The Experimental And Clinical Study Of Rejuvenation Operation Related To Postpartum Vaginal Laxity

Part 1 Histologic observation and nerve distribution study of the vaginal mucosa and the labia minoraObjective:To observe the structural morphology of the lower part of vagina and the labia minora by HE stain.To observe the distribution of nerve fibers in the vaginal mucosa groups the medial aspect of the labia minora group and the lateral aspect of the labia minora group by S100 protein immunohistochemically staining.To compare the distribution differences of nerve fibers among three groups by semi-quantitative analysis.To observe and analyze the correlationship between the age?labia minora width and the distribution density of nerve fibers among three groups.Materials and methods:Collected 23 discarded vagina mucosa and labia minora specimen separately,from the patients who underwent vaginal tightening surgery and labiaplasty in the gynaecology plastic center.Performed routine HE stain and S100 immunohistochemically stain.Observed the structural morphology and the distribution of nerve fibers.Collected the pictures and calculate the positive area?the mean optical density and the integral optical density by the Image-Pro Plus 6.0 software,performed statistical analysis to compare the differences of each group,analyzed the correlationship between the age?labia minora width and the distribution density of nerve fibers among three groups.Results:1.HE stain results:The vaginal mucosa is composed of stratified squamous epithelium and abundant fibrous tissue below,with less adipose tissue and the glandular tissue.The labia minora is composed of stratified squamous epithelium and dermal with the melanin cell.The dense connective tissue under the derma contain much more blood vessels and the smooth muscle?rich elastic tissue and sebaceous glands,but less fat tissue.2.S100 immunohistochemically staining results:S100 protein positive cells were with tan particles located in the cytoplasm.There were small and scattered nerve fibers found in the vaginal epithelium and lamina propria,and the rough nerve fiber trunk found in the deep layer.These were also found in the labia minora.And the phenomenon that nerves accompanying with blood vessels was also found in the both deep layer.3.S100 protein semi-quantitative test results:The positive area and the integral optical density value of the labia minora groups were higher than those of the vaginal mucosa group(P<0.05).The positive area and the integral optical density value differences between the labia minora groups had no statistical significance(P>0.05).The mean optical density value differences among the three groups had no statistical significance(P>0.05).4.There was no correlationship between the age and the distribution density of nerve fibers among three groups,and the differences among the three age groups had no statistical significance(P>0.05).5.There was no correlationship between the labia minora width and the distribution density of nerve fibers among three groups,and the differences among the two width groups had no statistical significance(P>0.05).Conclusions:The nerve fiber at the epithelial layer and superficial subdermal layer of both vagina mucosa and labia minora is small and thin,while the nerve fiber at the deep subdermal layer become large and rough with the phenomenon that nerves accompanying with blood vessels was also found in the deep layer.The nerve density of the labia minoragroups was higher than that of the vaginal mucosa group?The nerve densities between the labia minora groups had no statistically significant difference.There was no correlationship between the age?the labia minora width and the distribution density of nerve fibers among three groups.Part 2 The clinical research of the effect of perineal body reconstruction combined with vaginal mucosa rugation suturing vaginal tightening for the treatment of postpartum vaginal laxityObjective:To observe the effect of perineal body reconstruction combined with vaginal mucosa rugation suturing vaginal tightening for the treatment of postpartum vaginal laxity.To observe and compare the relationship between the age?the parity?the laxity degree?the delivery way and the vaginal contraction pressure.Materials and methods:From Sep 2014 to Aug 2015,Selected 85 cases patients with postpartum vaginal laxity to perform the perineal body reconstruction combined with vaginal mucosa rugation suturing vaginal tightening as the total group,and divided it into vaginal delivery group and cesarean delivery group according to the delivery way.Restore the sexual life 2 months after operation,and follow-up 6 months after operation.Observe the incision healing state,the shape change of the vulvar morphology,Measure the maximum contraction pressures and contraction duration of the vaginal introitus before and 6 months after the operation separately by perineometer.Ask the patients to fill in the FSFI(female sexual function index)questionnaire before and 6 months after the operation separately.Statistically analysis and compare the values before and 6 months after the operation.Analyzed the relationship between the age?the parity?the laxity degree?the delivery way and the vaginal contraction pressure.Results:1.68 cases accomplished the research;the drop-out rate is 20%.2.All the 68 cases had the primary healing,without complications found,such as bleeding,hematoma,infection,incision dehiscence and visceral organ injury.3.The vulvar morphology was improved,without vaginal mucosa prolapse.The perineal body was more plump and bulged.Digital palpation showed the disappearance of the depression sulcus in the lateral-posterior vaginal wall,the elasticity of vagina wall and perineal body was increased,and the contraction of vagina was much more powerful.4.In the 68 follow-up cases,53 cases(77.9%)had the obvious sense of vaginal tightened,and the powerlessness of the perineum was decreased while standing,62 cases(91.2%)themselves felt the life quality improved 6 months after the operation.5.The maximum contraction pressure of the lower vaginal segment 6 months after the operation in each of the three groups was higher than that before the operation(P<0.05)The difference of contraction duration of each group before and 6 months after the operation had no statistical significance(P>0.05).6.The total score of FSFI in each of the three groups before the operation was higher than that 6 months after the operation(P<0.05),and in the domains,the scores of orgasm and satisfaction domain in each of the three groups were higher than that before the operation(P<0.05),while the score difference of desire?arousal?lubrication and pain domain in each of the three groups had no statistical significance(P>0.05)before and 6 months after the operation.7.The age had the negative correlation with the vaginal contraction pressure of vaginal delivery group and cesarean delivery group,but had no correlation with the vaginal contraction pressure difference value.8.The vaginal contraction pressure differences among the mild laxity group?the moderate laxity group?the severe laxity group had statistical significance(P<0.05).9.The vaginal contraction pressure differences among the parity groups had statistical significance(P<0.05).10.The vaginal contraction pressure of cesarean delivery group was higher than that of natural birth group?episiotomy group and laceration group(P<0.05),the vaginal contraction pressure differences between the natural birth group and the episiotomy group had no statistical significance(P>0.05),and the vaginal contraction pressure of laceration group was lower than that of the natural birth group and the episiotomy group(P<0.05)?Conclusions:The vaginal tightening operation by perineal body reconstruction combined with vaginal mucosa rugation suturing was safe and had good effect to treat postpartum vaginal laxity,with fewer complications,could improve the vulvar morphology,enhance the contraction pressure of the vagina,and improve the quality of sexual life.The age had the negative correlation with the vaginal contraction pressure.The aggravation of vaginal laxity degree?the increase of parity and perineal laceration were in accordance with the decrease of the vaginal contraction pressure.Part 3 The preliminary study of blood supply of the labia minora by microdissection and three-dimensional reconstructionObjective:To observe the blood supply mode of the labia minora by vascular perfusion and angiography for the labia minora specimens,three-dimensional reconstruction after CT scanning,and perform microdissection,wish to provide anatomical basis for the perineum plastic surgery.Materials and methods:Collected 15 fresh perineum specimens from women cadaver,after pretreatment,performed Latex perfusion and microdissection for 10 cases,performed Latex-Bismuth oxide perfusion for 5 cases,three-dimensional reconstruction for the images after CT scanning,to observe the blood supply mode of the labia minora.Results:1.The result of microdissection:9 cases were successfully perfused and showed two blood supply mode of the labia minora.One was the anterior-posterior convergence type(6 cases),there were two main vessels from the anterior and posterior of the labia minora,and run forward to the distal margin of the labia minora,with branches anastomosed to network,there could have one dominant vessel,this mode was often found in the well-distributed labia minora.Another was the single trunk type(3 cases),there was one main vessel from the middle of the labial base,and run forward to the distal of the labia minora,with branches to the margin of the labia minora,this mode was often found in the local protruding labia minora.2.The result of three-dimensional reconstruction:3 cases were successfully perfused and developed,and we found the vessels coming from the anterior and posterior of the labia minora,and run forward to the distal margin of the labia minora,with branches anastomosed to network,the posterior branch was often the dominant vessel.Conclusions:The blood supply of the labia minora could be divided into two modes:the anterior-posterior convergence type(nearly 75%)and the single trunk type(nearly 25%),this could provide anatomical basis for the labia minora plastic surgery,and could provide theoretical foundation for surgical design to improve the vaginal sexual sensitivity by combining the labia minora pedicle flap transferred into the vagina with the vaginal plastic surgery.