Department of Urology, Nihon University School of Medicine, Tokyo, Japan.
Int J Urol. 2010 Apr;17(4):353-8. doi: 10.1111/j.1442-2042.2010.02469.x. Epub 2010 Feb 22.
To prospectively evaluate the efficacy of a tension-free vaginal mesh (TVM) procedure for pelvic organ prolapse (POP).
Between December 2005 and April 2008, 310 female patients (mean age 67.2 years, range 42-84) with POP underwent TVM procedures at our institute. Fifty-six individuals were qualified as stage 2 according to the POP quantification system and 162 and 92 were stage 3 and 4, respectively. One hundred ninety-one patients underwent anterior TVM, and seven underwent posterior TVM. One hundred twelve cases underwent both anterior and posterior TVM procedures. Each patient was systematically assessed at 1, 3, 6 and 12 months after surgery. Quality of life (QOL) was also assessed by using the Short Form-36 and the prolapse-QOL questionnaires.
Perioperative complications were the following: five bladder injuries (1.6%), no rectal injuries and three hemorrhages greater than 400 mL (1.0%). The anatomical cure rate (% stage 0 cases) at 3, 6 and 12 months after surgery were 94.1%, 93.5%, and 92.3%, respectively. Short Form-36 and prolapse-QOL parameters were significantly improved, and maintained during the follow-up period. Postoperative complications were the following: five pelvic hematomas (1.6%), one wound infection (0.3%), 10 vaginal mesh extrusions (3.2%), and three cases of pelvic pain (1.0%). Complications concerning lower urinary tract function were: eight cases of postoperative stress urinary incontinence (2.6%), three cases of transient urinary retention (1.0%), and two cases of de novo overactive bladder (0.6%).
The TVM procedure provides a good outcome at 1 year with a low incidence of surgical complications and recurrence. Further evaluation with a longer follow up is needed.
前瞻性评估经阴道无张力网片修补术（TVM）治疗盆腔器官脱垂（POP）的疗效。
2005 年 12 月至 2008 年 4 月，我院对 310 例 POP 女性患者（平均年龄 67.2 岁，范围 42-84 岁）施行 TVM 术。56 例患者根据 POP 量化系统评定为 2 期，162 例和 92 例分别为 3 期和 4 期。191 例行前 TVM，7 例行后 TVM，112 例行前后 TVM。术后 1、3、6、12 个月对每位患者进行系统评估。采用 36 项简短健康状况调查问卷（SF-36）和脱垂生活质量问卷（P-QOL）评估生活质量（QOL）。
围手术期并发症如下：膀胱损伤 5 例（1.6%），直肠损伤 0 例，出血量>400ml 3 例（1.0%）。术后 3、6、12 个月解剖学治愈率（0 期病例比例）分别为 94.1%、93.5%和 92.3%。SF-36 和 P-QOL 各项参数均显著改善，随访期间保持稳定。术后并发症如下：盆腔血肿 5 例（1.6%），伤口感染 1 例（0.3%），阴道网片脱出 10 例（3.2%），盆腔疼痛 3 例（1.0%）。下尿路功能障碍相关并发症如下：术后压力性尿失禁 8 例（2.6%），一过性尿潴留 3 例（1.0%），新发膀胱过度活动症 2 例（0.6%）。
TVM 术 1 年疗效良好，手术并发症和复发率低。需要进一步进行更长时间随访的评估。
