El Haddad R, Martan A, Masata J, Svabík K, Koleska T
Gynekologicko-porodnická klinika VFN a 1. LF UK, Praha.
Ceska Gynekol. 2009 Aug;74(4):282-5.
Pelvic organ prolapse affect 50% of parous women over 50 years of age. The lifetime risk of undergoing a single operation for prolapse or incontinence by age 80 is 11.1%. Recurrence rates for classical prolapse surgery are as high as 30%. For this reason various graft materials have been proposed to improve the long-term surgical outcomes. The aim of our study was to investigate the safety and efficacy of posterior colporrhaphy incorporating Vypro II (polyglactin 910-polypropylene) mesh in the treatment of posterior vaginal wall prolapse.
Retrospective study.
Gynaecological and Obstetric Clinic, First Medical Faculty of Charles University and General University Hospital, Prague.
Standard posterior colporrhaphy was performed with levator ani muscles plication. Vypro II (Ethicon, Somerville, NJ, USA) is a type III macroporous mixed fibre lightweight mesh composed of 50% absorbable multifilamentous polyglactin 910 and of 50% non-absorbable multifilamentous polypropylene fibres. This operation was performed in 28 women between March 2003 and November 2005. All patients underwent before surgery, urodynamics, ultrasound and physical examination. 22 women (78.5%) had a previous hysterectomy, 16 women (57%) had previous pelvic surgery for prolapse and/or urinary incontinence. Concomitant surgeries performed included vaginal hysterectomy 7% (n = 2), anterior colporrhaphy 50% (n = 14), anterior colporrhaphy with Vypro II mesh 21.4% (n = 6), TVT 7% (n = 2), TVT O 7% (n = 2), sacrospinous vaginal vault suspension 32% (n = 9). The pelvic organ prolapse was staged in ICS POP-Q system. All women had stage II-IV symptomatic prolapse of the posterior compartment (11 patients 39.2% with stage II, 14 patients 50% with stage III and 3 patients 10.7% with stage IV). All patients were examined always in case of complications and were invited to follow-up 2 months after surgery and once a year. The mean follow-up was 26.2 months (range 2-58), whereas 71% of patients had a follow up longer then 24 months.
Patients mean age was 63.7 years (range 46-83), mean parity 2.1 (1-3) and mean BMI 30.34 kg/m2 (25-42). There were no operative or early postoperative complications like bowel erosion or rectovaginal fistula. The incidence of rectocele recurrence was 10.7%: 1 case of stage II rectocele and 2 cases of stage III rectocele. The incidence of mesh vaginal erosion was 10.7%. Two cases were resolved by repeated excision in office and by local estrogen and local antimicrobial therapy. The third case required reoperation and mesh exstirpation.
Posterior colporrhaphy with levator ani muscles plication and incorporating a Vypro II mesh was associated with a higher incidence of post-operative complications even if cure rate was quite good.
盆腔器官脱垂影响50%的50岁以上经产妇。80岁时因脱垂或尿失禁接受单次手术的终生风险为11.1%。经典脱垂手术的复发率高达30%。因此，已提出各种移植材料以改善长期手术效果。我们研究的目的是调查采用Vypro II（聚乙交酯910 - 聚丙烯）网片的后穹窿修补术治疗阴道后壁脱垂的安全性和有效性。
回顾性研究。
布拉格查理大学第一医学院和综合大学医院妇产科诊所。
采用标准后穹窿修补术并缝合肛提肌。Vypro II（美国新泽西州萨默维尔市Ethicon公司生产）是一种III型大孔混合纤维轻质网片，由50%可吸收的多丝聚乙交酯910和50%不可吸收的多丝聚丙烯纤维组成。2003年3月至2005年11月期间，对28名女性进行了该手术。所有患者术前均接受了尿动力学、超声和体格检查。22名女性（78.5%）曾行子宫切除术，16名女性（57%）曾因脱垂和/或尿失禁接受过盆腔手术。同期进行的手术包括阴道子宫切除术7%（n = 2）、前壁修补术50%（n = 14）、采用Vypro II网片的前壁修补术21.4%（n = 6）、经阴道无张力尿道中段吊带术（TVT）7%（n = 2）、经闭孔无张力尿道中段吊带术（TVT - O）7%（n = 2）、骶棘韧带阴道穹窿悬吊术32%（n = 9）。盆腔器官脱垂采用国际尿控学会盆腔器官脱垂定量分期系统（ICS POP - Q）进行分期。所有女性后盆腔均有II - IV期症状性脱垂（11例患者39.2%为II期，14例患者50%为III期，3例患者10.7%为IV期）。所有患者出现并发症时均接受检查，并在术后2个月及每年接受随访。平均随访时间为26.2个月（范围2 - 58个月），71%的患者随访时间超过24个月。
患者平均年龄为63.7岁（范围46 - 83岁），平均产次2.1（1 - 3次），平均体重指数30.34 kg/m²（25 - 42）。未出现诸如肠侵蚀或直肠阴道瘘等手术或术后早期并发症。直肠膨出复发率为10.7%：1例II期直肠膨出和2例III期直肠膨出。网片阴道侵蚀发生率为10.7%。2例通过门诊重复切除及局部雌激素和局部抗菌治疗得到解决。第3例需要再次手术并切除网片。
采用缝合肛提肌并置入Vypro II网片的后穹窿修补术，即使治愈率相当高，但术后并发症发生率较高。
