Moore Robert D, Mitchell Gretchen K, Miklos John R
Atlanta Urogynecology Associates, Atlanta, GA, USA.
Int Urogynecol J. 2012 Jan;23(1):85-91. doi: 10.1007/s00192-011-1536-7. Epub 2011 Aug 25.
The safety and early efficacy of a new technique to treat cystocele and/or concomitant apical prolapse through a single vaginal incision with a lightweight mesh anchored apically bilaterally to the sacrospinous ligaments is reported.
Women with anterior compartment and/or apical prolapse ≥ stage II underwent repair through a single anterior vaginal wall incision with the Anterior Elevate System (AES). The technique utilizes a lightweight (24 g/m(2)) type I mesh anchored to the sacrospinous ligaments via two mesh arms with small self-fixating tips. The bladder neck portion of the graft is anchored to the obturator internus with similar self-fixating tips. The apical portion of the graft is adjustable to vaginal length prior to locking in place. Outcome measures included prolapse degree at last follow-up visit, intra/post-operative complications, and QOL assessments.
Sixty patients were implanted with average follow-up of 13.4 months (range 3-24 months). Mean pre-op Ba was +2.04 ± 1.3 and C -2.7 ± 2.9. Average blood loss was 47 cc and average hospital stay was 23 h. Sixty-two percent of patients had concomitant sling for SUI. Mean post-op Ba is -2.45 ± 0.9 and C -8.3 ± 0.9. There was no statistical difference in pre- to post-op TVL. Objective cure rate at current follow-up is 91.7% (≤ stage 1). To date, there have been no mesh extrusions. No patients have reported significant buttock or leg pain. No patients have required surgical revision for any reason.
The AES is a minimally invasive technique to treat anterior compartment and/or apical prolapse through a single vaginal incision. Initial results show the procedure to be safe and early efficacy is promising. Longer-term follow-up is ongoing.
报告了一种通过单一阴道切口，使用轻质网片双侧顶端锚定至骶棘韧带治疗膀胱膨出和/或伴随的顶端脱垂的新技术的安全性和早期疗效。
前盆腔和/或顶端脱垂≥II期的女性通过单一阴道前壁切口使用前位提升系统（AES）进行修复。该技术使用一种轻质（24 g/m²）的I型网片，通过两个带有小自固定尖端的网片臂锚定至骶棘韧带。移植物的膀胱颈部分通过类似的自固定尖端锚定至闭孔内肌。移植物的顶端部分在锁定到位前可根据阴道长度进行调整。结果指标包括最后一次随访时的脱垂程度、术中/术后并发症以及生活质量评估。
60例患者接受了植入，平均随访13.4个月（范围3 - 24个月）。术前平均Ba为+2.04 ± 1.3，C为 -2.7 ± 2.9。平均失血量为47 cc，平均住院时间为23小时。62%的患者同时进行了压力性尿失禁吊带术。术后平均Ba为 -2.45 ± 0.9，C为 -8.3 ± 0.9。术前至术后阴道总长度无统计学差异。目前随访时的客观治愈率为91.7%（≤I期）。迄今为止，没有网片外露情况。没有患者报告严重的臀部或腿部疼痛。没有患者因任何原因需要进行手术翻修。
AES是一种通过单一阴道切口治疗前盆腔和/或顶端脱垂的微创技术。初步结果表明该手术安全且早期疗效良好。正在进行长期随访。
