Shalom Dara F, Ledford Katy J, Qadir Anwaar, Lind Lawrence R, Winkler Harvey A
Division of Female Pelvic Medicine and Reconstructive Surgery, North Shore University Hospital/Long Island Jewish, Manhasset, NY, USA,
Int Urogynecol J. 2013 Nov;24(11):1909-14. doi: 10.1007/s00192-013-2106-y. Epub 2013 May 3.
Owing to the recent upsurge in adverse events reported after mesh-augmented pelvic organ prolapse (POP) repairs, our aim was to determine whether the location and depth of synthetic mesh can be measured postoperatively within the vaginal tissue microstructure using optical coherence tomography (OCT).
Seventeen patients with prior mesh-augmented repairs were recruited for participation. Patients were included if they had undergone an abdominal sacral colpopexy (ASC) or vaginal repair with mesh. Exclusion criteria were a postoperative period of <6 months, or the finding of mesh exposure on examination. OCT was used to image the vaginal wall at various POP-Q sites. If mesh was visualized, its location and depth was calculated and recorded.
Ten patients underwent ASC and 7 patients had 8 transvaginal mesh repairs. Mesh was visualized in 16 of the 17 patients using OCT. In all ASC patients, mesh was imaged centrally at the posterior apex. In patients with transvaginal mesh in the anterior and/or posterior compartments, the mesh was visualized directly anterior and/or posterior to the apex respectively. Mean depth of the mesh in the ASC, anterior, and posterior groups was 60.9, 146.7, and 125.7 μm respectively. Mesh was visualized within the vaginal epithelial layer in all 16 patients despite the route of placement.
In this pilot study we found that OCT can be used to visualize polypropylene mesh within the vaginal wall following mesh-augmented prolapse repair. Regardless of abdominal versus vaginal placement, the mesh was identified within the vaginal epithelial layer.
由于近期网状物增强盆底器官脱垂（POP）修复术后不良事件报告的激增，我们的目的是确定是否可以使用光学相干断层扫描（OCT）在术后阴道组织微观结构内测量合成网片的位置和深度。
招募了17例先前接受过网状物增强修复的患者。如果患者接受过腹骶阴道固定术（ASC）或网状物阴道修复术，则纳入研究。排除标准为术后时间<6个月，或检查发现网片暴露。使用OCT对不同POP-Q位点的阴道壁进行成像。如果观察到网片，则计算并记录其位置和深度。
10例患者接受了ASC，7例患者进行了8次经阴道网片修复。使用OCT在17例患者中的16例中观察到了网片。在所有ASC患者中，网片在中央后顶点成像。在前部和/或后部隔室中有经阴道网片的患者中，网片分别在顶点的直接前方和/或后方观察到。ASC组、前部组和后部组中网片的平均深度分别为60.9、146.7和125.7μm。尽管放置途径不同，但在所有16例患者的阴道上皮层内均观察到了网片。
在这项初步研究中，我们发现OCT可用于在网状物增强脱垂修复术后观察阴道壁内的聚丙烯网片。无论采用腹部还是阴道放置，网片均在阴道上皮层内被识别。
