腹骶阴道固定术网片侵蚀的发生率及处理

Incidence and management of abdominal sacrocolpopexy mesh erosions.

作者信息

Begley J Sean, Kupferman Susan P, Kuznetsov Dimitri D, Kobashi Kathleen C, Govier Fred E, McGonigle Kathryn F, Muntz Howard G

机构信息

Section of Gynecology and Gynecologic Oncology, Department of Surgery, Section of Urology, Virginia Mason Medical Center, Seattle, WA 98111, USA.

出版信息

Am J Obstet Gynecol. 2005 Jun;192(6):1956-62. doi: 10.1016/j.ajog.2005.02.062.

DOI:10.1016/j.ajog.2005.02.062

PMID:15970860

Abstract

OBJECTIVE

This study was undertaken to evaluate the occurrence and management of mesh erosions in patients undergoing abdominal sacrocolpopexy.

STUDY DESIGN

A retrospective chart review of the abdominal sacrocolpopexy procedure (n = 92) between 1997 and 2003 was performed. Patients with mesh erosion were identified. Incidence by graft type and treatment required for erosion resolution was analyzed with chi 2 and Fisher exact test.

RESULTS

Erosions occurred in 7.6 % (7/92). Erosions were identified only in patients with Gore-Tex (3/33, 9%) or silicone-coated mesh (4/21, 19%) compared with none of 38 patients with polypropylene mesh (n = 24) or fascia (n = 14) grafts ( P = .068.). Partial excision of exposed graft resolved all 3 Gore-Tex erosions, compared with none of the silicone-coated mesh erosions ( P = .03). Complete graft removal was required to resolve silicone-coated mesh erosions.

CONCLUSION

We observed a high rate of erosion with Gore-Tex and silicone-coated mesh. Partial graft excision was adequate for Gore-Tex erosions, but complete graft removal was necessary to resolve erosions associated with silicone-coated mesh.

摘要

目的

本研究旨在评估接受腹骶骨阴道固定术患者网片侵蚀的发生率及处理方法。

研究设计

对1997年至2003年间进行的腹骶骨阴道固定术（n = 92）进行回顾性图表审查。确定发生网片侵蚀的患者。采用卡方检验和Fisher精确检验分析按移植物类型的发生率及解决侵蚀所需的治疗方法。

结果

侵蚀发生率为7.6%（7/92）。仅在使用戈尔特斯（Gore-Tex）网片（3/33，9%）或硅胶涂层网片（4/21，19%）的患者中发现侵蚀，而38例使用聚丙烯网片（n = 24）或筋膜（n = 14）移植物的患者均未出现侵蚀（P = 0.068）。暴露移植物的部分切除解决了所有3例戈尔特斯网片侵蚀，而硅胶涂层网片侵蚀无一例通过此方法解决（P = 0.03）。解决硅胶涂层网片侵蚀需要完全移除移植物。