Lowman Joye, Moore Robert D, Miklos John R
Urogynecology Associates, Indiana University/Purdue University, Indianapolis, Indiana, USA.
J Reprod Med. 2007 Jun;52(6):560-2.
Patients with previous irradiation are at high risk for complications following pelvic reconstructive surgery. The treatment of these complications and the patient's initial disorder can be complex and difficult, especially when the use of various graft materials, including mesh, is involved in the original complication.
A 49-year-old woman with a history of anal and vulvar cancer treated with pelvic irradiation underwent a tension-free vaginal tape (TVT) sling for stress urinary incontinence (SUI) and experienced complications of urethral mesh erosion and urethrovaginal fistula (UVF). The mesh was removed and the urethra repaired, but the repair failed, and she continued to have a persistent UVF. The patient presented to our center, and the UVF was repaired successfully with a Martius flap. Secondary to persistent SUI with intrinsic sphincter deficiency (ISD), the patient underwent a repeat TVT sling with a porcine interposition graft between the mesh and urethra to help prevent urethral mesh erosion. The patient healed without complications and achieved 80% improvement in her symptoms at 3 months, with only occasional SUI. She was eventually able to achieve 100% cure with the addition of periurethral collagen injections.
Porcine interposition grafts while constructing a TVT sling may help reduce urethral erosion rates in patients with previous irradiation.
既往接受过放疗的患者在骨盆重建手术后发生并发症的风险很高。这些并发症以及患者最初疾病的治疗可能复杂且困难，尤其是当原始并发症涉及使用包括网片在内的各种移植材料时。
一名49岁女性，有肛门和外阴癌病史，接受过盆腔放疗，因压力性尿失禁（SUI）接受了无张力阴道吊带（TVT）手术，出现了尿道网片侵蚀和尿道阴道瘘（UVF）并发症。移除了网片并修复了尿道，但修复失败，她仍持续存在UVF。该患者前来我们中心就诊，采用Martius皮瓣成功修复了UVF。由于存在内在括约肌缺陷（ISD）导致持续性SUI，患者再次接受TVT吊带手术，在网片和尿道之间置入猪源移植材料以帮助预防尿道网片侵蚀。患者愈合良好，无并发症，3个月时症状改善了80%，仅偶尔出现SUI。最终通过添加尿道周围胶原蛋白注射，她实现了100%治愈。
在构建TVT吊带时使用猪源移植材料可能有助于降低既往接受过放疗患者的尿道侵蚀率。
