Yang Tsai-Hwa, Wu Ling-Ying, Chuang Fei-Chi, Kung Fu-Tsai, Huang Kuan-Hui
Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Taiwan J Obstet Gynecol. 2017 Feb;56(1):81-86. doi: 10.1016/j.tjog.2016.12.001.
The aim of this study is to compare perioperative parameters and midterm clinical outcomes using two different mesh kits: transobturator vaginal mesh (TVM) (both Perigee and Apogee), versus single incision vaginal mesh (SIM) (combined Elevate anterior/apical system and Elevate posterior/apical system) in treating severe pelvic organ prolapse (POP).
This is a retrospective cohort study. During 2008 and 2013, those women with severe POP [POP quantification system (POP-Q), Stage III and Stage IV], who received either TVM or SIM operation, were enrolled for cohort comparison. There were 111 patients in the TVM group, and 136 in the SIM group. Those with an incomplete POP-Q record, or who did not complete postoperative urodynamic study were excluded. Perioperative characteristics and outcomes, postoperative urinary symptoms, urodynamic parameters, prolapse recurrence (defined as the leading edge > 0 using the POP-Q system), and mesh extrusion rate were compared.
There were no differences in the operation time, blood loss, hospital stay, and the postoperative visual analog scale for pain. Urodynamic studies showed improvement in bladder outlet obstruction in both groups. The postoperative stress urinary incontinence was significantly higher in the SIM group. The recurrence of prolapse was comparable between the two groups at a median follow-up of 2 years. The mesh extrusion rate was significantly lower in the SIM group.
At an average of 2 years of follow-up, the mesh extrusion rate was lower in the SIM group than in the TVM group, but there was no difference in postoperative visual analog scale for pain. The postoperative stress urinary incontinence was higher in the SIM group.
本研究旨在比较使用两种不同网片套件治疗严重盆腔器官脱垂（POP）时的围手术期参数和中期临床结果：经闭孔阴道网片（TVM）（包括Perigee和Apogee）与单切口阴道网片（SIM）（联合Elevate前/顶系统和Elevate后/顶系统）。
这是一项回顾性队列研究。在2008年至2013年期间，纳入接受TVM或SIM手术治疗的重度POP患者[POP量化系统（POP-Q），III期和IV期]进行队列比较。TVM组有111例患者，SIM组有136例患者。排除POP-Q记录不完整或未完成术后尿动力学研究的患者。比较围手术期特征和结果、术后泌尿系统症状、尿动力学参数、脱垂复发（使用POP-Q系统定义为前缘>0）和网片挤出率。
手术时间、失血量、住院时间和术后疼痛视觉模拟评分无差异。尿动力学研究显示两组膀胱出口梗阻均有改善。SIM组术后压力性尿失禁明显更高。两组在中位随访2年时脱垂复发情况相当。SIM组网片挤出率明显更低。
平均随访2年时，SIM组网片挤出率低于TVM组，但术后疼痛视觉模拟评分无差异。SIM组术后压力性尿失禁更高。
