report

Introduction

During cloacal reconstruction, vaginal replacement with an intestinal graft is considered when native vagina does not reach the perineum. Risks include need for revision surgery, mucus production, colitis, and rarely dysplasia. Given these concerns, alternative vaginal reconstructive procedures are being considered. We present a novel case using AlloDerm for vaginal replacement in a female infant undergoing cloacal reconstruction.

Case presentation

A 17-month-old female with a complex medical history including Stage 5 chronic kidney disease (CKD) underwent repair of a 4.5 cm cloaca via a posterior sagittal approach. Although the rectum was adequately mobilized off tension, the vagina remained 4 cm from the perineum when off tension. Because vaginal replacement using sigmoid colon would have required exploratory laparotomy in this medically complex child, decision was made to proceed with vaginoplasty using an AlloDerm graft. Two 2 × 4 cm pieces of AlloDermwere placed longitudinally to create the anterior and posterior vaginal walls. The lateral walls and surrounding fat were then secured and the introitus was created. Vaginoscopy was performed three months post-operatively and confirmed an intact graft approximately 2–3 cm long with a patent anastomosis to the native vagina.

Conclusion

AlloDerm is an acellular tissue matrix that supports tissue regeneration. This is a promising vaginal replacement option for patients with cloaca who are not good candidates for a colonic vaginoplasty. Future studies are needed to assess long-term outcomes of this graft for prepubertal vaginoplasties.

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来源期刊
CiteScore
0.60
自引率
25.00%
发文量
348
审稿时长
15 days
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