摘要目的:探讨一体化设计的三叶瓣法在小阴唇-阴蒂包皮复合整形术中的应用效果。方法:回顾性分析2019年4月至2024年1月于中国医学科学院整形外科医院应用三叶瓣法矫治的小阴唇-阴蒂包皮复合增生型患者的临床资料。采用一体化设计理念，分别在阴蒂包皮和小阴唇交界处(M瓣)、小阴唇的内侧面(I瓣)和外侧面(E瓣)设计3个组织瓣，旨在保留阴蒂-阴唇三角，以及选择并保留质地和颜色相对较好的组织，拼接缝合重塑阴蒂包皮和小阴唇形态。术后7～10 d及3个月对患者进行随访，包括阴蒂包皮-小阴唇外观、不适症状是否改善、有无并发症等情况；术后3个月，由患者完成女性生殖器自我形象量表(FGSIS)评分，总分为7～28分，分数越高表示生殖器自我形象越积极，总分≥21分表示对手术效果满意。应用SPSS 29.0软件对数据进行分析。年龄、手术时间以 ± s表示；术前和术后FGSIS评分以 M( Q1， Q3)表示，两者比较采用Wilcoxon符号秩检验， P<0.05表示差异有统计学意义。 结果:共纳入556例女性小阴唇-阴蒂包皮复合增生型患者(938侧阴唇)，年龄(29.3±7.7)岁(18～53岁)；患者存在阴蒂包皮和小阴唇外形不美观、疼痛或摩擦不适、不易清洁、排尿偏斜、性生活不适等问题。手术过程顺利，术中出血量较少。术后有8例患者一侧小阴唇于术后24 h内在M瓣区域发生小血肿(面积≤2 cm 2)，其中2例于术后2 d内返院通过挤压排出小血块，6例未予处理，均不影响切口愈合；2例术后7 d内一侧三叶瓣交界处切口裂开，长0.3～0.8 cm，拆线时均未予处理，术后3个月复查时未见明显瘢痕或畸形。540例(97.12%)患者获得3个月随访，无严重并发症和畸形发生，有6例(1.11%)因双侧不完全对称要求行二次手术修复，其余患者阴蒂包皮-小阴唇外形对称、美观。540例患者术后3个月FGSIS评分为26(23，27)分，明显高于术前的14(9，15)分( Z＝－20.38， P<0.001)。其中，506例(93.70%)FGSIS评分≥21分，患者对外生殖器美容效果及功能改善均比较满意。 结论:三叶瓣法小阴唇-阴蒂包皮复合整形术通过一体化设计切口可以同时切除小阴唇水平和垂直2个方向的冗余组织，并去除阴蒂包皮外侧褶皱，并发症少，术后功能和外观满意度高。

abstractsObjective:The study aimed to investigate the clinical efficacy of integrated trilobal method for composite reduction labiaplasty.Methods:This study was a single-center, retrospective and observational study. The clinical data of patients diagnosed with hypertrophy of the labia minora and clitoral hood who underwent trilobal labiaplasty at the Plastic Surgery Hospital, Chinese Academy of Medical Sciences from April 2019 to January 2024 were retrospectively analyzed. In this technique, three flaps were designed at the junction of the clitoral hood and labia minora (M flap), as well as the medial (I flap) and lateral surfaces (E flap) of the labia minora. The goal was to preserve the clitoral-labial triangle while selecting and retaining tissues with optimal texture and color for reshaping the clitoral hood and labia minora. Patients were followed up 7-10 days and 3 months post-surgery, during which pre- and postoperative appearance comparisons, symptom improvement, complications and satisfaction questionnaires. At 3 months post-surgery, the patients completed the female genital self-image scale (FGSIS) score, which has a total score range of 7-28 points, with higher score indicating a more positive genital self-image. A total score of ≥21 points indicated satisfaction with the surgical outcome. SPSS 29.0 software was used to analyze the data. Age and operation time were reported as Mean ± SD. Preoperative and postoperative FGSIS scores were described as M ( Q1, Q3) and compared using the Wilcoxon Signed Rank test. Statistical significance was set at P<0.05. Results:A total of 556 patients were enrolled in this study, aged 18-53 years, with a mean age of (29.3±7.7) years. The primary concerns included poor aesthetic appearance, pain or discomfort, difficulty in cleaning, urinary deviation, and sexual discomfort. The procedure was performed smoothly with minimal bleeding. Small hematomas (≤2 cm 2) developed in the M flap in 8 cases within 24 hours post-procedure. Two patients returned to the hospital for hematoma removal, while 6 patients did not require additional treatment, which did not affect the healing of the incision. Postoperative wound dehiscence was observed in 2 cases at the junction of three flaps. However, the dehiscence was short (0.3-0.8 cm) and superficial, with no reports of secondary infection or poor wound healing. A total of 540 patients (97.12%) were followed up for 3 months, and no serious complications or deformities were reported. Six patients (1.11%) underwent a secondary repair surgery due to bilateral incomplete symmetry. The FGSIS score for the 540 patients was 26 (23, 27) points at 3 months post-operation, significantly higher than the preoperative score of 14 (9, 15) points before the operation ( Z=-20.38, P<0.001). Among these, 506 patients (93.70%) achieved FGSIS scores of ≥21 points, indicating satisfaction with both the cosmetic results and functional improvements. Conclusion:The trilobal method, featuring an integrated design for composite reduction labiaplasty, effectively removes redundant tissue in both the horizontal and vertical directions of the labia minora. Additionally, it addresses the lateral folds of the clitoral hood, resulting in fewer complications and high levels of postoperative functional and aesthetic satisfaction.