Altman Daniel, Falconer Christian
Division of Obstetrics and Gynecology, Karolinska Institutet Danderyd Hospital, 182 88 Stockholm, Sweden.
Obstet Gynecol. 2007 Feb;109(2 Pt 1):303-8. doi: 10.1097/01.AOG.0000250970.23128.63.
To describe the perioperative morbidity associated with transvaginal mesh repair of pelvic organ prolapse.
During a 6-month time period, 25 centers registered all surgical procedures using a commercially available mesh. The frequency and type of perioperative complications, during surgery and the associated hospital stay, were documented using a standardized protocol.
During the inclusion period, 248 women underwent transvaginal mesh surgery: anterior repair in 106 patients (43%), posterior repair in 71 (29%), combined anterior and posterior repair in 20 (8%), and total repair in 51 (21%). Mean age was 67.8 years (+/-10.3 standard deviation) and median parity was 2 (range 0-6). Surgery for prolapse recurrence was performed in 56% of the patients (n=140), and 91% (n=225) had undergone at least one previous pelvic floor surgical procedure. Serious complications occurred in 4.4% of patients (n=11) and were dominated by visceral injury (10 of 11 cases). One case of bleeding in excess of 1,000 mL occurred. Minor complications occurred in 14.5% of patients (n=36), and the majority were urinary tract infections, urinary retention, and postoperative fever. A multivariable risk analysis showed that concurrent pelvic floor surgery was associated with an increased risk for minor complications, odds ratio 2.8 (95% confidence interval 1.1-6.9). There were no other predictors of outcomes when assessing the association with age, parity, weight, previous pelvic floor surgery, previous hysterectomy, or concurrent hysterectomy.
Perioperative serious complications are uncommon after transvaginal mesh procedures although particular care should be taken to detect visceral injury at the time of surgery.
III.
描述盆腔器官脱垂经阴道网片修补术的围手术期发病率。
在6个月的时间段内，25个中心记录了所有使用市售网片的手术操作。采用标准化方案记录手术期间及相关住院期间围手术期并发症的频率和类型。
在纳入期间，248名女性接受了经阴道网片手术：106例（43%）为前路修补术，71例（29%）为后路修补术，20例（8%）为前后联合修补术，51例（21%）为全盆底修补术。平均年龄为67.8岁（标准差±10.3），中位产次为2次（范围0 - 6次）。56%（n = 140）的患者因脱垂复发接受手术，91%（n = 225）的患者此前至少接受过一次盆底手术。4.4%（n = 11）的患者发生严重并发症，主要为内脏损伤（11例中的10例）。发生1例出血量超过1000 mL的出血。14.5%（n = 36）的患者发生轻微并发症，主要为尿路感染、尿潴留和术后发热。多变量风险分析显示，同期盆底手术与轻微并发症风险增加相关，比值比为2.8（95%置信区间1.1 - 6.9）。在评估与年龄、产次、体重、既往盆底手术、既往子宫切除术或同期子宫切除术的关联时，未发现其他结局预测因素。
经阴道网片手术后围手术期严重并发症并不常见，不过手术时应特别注意检测内脏损伤。
III级。
