Warner William B, Vora Sonali, Hurtado Eric A, Welgoss Jeffrey A, Horbach Nicolette S, von Pechmann Walter S
Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Female Pelvic Med Reconstr Surg. 2012 Mar-Apr;18(2):113-7. doi: 10.1097/SPV.0b013e318249bd54.
To determine if opening the vaginal cuff during laparoscopic sacrocolpopexy influences the rate of mesh exposure.
A total of 390 medical records were retrospectively reviewed for demographic information, operative technique, and relevant outcomes.
Eleven mesh exposures (2.8%) and 14 suture extrusions (3.6%) were found, none involving visceral organs. Mesh exposure was more common when the vaginal cuff was opened, either during hysterectomy or when allowing transvaginal attachment of mesh in patients with a prior hysterectomy (4.9% vs 0.5%; relative risk [RR], 9.0, P = 0.012). In cases where concomitant hysterectomy was performed, a higher mesh exposure rate was seen in open-cuff hysterectomy (total vaginal hysterectomy/laparoscopically assisted vaginal hysterectomy) compared to supracervical hysterectomy (4.9% [9/185] vs 0% [0/92]; P = 0.032). Mesh exposure was more common when the mesh was sutured laparoscopically compared with transvaginally in patients undergoing open-cuff hysterectomy (14.3% [5/35] vs 2.7% [4/150]; RR, 5.4; P = 0.013). Permanent suture extrusion was significantly associated with laparoscopic versus transvaginal suturing of mesh (5.6% vs 0.6%; RR, 8.8; P = 0.010). Five patients underwent reoperation for mesh exposure, whereas most suture extrusions were asymptomatic; and all were managed nonsurgically.
We found that preserving the integrity of the vaginal cuff led to a lower incidence of mesh exposure in patients undergoing laparoscopic sacrocolpopexy. When hysterectomy is indicated, a supracervical technique should be strongly considered as the mesh exposure rate was significantly lower. If removal of the cervix is indicated, the risk for mesh exposure remains low and should not preclude total hysterectomy, though transvaginal mesh attachment may be preferable.
确定在腹腔镜骶骨阴道固定术中打开阴道断端是否会影响网片暴露率。
回顾性分析390份病历，收集人口统计学信息、手术技术及相关结果。
发现11例网片暴露（2.8%）和14例缝线外露（3.6%），均未累及内脏器官。在子宫切除术中打开阴道断端时，或在既往有子宫切除术的患者中经阴道固定网片时，网片暴露更为常见（4.9%对0.5%；相对危险度[RR]，9.0，P = 0.012）。在同期行子宫切除术的病例中，与次全子宫切除术相比，开放式断端子宫切除术（全子宫切除术/腹腔镜辅助阴道子宫切除术）的网片暴露率更高（4.9%[9/185]对0%[0/92]；P = 0.032）。在开放式断端子宫切除术患者中，与经阴道缝合网片相比，腹腔镜缝合网片时网片暴露更为常见（14.3%[5/35]对2.7%[4/150]；RR，5.4；P = 0.013）。永久性缝线外露与腹腔镜缝合网片和经阴道缝合网片显著相关（5.6%对0.6%；RR，8.8；P = 0.010）。5例患者因网片暴露接受再次手术，而大多数缝线外露无症状；所有患者均采取非手术治疗。
我们发现，在接受腹腔镜骶骨阴道固定术的患者中，保持阴道断端的完整性可降低网片暴露的发生率。当需要行子宫切除术时，应强烈考虑采用次全子宫切除术技术，因为其网片暴露率显著较低。如果需要切除子宫颈，网片暴露的风险仍然较低，不应排除行全子宫切除术，尽管经阴道固定网片可能更可取。
