From the Departments of Obstetrics and Gynaecology and Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; and the Department of Obstetrics and Gynaecology, Reinier de Graaf Group, Delft, the Netherlands.
Obstet Gynecol. 2011 Sep;118(3):629-636. doi: 10.1097/AOG.0b013e31822ada95.
To identify possible risk factors for exposure, dyspareunia, and pain after insertion of tension-free vaginal mesh in pelvic organ prolapse surgery.
This was a prospective observational cohort study. Consecutive women who underwent surgery with a trocar-guided tension-free vaginal mesh kit were included and evaluated at 6 weeks and at 6 and 12 months after surgery with respect to anatomy and complications. Logistic regression analysis was performed to identify risk factors for exposure, dyspareunia, and pain.
Two hundred ninety-four patients were included. Exposure was found in 34 patients (12%). Smoking and total mesh were risk factors for exposure (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.1-8.7 and OR 3.0, 95% CI 1.2-7.0, respectively). Clinical and surgical experience were inversely related to the risk of exposure (OR 0.5, 95% CI 0.3-0.8 per decade). Pain (OR 3.2, 95% CI 1.2-8.4) and dyspareunia (OR 4.7, 95% CI 1.7-12.8) before surgery were predictive for pain and dyspareunia after surgery, respectively. Pain after surgery was found in 35 out of 275 (13%) patients and dyspareunia was found in 77 out of 171 (45%) patients.
Smoking, total tension-free vaginal mesh, and experience were predictive factors for mesh exposure.
确定在盆腔器官脱垂手术中使用经阴道无张力网片修补时暴露、性交困难和疼痛的可能危险因素。
这是一项前瞻性观察性队列研究。纳入连续行经阴道无张力网片修补术的患者，分别于术后 6 周和 6、12 个月评估解剖和并发症。采用逻辑回归分析确定暴露、性交困难和疼痛的危险因素。
共纳入 294 例患者。34 例（12%）患者出现暴露。吸烟和总网片是暴露的危险因素（比值比[OR]3.1，95%置信区间[CI]1.1-8.7 和 OR 3.0，95% CI 1.2-7.0）。临床和手术经验与暴露风险呈负相关（每增加 10 年 OR 0.5，95% CI 0.3-0.8）。术前疼痛（OR 3.2，95% CI 1.2-8.4）和性交困难（OR 4.7，95% CI 1.7-12.8）是术后疼痛和性交困难的预测因素。术后疼痛发生于 275 例患者中的 35 例（13%），性交困难发生于 171 例患者中的 77 例（45%）。
吸烟、总无张力阴道网片和经验是网片暴露的预测因素。
