Giri Subhasis K, Hickey John P, Sil Debasri, Mabadeje Oladapo, Shaikh Faisal M, Narasimhulu Girish, Flood Hugh D
University Hospital, Limerick, Ireland.
J Urol. 2006 May;175(5):1788-92; discussion 1793. doi: 10.1016/S0022-5347(05)01023-2.
Acellular cross-linked porcine dermis is a potential substitute for rectus fascia as a sling material with the advantage of decreased morbidity. However, the long-term efficacy is unknown. We compared the 3-year efficacy of PD vs autologous rectus fascia as a sling material for pubovaginal sling surgery in the treatment of urodynamic stress incontinence.
Between July 2000 and December 2001 a total of 101 consecutive, nonrandomized patients with USI underwent a PD (51) or RF (50) sling procedure. Patients were assessed at 6 weeks, and at 3, 6 and 12 months postoperatively. Urodynamic study was repeated in cases of treatment failure. A detailed survey questionnaire was mailed to all patients at least 36 months after surgery and all responders were then retested by telephone interview by a blinded assessor. The primary outcome measure was patient perceived success rate (cured or improved) at least 36 months after PVS. Secondary outcome measures were patient satisfaction 36 months after surgery, durability of success with time and reoperation rate.
Complete data were available on 94 patients (48 treated with PD and 46 treated with RF sling). The groups were well matched for age, leak point pressure, prior incontinence surgery and urge symptoms. Pubovaginal sling was successful (cured or improved) in 37 (80.4%) patients treated with RF but in only 26 (54%) patients treated with PD 36 months after surgery (Fisher's exact test p = 0.009; 95% CI 8.03, 44.4). Treatment failure occurred by 9 months after RF and by 24 months after PD sling procedure. Repeat urodynamic study showed USI to be the cause of treatment failure in 18 (37.5%) of 20 patients treated with PD but in only 3 (6.5%) of 8 patients treated with RF.
We have shown that use of the PD sling, although reducing early morbidity, results in a significantly inferior long-term cure rate in comparison to the RF sling. Therefore, acellular cross-linked porcine dermis should not be used as a substitute for rectus fascia.
脱细胞交联猪真皮是一种潜在的替代腹直肌筋膜的吊带材料，具有降低发病率的优势。然而，其长期疗效尚不清楚。我们比较了脱细胞交联猪真皮（PD）与自体腹直肌筋膜作为耻骨后阴道吊带手术中治疗尿动力学压力性尿失禁的吊带材料的3年疗效。
2000年7月至2001年12月，共有101例连续的、非随机的压力性尿失禁患者接受了PD（51例）或RF（50例）吊带手术。在术后6周、3、6和12个月对患者进行评估。治疗失败的患者重复进行尿动力学研究。在手术后至少36个月向所有患者邮寄详细的调查问卷，然后由一名盲法评估者通过电话访谈对所有回复者进行重新测试。主要结局指标是耻骨后阴道吊带手术后至少36个月患者自我感觉的成功率（治愈或改善）。次要结局指标是术后36个月患者的满意度、成功的持久性以及再次手术率。
94例患者（48例接受PD吊带治疗，46例接受RF吊带治疗）有完整数据。两组在年龄、漏点压力、既往尿失禁手术史和急迫性症状方面匹配良好。耻骨后阴道吊带手术在术后36个月时，46例接受RF吊带治疗的患者中有37例（80.4%）成功（治愈或改善），而48例接受PD吊带治疗的患者中只有26例（54%）成功（Fisher精确检验p = 0.009；95%可信区间8.03，44.4）。RF吊带治疗后9个月内及PD吊带手术后24个月内出现治疗失败。重复尿动力学研究显示，在20例接受PD吊带治疗的患者中，有18例（37.5%）治疗失败的原因是压力性尿失禁，而在8例接受RF吊带治疗的患者中只有3例（6.5%）是这个原因。
我们已经表明，使用PD吊带虽然能降低早期发病率，但与RF吊带相比，其长期治愈率明显较低。因此，脱细胞交联猪真皮不应作为腹直肌筋膜的替代品。
