Sekiguchi Yuki, Kinjo Manami, Maeda Yoshiko, Kubota Yoshinobu
Yokohama Motomachi Women's Clinic LUNA, 3-115 Hyakudan-kan 5F, Motomach, Nakaku, Yokohama, 231-0861, Japan,
Int Urogynecol J. 2014 Jun;25(6):783-9. doi: 10.1007/s00192-013-2281-x. Epub 2013 Dec 7.
In 2005, a new minimally invasive procedure, the tissue fixation system (TFS) was reported. Like TVT (tension-free vaginal tape), the TFS works by creating a foreign body collagenous tissue reaction that reinforces a weakened pelvic ligament. The objective was to assess the effectiveness and perioperative safety of TFS in a day surgery clinic for the treatment of pelvic organ prolapse (POP).
The TFS tape was applied in a tunnel adjacent to natural ligaments to repair the anterior cervical ring and cardinal ligament, paravaginal tissues and uterosacral ligaments under local anesthesia/sedation. We prospectively studied 60 patients, mean age 67, between October 2008 and February 2010 at Women's Clinic LUNA. Levels of POP were grade 2 (n = 20; 7 %), grade 3 (n = 30; 55 %), and grade 4 (n = 4; 7 %) according to the ICS POPQ classification. Fifty-four patients (90 %) who underwent a total of 162 POP operations presented for review. Follow-up was performed at 12 months. We defined surgical failure according to the ICS POPQ classification. We used prolapse quality of life (P-QOL) questions for QOL measurement.
Ninety-eight percent of patients were discharged on the day of surgery. Of the 162 TFS operations reviewed, 157 were successful and 5 failed. The 5 failed operations comprised 4 cystoceles and 1 rectocele. Two patients developed cervical protrusions at the introitus at 6 months with no prolapse of the uterine body. We found 5 cases of erosion in 162 tape insertions. The total number of patients who had no complications, no surgical failures, no erosions, no sensation of bulging, and no cervical protrusions was 47 (87 %).
The TFS uses the same surgical principle for repair as the TVT; this principle vastly minimizes the volume of mesh used, erosions, and other complications.
2005年，一种新的微创手术——组织固定系统（TFS）被报道。与经阴道无张力尿道中段吊带术（TVT）一样，TFS通过引发异物胶原组织反应来增强薄弱的盆腔韧带，从而发挥作用。目的是评估在日间手术诊所中TFS治疗盆腔器官脱垂（POP）的有效性和围手术期安全性。
在局部麻醉/镇静下，将TFS吊带置于与天然韧带相邻的隧道内，以修复宫颈前环、主韧带、阴道旁组织和子宫骶韧带。我们于2008年10月至2010年2月在LUNA妇女诊所对60例平均年龄67岁的患者进行了前瞻性研究。根据国际尿控学会（ICS）盆腔器官脱垂定量分期（POPQ）分类，POP的程度为2级（n = 20；7%）、3级（n = 30；55%）和4级（n = 4；7%）。54例（90%）共接受了162次POP手术的患者接受了复查。随访在12个月时进行。我们根据ICS POPQ分类定义手术失败。我们使用脱垂生活质量（P-QOL）问题来测量生活质量。
98%的患者在手术当天出院。在复查的162例TFS手术中，157例成功，5例失败。5例失败手术包括4例膀胱膨出和1例直肠膨出。2例患者在6个月时阴道外口出现宫颈突出，但子宫体无脱垂。我们在162次吊带置入中发现5例侵蚀。无并发症、无手术失败、无侵蚀、无膨出感且无宫颈突出的患者总数为47例（87%）。
TFS采用与TVT相同的手术修复原则；该原则极大地减少了网片的使用量、侵蚀及其他并发症。
