26 nov. 2009 RECONSTRUCTIA VAGINALA CU LAMBOU MIOCUTANAT DE DREPT ABDOMINAL
V. Muntean*, Delia Mirela Muntean**, F.Ovidiu*, I.Domsa**, R.Bosu**, C.Valcu**
*Clinica Chirurgie IV, UMF “Iuliu Hatieganu”, Cluj-Napoca
**Spital Clinic CF, Cluj-Napoca
Rezumat
Reconstructia vaginala a devenit parte integranta a interventiilor chirurgicale de exereza radicala extinsa a tumorilor maligne pelvine. In ultimii 10 ani am facut 23 plastii vaginale cu lambou miocutanat de drept abdominal, transversal (TRAM) sau vertical (VRAM), la paciente cu exenteraatii pelvine pentru cancere local avansate sau recidivate.
In 16 cazuri colpoplastia a fost totala, cu lambou modelat în cilindru si în alte 7 cazuri posterioara, cu lambou în semicilindru, cu concavitatea anterioara. Dintre cele 15 paciente în viata la data studiului,12 (80I) au avut cel putin un contact sexual vaginal dupa operatie. Dintre acestea, patru apreciaza functia sexuala buna, patru acceptabila, doua nesatisfacatoare iar doua paciente au renuntat la contactele sexuale.
Abstract – VAGINAL RECONSTRUCTION WITH RECTUS ABDOMINIS MYOCUTANEOUS FLAP
Vaginal reconstruction is now an integral part of exenterative or extended radical pelvic surgery for cancer treatment. During the last 10 years we have performed 23 vaginal reconstructions with rectus abdominis myocutaneous flap, transverse (TRAM) or vertical (VRAM), in patients with pelvic exenterations for locally advanced or recurrent cancers.
In 16 cases with circumferential vaginal defects, the flap was fationed in cylindrical pouch and in 7 was used as half cylinder with anterior concavity, to reconstruct the posteror vaginal wall. At the time of survey 12 out of 15 survivors (80I) have had vaginal intercourse after vaginal reconstruction. Four patients are satisfied with with their sexual life, four reasonably satisfied, two have dyspareunia and two discontinued vaginal intercourse.