Moore Robert D, Miklos John R
Atlanta Urogynecology Associates, Northside Hospital, Atlanta, GA, USA.
ScientificWorldJournal. 2009 Mar 1;9:163-89. doi: 10.1100/tsw.2009.19.
Graft use in vaginal prolapse surgery has become more common secondary to high failure rates seen with traditional repairs. Mesh has been shown to be successful when suspending the upper portion of the vagina with sacralcolpopexy and its use vaginally isi n an attempt to reproduce those results seen from the more invasive abdominal approach. A recent Cochrane review has supported its use in the anterior compartment vaginally as lower failure rates have been shown. Vaginal mesh "kits" have been developed in an attempt to make these surgeries less invasive, more standardized, and easier to perform. One of the problems that does seem to be emerging is the thought that, just because these procedures are now being produced in "kits", they can be completed by any surgeon. This may not hold true, as these are still advanced techniques that require advanced pelvic surgery skills and, therefore, it is up to surgeons to also understand this and the limitations of these procedures. The current paper reviews the history of the development of mesh kits, the techniques utilized, and the data that have been published to date on results and complications, and recommendations on how to avoid these complications. Although initial studies are encouraging, more will need to be completed prior to the recommendations of general use of these kits in all prolapse patients. We need to have further investigation on proper patient selection, we must continue research on graft composition, and we must continue to develop techniques to minimize complications of needle passage or mesh placement. Even after we gain this knowledge, it will still require advanced surgical skills to complete these types of surgeries, and to help minimize complications and maximize results.
由于传统修复手术的高失败率，移植物在阴道脱垂手术中的应用变得更加普遍。当通过骶骨阴道固定术悬吊阴道上部时，网状物已被证明是成功的，其在阴道内的使用旨在重现从更具侵入性的腹部手术方法中看到的结果。最近的一项Cochrane综述支持其在阴道前壁的应用，因为已显示出较低的失败率。阴道网状物“套件”已经开发出来，试图使这些手术侵入性更小、更标准化且更易于执行。似乎正在出现的一个问题是，仅仅因为这些手术现在以“套件”形式生产，就认为任何外科医生都可以完成。这可能并不正确，因为这些仍然是需要先进盆腔手术技能的先进技术，因此，外科医生也需要理解这一点以及这些手术的局限性。本文回顾了网状物套件的发展历史、所采用的技术以及迄今为止已发表的关于结果和并发症的数据，以及关于如何避免这些并发症的建议。尽管初步研究令人鼓舞，但在建议在所有脱垂患者中普遍使用这些套件之前，还需要完成更多研究。我们需要对合适的患者选择进行进一步调查，必须继续研究移植物的组成，并且必须继续开发技术以尽量减少穿刺针或网状物放置的并发症。即使我们获得了这些知识，完成这类手术仍然需要先进的手术技能，以帮助尽量减少并发症并使效果最大化。
