Ross Jim W
Center for Female Continence, Salinas, California 93901, USA.
J Minim Invasive Gynecol. 2007 Jul-Aug;14(4):470-4. doi: 10.1016/j.jmig.2007.02.003.
To assess the efficacy of a xenogenic barrier in preventing vaginal mucosal erosion and the use of a collagen-coated polypropylene mesh in preventing small bowel obstruction with laparoscopic sacrocolpopexy for the treatment of severe vaginal prolapse.
Prospective longitudinal study (Canadian Task Force classification II-1).
Private urogynecology clinic.
A total of 31 consecutive post-hysterectomy patients with severe apical vaginal prolapse (pelvic organ prolapse quantification [POP-Q] stages 2-4).
Laparoscopic sacrocolpopexy, in conjunction with other laparoscopic and/or vaginal procedures, was used to correct pelvic floor disease. A Y-shaped polyester multifilament mesh, with a resorbable collagen coating, was used for the implant. The inner surfaces of the Y-shaped synthetic mesh had porcine dermal strips attached to act as a buffer/barrier for the vaginal wall.
A total of 29 (94%) of 31 patients were cured at 12 months (defined as POP-Q < stage II). There were no more failures in the 28 patients followed-up at 24 months. Two patients had recurrent apical prolapse (Point C = -1 and 0). There were no small bowel obstructions and no vaginal mesh erosions during the 2-year follow-up. There was significant improvement in the sexual and quality of life questionnaires after repair.
Laparoscopic sacrocolpopexy is an effective treatment for apical vault prolapse. There were no cases of vaginal erosion in the first 2 years of follow-up with the "combination" biosynthetic mesh. It is suggested that the interposition of a collagen barrier between the synthetic mesh and the vaginal mucosa prevents erosion. Biosynthetic engineering appears promising in aiding the prevention of the most common complication in pelvic floor reconstructive surgery with permanent implants. The use of permanent synthetic mesh plays an important role in the success of sacrocolpopexy, removing the dependence on the use of poor in situ tissue seen in classic and site-specific repairs. The use of biologic barriers developed specifically for certain actions may be useful in minimally invasive vaginal repair surgery.
评估一种异种屏障在预防阴道黏膜糜烂方面的疗效，以及在腹腔镜骶骨阴道固定术治疗严重阴道脱垂中使用胶原涂层聚丙烯网预防小肠梗阻的效果。
前瞻性纵向研究（加拿大工作组分类II-1）。
私立泌尿妇科诊所。
共31例连续的子宫切除术后严重阴道顶端脱垂患者（盆腔器官脱垂定量[POP-Q]分期2-4期）。
采用腹腔镜骶骨阴道固定术联合其他腹腔镜和/或阴道手术来纠正盆底疾病。使用一种带有可吸收胶原涂层的Y形聚酯复丝网进行植入。Y形合成网的内表面附着有猪真皮条，作为阴道壁的缓冲/屏障。
31例患者中有29例（94%）在12个月时治愈（定义为POP-Q＜II期）。在24个月随访的28例患者中无更多失败病例。2例患者出现复发性顶端脱垂（C点=-1和0）。在2年随访期间无小肠梗阻及阴道网片糜烂发生。修复后性功能和生活质量问卷有显著改善。
腹腔镜骶骨阴道固定术是治疗顶端穹窿脱垂的有效方法。使用“联合”生物合成网在随访的前2年无阴道糜烂病例。提示在合成网和阴道黏膜之间置入胶原屏障可预防糜烂。生物合成工程在辅助预防盆底重建手术中使用永久性植入物时最常见的并发症方面似乎很有前景。永久性合成网的使用在骶骨阴道固定术的成功中起重要作用，消除了对经典和特定部位修复中使用不良原位组织的依赖。专门为某些操作开发的生物屏障在微创阴道修复手术中可能有用。
