Frank intermittent pressure

Frank intermittent compression is used for congenital, non-vaginal treatment. Congenital absence of vagina is due to the influence of internal and external factors, resulting in the development or obstruction of the development of the end of the renal tube. Therefore, this type of patient has only a solid primordial uterus, the vagina is not developed; but the middle renal parane canal and genital warts develop normally, there may be normal fallopian tubes and ovaries, and women's secondary sexual characteristics develop normally, but patients are often accompanied by Developmental abnormalities in the urinary system and bones. At present, there are many surgical methods for the treatment of congenital absence of vagine in China. The earlier commonly used surgery has free skin graft, or pedicle flap transplantation and amniotic membrane transplantation. After that, Vechitti surgery was prevalent in foreign countries. In recent years, sigmoid colon transplantation, peritoneal transplantation and musculoskeletal vaginoplasty have been carried out at home and abroad, especially with the development of microsurgery, which has opened up a new way for this operation. However, these methods have their own advantages and disadvantages, and should be selected according to local medical conditions, technical level and psychological requirements of patients. Good vaginoplasty should be simple, once and for all, less damage, less complications, good efficacy, safe and reliable, economical and practical requirements, the current methods are not ideal, still need to continue to cover materials and surgical methods Innovative and perfect. The patient is taught to apply a specific dilator to the occluded vestibular vestibule, intermittently applying appropriate pressure to expand the urethral rectal space along the normal vaginal axis, gradually increasing the dilator diameter, and ultimately forming an artificial lumen. The key to success is first and foremost the patient's confidence and passion for top-loading operations. The vulva develops well, the vestibule has a shallow dimple, and the expansion is more hopeful. The time to complete varies depending on the degree of density of the fascia between the bladder and rectum of the urethra, which usually takes six months to one year. The biggest advantage of this method is that it does not require surgery, no special technology, can be carried out in the clinic, and is suitable for the primary door clinic without surgical conditions; it avoids the pain of surgery and saves the cost of hospitalization; but it takes longer and the failure rate is higher. high. At present, many scholars suggest that this method can be used as a pre-test treatment before surgery. After examination and discovery after puberty, the method can be used for pre-treatment, and if surgery fails after 2 to 3 years. Treatment of diseases: congenital without vagina Indication Frank intermittent press is suitable for: 1. Congenital without vagina, to solve the patient's sexual life. 2. Uterine or vaginal malignant tumors, most or all of the vaginal resection, in order to solve the patient's sexual life. Preoperative preparation 1. Inform the patient in detail about the purpose and requirements of the therapy, and emphasize that the key to success is that the patient is sensible and closely coordinated with the physician and is constantly working as required. 2. Patiently and meticulously teach the patient to understand that the vestibular part of the vagina is on the dorsal side of the urethral opening. Select the depression or select the soft part in the center (pointing with the help of the mirror if necessary) is the position of pressure. Surgical procedure Bladder lithotomy, general anesthesia or continuous epidural anesthesia or spinal anesthesia. 1.Frank method 1 Apply a test tube with an outer diameter of 0.8 cm. The patient takes the bladder lithotomy position. The doctor points the test tube at the center of the vestibular vestibule and presses it toward the back side (slightly toward the head side). The patient is taught to perform the operation according to the demonstration, at least 3 times a day, at least 30 minutes each time. The intensity of the applied pressure is such that the patient feels a feeling of distraction or mild discomfort in the vaginal area, and it is not suitable to have severe pain. If there is a slight amount of bleeding, it indicates that the mucous membrane is damaged and the applied pressure is too large. At this stage, care should be taken to avoid distortion and dilation of the urethral opening when stretching the vestibular mucosa. 2 After one week, observe whether the patient's operation is correct, and whether the test tube can be pressed slightly inward toward the back side. If this level has been reached, the direction of the top pressure can be changed and pressed in the direction of the normal vaginal axis (slightly to the side of the head side), half an hour in the morning and evening. 3 generally in 2 to 4 weeks, the test tube can be deep into 6 ~ 7cm. Once the short test tube can be fully pressed into the artificial cavity, a small cotton pad can be placed in the vulva, fixed with a T-belt, placed overnight, and taken out the next morning. 4 Generally, the length of the artificial cavity can reach 5-6 cm within 6-8 weeks. At this time, the test tube with a diameter of 1.5 cm can be used, and after 7 cm deep, it can be kept for 8-10 hours during sleep at night. 5 Finally, use a 2 to 3 cm diameter dilator until you get married. 6 patients with successful follow-up can see normal vulva and vaginal opening, the vagina can loosely extend into 2 fingers, the depth can reach 6.5 ~ 7cm, the cavity is covered with a soft elastic film. The insertion and opening of the standard vaginal speculum does not cause discomfort to the patient. 2.Ingram improvement method In view of the following disadvantages of the Frank method: 1 position taken: the operation of the bladder lithotomy position is not easy; the position is difficult to last; 2 the operation is easy to cause wrist and finger fatigue; 3 can not perform other work during operation, more time-consuming Wait. Ingram (1981) envisages the use of body torso weight instead of surgical operation, in place of the above various postures in a sitting position, and can perform desk work simultaneously when pressing, without wasting time, designing a simple bicycle cushion chair, using bicycle racing or male The seat cushion device adjusts the height on the swivel chair shaft. 4 Prepare three sets of dilators and vaginal molds of different sizes, all of which are cylindrical; the first group has a total of 10 dilators, 1.5 cm in diameter, 1.5 to 10 cm in length, and 2.5 cm and 3.5 cm in the second and third groups respectively. The length is from 3 to 10 cm, each of which is 5. Specific progress: 1 Start with the first 1.5cm diameter dilator, the length starts from 1.5cm, gradually increase with the depth of the press, fix the dilator with the T-belt, put on the underwear or skirt, ride on the bicycle mat, body Slightly lean forward, rely on the body's own weight to push the dilator in the required direction, each time 15 ~ 30min, as long as possible, the total number of hours per day is not less than 2h. After 21 to 2 weeks, the patient will be reviewed again, and the patient will be reviewed once a month to change the dilator. Generally, a narrower lumen (1.5 cm wide and about 6 cm long) can be formed within 4 to 6 weeks. 3 When the artificial lumen reaches a depth of 10 cm for another 4 weeks, switch to the second set of dilators (2.5 cm in diameter). 4 Finally, the third set of dilators with a diameter of 3.5 cm is applied, and the total time takes about 4 to 6 months.