Culligan Patrick J, Gurshumov Emil, Lewis Christa, Priestley Jennifer L, Komar Jodie, Shah Nihar, Salamon Charbel G
Atlantic Health System, Urogynecology and Pelvic Reconstructive Surgery, 435 South Street, Suite 370, Morristown, NJ, 07960, USA,
Int Urogynecol J. 2014 Jun;25(6):731-5. doi: 10.1007/s00192-013-2265-x. Epub 2013 Nov 22.
The objective of this study was to assess outcomes following robotic sacrocolpopexy using a lightweight polypropylene Y-mesh.
During our study period, all patients who underwent robotic sacrocolpopexy were enrolled in this single-arm prospective trial. Endpoints included Pelvic Organ Prolapse Quantification (POP-Q) values; Pelvic Floor Distress Inventory, short form 20 (PFDI-20); Pelvic Floor Impact Questionnaire, short form 7 (PFIQ-7); Surgical Satisfaction scores; and the Sandvik Incontinence Severity Index. All surgeries were performed with a pre-configured monofilament type 1 polypropylene Y-mesh (Alyte©, C.R. Bard, Covington, GA, USA). Cure rates at 12 months were calculated using two separate definitions: (1) "clinical cure": no POP-Q points > 0, point C ≤ -5, no prolapse symptoms on the PFDI-20, and no reoperations for prolapse and (2) "objective anatomic cure": POP-Q stage 0 or 1, point C of ≤ -5, and no reoperations for prolapse.
A total of 150 patients underwent robotic sacrocolpopexy and 143 (95 %) were available for 12-month follow-up. Mean age was 58.6 ± 9.8 and mean body mass index was 26.3 ± 4.5. Mean operative time and blood loss were 148 ± 27.6 min (range 75-250 min) and 51.2 ± 32, respectively. There were no mesh erosions or exposures, and mesh edges were not palpable in any patient. At 12 months the clinical cure rate was 95 %, and the objective anatomic cure rate was 84 %. The PFDI-20 mean score improved from 98 at baseline to 17 at 12 months (p < 0.0001); PFIQ-7 scores improved from 59 to 6.5 (p < 0.0001).
Robotic sacrocolpopexy using this lightweight polypropylene Y-mesh offers excellent subjective and objective results at 1 year.
本研究的目的是评估使用轻质聚丙烯Y形网片进行机器人骶骨阴道固定术的疗效。
在我们的研究期间，所有接受机器人骶骨阴道固定术的患者均纳入了这项单臂前瞻性试验。观察指标包括盆腔器官脱垂定量（POP-Q）值；盆底困扰量表简表20（PFDI-20）；盆底影响问卷简表7（PFIQ-7）；手术满意度评分；以及山德维克尿失禁严重程度指数。所有手术均使用预先配置的单丝1型聚丙烯Y形网片（Alyte©，美国科维顿市C.R. Bard公司）进行。采用两种不同的定义计算12个月时的治愈率：（1）“临床治愈”：POP-Q评分无>0分，C点≤-5分，PFDI-20上无脱垂症状，且无因脱垂而再次手术；（2）“客观解剖学治愈”：POP-Q分期为0或1期，C点≤-5分，且无因脱垂而再次手术。
共有150例患者接受了机器人骶骨阴道固定术，143例（95%）患者完成了12个月的随访。平均年龄为58.6±9.8岁，平均体重指数为26.3±4.5。平均手术时间和失血量分别为148±27.6分钟（范围75 - 250分钟）和51.2±32。没有出现网片侵蚀或暴露情况，且在任何患者中均未触及网片边缘。12个月时临床治愈率为95%，客观解剖学治愈率为84%。PFDI-20平均评分从基线时的98分改善至12个月时的17分（p<0.0001）；PFIQ-7评分从59分改善至6.5分（p<0.0001）。
使用这种轻质聚丙烯Y形网片进行机器人骶骨阴道固定术在1年时可提供优异的主观和客观疗效。
