Quiroz Lieschen H, Gutman Robert E, Fagan Matthew J, Cundiff Geoffrey W
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD 21224, USA.
Int Urogynecol J Pelvic Floor Dysfunct. 2008 Feb;19(2):261-6. doi: 10.1007/s00192-007-0416-7. Epub 2007 Jul 17.
The purpose of this study is to describe the outcomes of partial colpocleisis for mesh erosions after sacrocolpopexy. We retrospectively report our surgical management of mesh erosion after sacrocolpopexy. Between 1998 and 2006, we performed 499 sacral colpopexies and treated 21 patients for mesh erosion, including three referrals. Mean (range) time to diagnosis was 10.3 months (1-49). Grafts materials included: Mersilene (13), Prolene (7), and Pelvicol (1). Surgical outcomes were available for 19 patients. Ten (48%) patients were cured by the initial partial colpocleisis, while nine (45%) required a second or third (2, 10%) vaginal operation. All of the second and third vaginal excisions failed. Eight patients had an abdominal excision, and two patients required a second abdominal procedure. The success rate for the first and second abdominal resections was 38% (3/8) and 100% (2/2). Abdominal surgeries had higher blood loss (84 vs 378 cc, p = 0.012) longer hospitalization (outpatient vs 4.2 days p = 0.001), and additional morbidity (18.6%). Potential contributing factors to surgical failure were the presence of Actinomyces and current smoking. We recommend initial transvaginal mesh resection with partial colpocleisis for synthetic mesh erosions after sacrocolpopexy. Vaginal failures may be better served by an abdominal excision. Potential contributors to failure include current smoking and the presence of Actinomyces.
本研究的目的是描述骶骨阴道固定术后网片侵蚀行部分阴道封闭术的结果。我们回顾性报告了骶骨阴道固定术后网片侵蚀的手术处理情况。1998年至2006年间，我们共进行了499例骶骨阴道固定术，并对21例网片侵蚀患者进行了治疗，其中包括3例转诊患者。诊断的平均（范围）时间为10.3个月（1 - 49个月）。移植材料包括：Mersilene（13例）、Prolene（7例）和Pelvicol（1例）。19例患者有手术结果。10例（48%）患者通过初次部分阴道封闭术治愈，而9例（45%）患者需要第二次或第三次（2例，10%）阴道手术。所有第二次和第三次阴道切除术均失败。8例患者进行了腹部切除术，2例患者需要第二次腹部手术。第一次和第二次腹部切除术的成功率分别为38%（3/8）和100%（2/2）。腹部手术的失血量更多（84 vs 378 cc，p = 0.012），住院时间更长（门诊手术vs 4.2天，p = 0.001），且有额外的发病率（18.6%）。手术失败的潜在促成因素是放线菌的存在和当前吸烟。我们建议对骶骨阴道固定术后合成网片侵蚀的患者，初始采用经阴道网片切除术并结合部分阴道封闭术。对于阴道手术失败的患者，腹部切除术可能效果更好。失败的潜在因素包括当前吸烟和放线菌的存在。
