Svabík Kamil, Martan Alois, Masata Jaromir, El-Haddad Rachid, Hubka Petr, Pavlikova Marketa
Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Apolinarska 18, Prague 2 128 00, Czech Republic.
Int Urogynecol J. 2011 May;22(5):529-33. doi: 10.1007/s00192-010-1308-9. Epub 2010 Oct 26.
Polypropylene meshes are frequently used in abdominal and vaginal reconstructive surgery. Recently, several authors have claimed that mesh-associated complications may be linked to mesh shrinkage. We have performed a prospective study with postoperative follow-up by ultrasound examination at two time points after Prolift anterior implantation to assess changes in the ultrasound appearance of mesh implants over time.
We assessed 36 patients who had undergone mesh implantation with Prolift anterior mesh for the correction of symptomatic anterior vaginal wall prolapse. During the surgery, we measured the actual midline length of the mesh (initial length). On the fourth postoperative day, we performed a vaginal ultrasound examination (US) to measure mesh length in the midsagittal plane. A second US was performed 3-5 months after surgery to repeat this measurement.
There was a significant difference in mesh length determined before and 4 days after surgery (90.3 vs. 57.1 mm, P = <0.0001) indicating intraoperative folding. On comparing early and late postoperative ultrasound measurements, there was a reduction in length from 57.1 to 48.3 mm (P < 0.0001), indicating possible shrinkage or retraction.
Intraoperative folding seems to be responsible for a large part of the difference between preoperative (in vitro) and postoperative (US) measurements of mesh dimensions, suggesting that surgical techniques may require adjustment.
聚丙烯网片常用于腹部和阴道重建手术。最近，一些作者声称与网片相关的并发症可能与网片收缩有关。我们进行了一项前瞻性研究，在植入前盆底重建系统（Prolift anterior）后两个时间点通过超声检查进行术后随访，以评估网片植入物超声表现随时间的变化。
我们评估了36例接受前盆底重建系统网片植入术以纠正有症状的阴道前壁脱垂的患者。在手术过程中，我们测量了网片的实际中线长度（初始长度）。术后第四天，我们进行了阴道超声检查（US）以测量矢状面中网片的长度。术后3 - 5个月进行第二次超声检查以重复该测量。
手术前和术后4天测定的网片长度存在显著差异（90.3对57.1毫米，P = <0.0001），表明术中存在折叠。比较术后早期和晚期的超声测量结果，长度从57.1毫米减少到48.3毫米（P < 0.0001），表明可能存在收缩或回缩。
术中折叠似乎是术前（体外）和术后（超声）网片尺寸测量差异的很大一部分原因，这表明手术技术可能需要调整。
