Feiner B, Jelovsek J E, Maher C
Division of Urogynaecology and Reconstructive Pelvic Surgery, Royal Women's, Mater and Wesley Hospitals, Brisbane, Queensland, Australia.
BJOG. 2009 Jan;116(1):15-24. doi: 10.1111/j.1471-0528.2008.02023.x.
Vaginal mesh kits are being used to surgically treat apical vaginal prolapse; however, their safety and efficacy are currently unknown.
To summarise success and complication rates for commonly used vaginal mesh kits in the treatment of apical prolapse.
MEDLINE and other scientific databases were queried for primary research addressing the use of vaginal mesh kits for apical prolapse published between 1950 and 2007, including abstracts presented in major scientific meetings.
Studies describing the use of mesh to support either the anterior or posterior compartment alone, for incontinence or fistula repair or not addressing the vaginal apex were excluded.
Identified studies were grouped by the mesh kit and complications categorised using the Dindo classification system. Weighted averages and confidence intervals were calculated on objective success, follow-up length and complications.
Thirty studies totalling 2653 women met inclusion criteria. Objective success rates (95% CI) were Apogee (American Medical Systems Inc., Minnetonka, MN, USA) 95% (95-96), Prolift (Ethicon Women's Health and Urology, Somerville, NJ, USA) 87% (86-87) and posterior intravaginal slingplasty 88% (87-89). Reoperations not requiring anaesthesia (Dindo IIIa) occurred in 0.4-2.3% and requiring anaesthesia (Dindo IIIb) in 1.5-6.0%, with a follow up between 26 and 78 weeks. Mesh erosion was the most commonly reported complication occurring in 4.6-10.7%.
AUTHOR'S CONCLUSIONS: Overall objective success using transvaginal mesh kits in restoring apical vaginal prolapse is high. However, an increasing number of women require surgical intervention for mesh-related complications based on limited data quality and short follow up. Further research addressing functional outcomes and the impact of these procedures on women's symptoms and quality of life is mandatory.
阴道网片套件正被用于手术治疗阴道顶端脱垂；然而，其安全性和有效性目前尚不清楚。
总结常用阴道网片套件治疗顶端脱垂的成功率和并发症发生率。
查询MEDLINE及其他科学数据库，以获取1950年至2007年间发表的关于使用阴道网片套件治疗顶端脱垂的原始研究，包括在主要科学会议上发表的摘要。
排除描述仅使用网片支撑前或后盆腔、用于治疗尿失禁或瘘管修复或未涉及阴道顶端的研究。
将纳入的研究按网片套件分组，并使用Dindo分类系统对并发症进行分类。计算客观成功率、随访时间和并发症的加权平均值及置信区间。
共有30项研究纳入了2653名女性，符合纳入标准。客观成功率（95%可信区间）分别为：Apogee（美国美敦力公司，明尼通卡，明尼苏达州，美国）95%（95 - 96）、Prolift（美国强生公司旗下Ethicon Women's Health and Urology，萨默维尔，新泽西州，美国）87%（86 - 87）以及经阴道后路吊带成形术88%（87 - 89）。无需麻醉的再次手术（Dindo IIIa）发生率为0.4 - 2.3%，需要麻醉的再次手术（Dindo IIIb）发生率为1.5 - 6.0%，随访时间为26至78周。网片侵蚀是最常报告的并发症，发生率为4.6 - 10.7%。
使用经阴道网片套件恢复阴道顶端脱垂的总体客观成功率较高。然而，基于有限的数据质量和较短的随访时间，越来越多的女性因网片相关并发症需要手术干预。必须开展进一步研究，以探讨功能结局以及这些手术对女性症状和生活质量的影响。
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