Mattox T Fleming, Stanford Edward J, Varner E
Greenville Hospital System, Division of Urogynecology, Department of Obstetrics and Gynecology, University of South Carolina, Greenville, SC, USA.
Int Urogynecol J Pelvic Floor Dysfunct. 2004 Sep-Oct;15(5):319-23. doi: 10.1007/s00192-004-1170-8. Epub 2004 May 14.
The abdominal sacrocolpopexy is an excellent procedure to surgically treat vaginal vault prolapse. A synthetic graft is often used to support the vaginal apex, but has the potential to become infected or erode, requiring its removal or revision. The purpose of this paper is to report our experience in the management of patients with infected synthetic grafts after abdominal sacrocolpopexy. A review of the patient databases from three specialty gynecology centers was performed from March 1996 to June 2002. Only patients with an infected graft after an abdominal sacrocolpopexy were included in the study; patients with either suture or graft erosion responding to conservative treatment were excluded. Twenty-two women, ages 37-73 years, developed infection of the synthetic graft after an abdominal sacrocolpopexy (1-60 months after their initial surgery, mean 8.8 months). The infected materials included polytetrafluoroethylene (PTFE, Goretex, n =15) and polypropylene (n=7). Nine of the 15 PTFE meshes and four of the seven polypropylene meshes were placed at the time of a contaminated case (abdominal hysterectomy [n=12], colon resection [n=1]). Eighteen (82%) of the infected grafts involved braided permanent suture to attach the graft to the vaginal wall, monofilament/non-braided permanent suture was used in three patients, and suture type could not be determined in one. All graft removals were attempted vaginally, and this was successful in 16 cases (73%). Two patients experienced significant bleeding: the first patient required an emergency laparotomy and the second patient's bleeding was controlled with packing. A rectovaginal fistula occurred 3 weeks postoperatively in one patient. Synthetic graft infection should be considered as the differential diagnosis in a patient who has undergone an abdominal sacrocolpopexy. Transvaginal removal is preferred, but is fraught with potentially serious complications. The use of braided permanent sutures to affix the graft to the vagina may be associated with mesh infections.
腹骶阴道固定术是手术治疗阴道穹窿脱垂的一种极佳术式。常使用合成移植物来支撑阴道顶端，但该移植物有感染或侵蚀的风险，需要移除或修正。本文旨在报告我们处理腹骶阴道固定术后合成移植物感染患者的经验。对1996年3月至2002年6月间三个专业妇科中心的患者数据库进行了回顾。本研究仅纳入腹骶阴道固定术后移植物感染的患者；对保守治疗有反应的缝线或移植物侵蚀患者被排除。22名年龄在37 - 73岁的女性在腹骶阴道固定术后发生合成移植物感染（初次手术后1 - 60个月，平均8.8个月）。感染的材料包括聚四氟乙烯（PTFE，戈尔特斯，n = 15）和聚丙烯（n = 7）。15个PTFE网片中的9个以及7个聚丙烯网片中的4个是在污染病例（腹式子宫切除术[n = 12]、结肠切除术[n = 1]）时放置的。18例（82%）感染的移植物涉及用编织的永久性缝线将移植物固定于阴道壁，3例患者使用单丝/非编织永久性缝线，1例患者的缝线类型无法确定。所有移植物均尝试经阴道移除，16例（73%）成功。2例患者出现大量出血：第一例患者需要急诊剖腹手术，第二例患者的出血通过填塞得以控制。1例患者术后3周发生直肠阴道瘘。对于接受腹骶阴道固定术的患者，应将合成移植物感染作为鉴别诊断考虑。经阴道移除是首选，但充满潜在的严重并发症。使用编织的永久性缝线将移植物固定于阴道可能与网片感染有关。
