Salomon L J, Detchev R, Barranger E, Cortez A, Callard P, Darai E
Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, 4 rue de la Chine, 75020 Cedex 20, Paris, France.
Eur Urol. 2004 Feb;45(2):219-25. doi: 10.1016/j.eururo.2003.09.005.
To assess the feasibility and efficacy of porcine skin collagen (Pelvicol) implant by the transobturator route for the treatment of anterior vaginal wall prolapse.
Twenty-seven women with stage III or IV prolapse underwent anterior vaginal wall repair with porcine skin collagen implantation by the transobturator route, together with bilateral sacropinofixation; respectively 17 and 16 women underwent hysterectomy and bilateral sapingo-oophorectomy during the same procedure. The feasibility and peri/postoperative complications of the transobturator procedure were assessed, together with anatomical and functional outcome.
Porcine skin collagen implantation was feasible in every case. The transobturator procedure lasted a median of 25 min (range 20-35). There were no vessel or bladder injuries and no postoperative complications (including infections). Median follow-up was 14 months (range 8 to 24). No rejection of the porcine grafts occurred. Twenty-two women (81%) had optimal anatomic results, while the remaining five women (19%) had persistent asymptomatic stage I or II anterior vaginal wall prolapse (1 and 4 cases, respectively). In one case the collagen implant had to be removed after one year because of persistent pain due to transfixing vaginal stitch. One patient with optimal anatomic results had recurrent stage III Ba prolapse at 18 months. Quality of life and urinary discomfort scores improved significantly after the procedure (p<0.0001 and p<0.005, respectively).
These preliminary results suggest that porcine skin collagen implantation by the transobturator route is a safe and effective treatment for anterior vaginal wall prolapse.
评估经闭孔途径植入猪皮胶原蛋白（Pelvicol）治疗阴道前壁脱垂的可行性和疗效。
27例Ⅲ期或Ⅳ期脱垂的女性患者经闭孔途径植入猪皮胶原蛋白并同时行双侧骶棘韧带固定术进行阴道前壁修复；分别有17例和16例女性在同一手术过程中接受了子宫切除术和双侧输卵管卵巢切除术。评估经闭孔手术的可行性及围手术期/术后并发症，以及解剖学和功能学结果。
每例患者均可行猪皮胶原蛋白植入。经闭孔手术中位时长为25分钟（范围20 - 35分钟）。未发生血管或膀胱损伤，也无术后并发症（包括感染）。中位随访时间为14个月（范围8至24个月）。未发生猪移植物排斥反应。22例女性（81%）获得了最佳解剖学结果，其余5例女性（19%）存在持续性无症状的Ⅰ期或Ⅱ期阴道前壁脱垂（分别为1例和4例）。1例患者因阴道贯穿缝合导致持续疼痛，1年后不得不取出胶原蛋白植入物。1例解剖学结果最佳的患者在18个月时复发Ⅲ度Ba脱垂。术后生活质量和泌尿不适评分显著改善（分别为p<0.0001和p<0.005）。
这些初步结果表明，经闭孔途径植入猪皮胶原蛋白是治疗阴道前壁脱垂的一种安全有效的方法。
