Osmundsen Blake C, Clark Amanda, Goldsmith Crystal, Adams Kerrie, Denman Mary Anna, Edwards Renee, Gregory William Thomas
Oregon Health & Science University, Portland, OR, USA.
Female Pelvic Med Reconstr Surg. 2012 Mar-Apr;18(2):86-8. doi: 10.1097/SPV.0b013e318246806d.
This study aimed to compare the incidence of mesh erosion after robotic sacrocolpopexy between women undergoing total and those undergoing supracervical hysterectomy (SH).
This is a retrospective cohort study of women who underwent sacrocolpopexy and concomitant hysterectomy using the DaVinci surgical robot between May 2007 and December 2010 at 2 sites. Baseline data were gathered before surgery. The primary outcome was mesh erosion identified during 3 months of follow-up.
A total of 102 women underwent sacrocolpopexy, of whom 45 were with concomitant SH and 57 were with total hysterectomy (TH). Their mean age was 58 years, mean body mass index was 26.8 kg/m, 98% were white, 6% smoked, and 25% were on systemic hormone replacement therapy. Mean preoperative Ba = +1.4, C = -2.2. These were not different between the 2 groups or by site. Within 3 months of surgery, mesh erosion was diagnosed in 8 women, all of whom had TH. No mesh erosions occurred in the SH group (14% vs 0%). Total hysterectomy mesh erosion rate at site 1 was 37% compared with 3% [corrected] at site 2. Mesh type was the only identifiable difference between sites: self-cut polypropylene at site 1, precut polypropylene at site 2. Two women in the SH had abnormal uterine pathology: 1 endometrial adenocarcinoma and 1 focus of hyperplasia with atypia.
No mesh erosions were associated with SH within the first 3 months. In TH, the graft material used may be a modifiable factor needing further investigation. Unexpected abnormal uterine pathologic diagnosis remains a possibility with SH. Longer-term follow-up and a randomized trial are warranted to answer these questions.
本研究旨在比较全子宫切除术和次全子宫切除术（SH）的女性在机器人骶骨阴道固定术后网片侵蚀的发生率。
这是一项回顾性队列研究，研究对象为2007年5月至2010年12月期间在2个地点使用达芬奇手术机器人接受骶骨阴道固定术及同期子宫切除术的女性。术前收集基线数据。主要结局是在随访3个月期间发现的网片侵蚀。
共有102名女性接受了骶骨阴道固定术，其中45名同时进行了SH，57名进行了全子宫切除术（TH）。她们的平均年龄为58岁，平均体重指数为26.8kg/m，98%为白人，6%吸烟，25%接受全身激素替代治疗。术前平均Ba=+1.4，C=-2.2。两组之间或不同地点之间无差异。术后3个月内，8名女性被诊断为网片侵蚀，她们均接受了TH。SH组未发生网片侵蚀（14%对0%）。地点1的全子宫切除术网片侵蚀率为37%，而地点2为3%[校正后]。网片类型是不同地点之间唯一可识别的差异：地点1为自切割聚丙烯网片，地点2为预切割聚丙烯网片。SH组中有2名女性存在异常子宫病理情况：1例子宫内膜腺癌和1例非典型增生灶。
在最初3个月内，SH与网片侵蚀无关。在TH中，所使用的移植材料可能是一个需要进一步研究的可改变因素。SH仍有可能出现意外的异常子宫病理诊断。需要进行长期随访和随机试验来回答这些问题。
