Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan.
J Minim Invasive Gynecol. 2010 Jul-Aug;17(4):473-9. doi: 10.1016/j.jmig.2010.03.003. Epub 2010 May 23.
To estimate the safety and efficacy of performing concurrent anterior and posterior transvaginal mesh surgery using a commercially available kit (Gynecare PROLIFT Pelvic Floor Repair System; Ethicon, Inc., Somerville, NJ) for treatment of advanced urogenital prolapse (stage III or higher, Pelvic Organ Prolapse Quantification [POP-Q] system staging).
Case control series study (Canadian Task Force classification II-2).
Medical school-affiliated hospital.
Forty-three patients with severe prolapse, POP-Q stage III (n=23) or IV (n=20), underwent surgery and were followed up for more than 1 year. In patients with any prolapse greater than stage I, surgery were considered to have functional failure. The Surgical Satisfaction Questionnaire was used for subjective evaluation at 1 year postoperatively.
Extensive pelvic reconstructive procedures were primarily performed using a combination of the PROLIFT anterior and posterior pelvic systems (i.e., similar to sparing the intermediate section of the PROLIFT total pelvic system). The concurrent pelvic surgery included sequential vaginal total hysterectomy, perineorrhaphy, and suburethra sling, if indicated. Additional subjective and objective evaluations included POP-Q staging, urodynamic assessment, and preoperative and 12-month postoperative questionnaires.
Objective and subjective data were available for 42 patients. The subjective cure rate and objective success rate for prolapse at 12-month follow-up was 95.2% and 97.6%, respectively. Mean follow-up was 15.7 months, operation time was 79.2 minutes, operative blood loss was 109.1 mL, and postoperative hospital stay was 4.1 days. Intraoperative and postoperative complications were minor. All patients voided spontaneously before discharge. One mesh extrusion, no wound defective healing, and no rejection were observed. Two patients developed asymptomatic recurrent rectocele (stage II, POP-Q staging) that required no surgical intervention. Urodynamic parameters related to voiding dysfunction improved after surgery. Significant improvements were found using the Incontinence Impact Questionnaire and the Urogenital Distress Inventory.
Using concurrent anterior and posterior transvaginal mesh for pelvic reconstructive surgery is a safe and an effective method for treating advanced pelvic prolapse. Mesh-related complications are likely minimal, and mesh protrusion at the apex is likely to not occur. Further studies with longer follow-up are required to evaluate long-term effectiveness.
使用市售套件（Ethicon，Inc.，Somerville，NJ 的 Gynecare PROLIFT 盆底修复系统）同时进行前侧和后侧经阴道网片手术，以治疗高级泌尿生殖系统脱垂（III 期或更高，盆腔器官脱垂定量 [POP-Q]系统分期），评估其安全性和有效性。
病例对照系列研究（加拿大任务组分类 II-2）。
医学院附属医院。
43 名患有严重脱垂的患者，POP-Q 分期 III 期（n=23）或 IV 期（n=20），接受手术并随访超过 1 年。任何大于 I 期的脱垂患者均被认为手术功能失败。术后 1 年使用手术满意度问卷进行主观评估。
广泛的盆腔重建手术主要采用 PROLIFT 前侧和后侧盆腔系统的组合（即类似于保留 PROLIFT 全盆腔系统的中间部分）进行。同期盆腔手术包括序贯阴道全子宫切除术、会阴修补术和尿道下吊带术（如适用）。附加的主观和客观评估包括 POP-Q 分期、尿动力学评估以及术前和 12 个月后的问卷调查。
42 名患者有客观和主观数据。术后 12 个月时，脱垂的主观治愈率和客观成功率分别为 95.2%和 97.6%。平均随访时间为 15.7 个月，手术时间为 79.2 分钟，手术出血量为 109.1 毫升，术后住院时间为 4.1 天。术中及术后并发症轻微。所有患者均在出院前自行排尿。1 例网片挤出，无伤口愈合不良，无排斥反应。2 例患者无症状性复发性直肠前突（II 期，POP-Q 分期），无需手术干预。与排尿功能障碍相关的尿动力学参数在手术后得到改善。使用尿失禁影响问卷和泌尿生殖窘迫量表发现有显著改善。
使用经阴道同时进行前侧和后侧网片盆腔重建手术是治疗高级盆腔脱垂的一种安全有效的方法。与网片相关的并发症可能很少，网片尖端突出也可能不会发生。需要进行更长时间随访的进一步研究来评估长期效果。
