Department of Urology, Columbia University Medical Center, New York, New York.
Department of Urology, Columbia University Medical Center, New York, New York.
J Urol. 2017 Sep;198(3):632-637. doi: 10.1016/j.juro.2017.04.015. Epub 2017 Apr 8.
The use of mesh in vaginal cystocele repair has decreased. We analyzed the ACS NSQIP® (American College of Surgeons National Surgical Quality Improvement Project) database to compare outcomes of repairs with and without mesh.
CPT was used to identify patients who underwent cystocele repair with and without mesh from 2006 to 2013. Patient characteristics and complications were analyzed.
We identified 6,849 patients, of whom 5,667 (82.5%) underwent native tissue repair and 1,182 (17.5%) underwent repair with mesh. Patients who received mesh were older (mean ± SD age 64 ± 11 vs 60 ± 12 years, p <0.001) and more had comorbidities (56% vs 47%, p <0.001). Mean mesh vs nonmesh operative time (97 ± 67 vs 95 ± 53 minutes, p = 0.2) and mean length of stay (1.3 ± 2.4 vs 1.4 ± 1.3 days, p = 0.2) were similar in the 2 groups. Urinary tract infection was the most common complication in cases without vs with mesh (3.8% vs 3.5%). Mesh procedure rates of mortality (0% vs 0.3%, p = 0.04) and overall surgical complications (1.8% vs 3.9% p <0.001) were higher. On multivariate analysis ASA® class 3 or greater (OR 1.4, p = 0.01), longer operative time (OR 1.004, p <0.001) and mesh (OR 1.32, p = 0.05) were associated with greater morbidity. Patient comorbidities, surgeon specialty and concomitant procedures did not confer an increased risk of complications.
Native tissue repair is performed more commonly than mesh repair. ASA class, operative time and mesh use are associated with an increased risk of postoperative morbidity. These results suggest an increased risk of complications when using mesh in vaginal anterior repair, although the overall risk in each procedure was low.
阴道膀胱膨出修补术中使用网片的情况有所减少。我们分析了 ACS NSQIP®（美国外科医师学会国家外科质量改进计划）数据库，以比较有网片和无网片修补的结果。
使用 CPT 从 2006 年至 2013 年确定接受膀胱膨出修补术伴或不伴网片的患者。分析患者特征和并发症。
我们共确定了 6849 例患者，其中 5667 例（82.5%）行固有组织修复，1182 例（17.5%）行网片修复。接受网片的患者年龄更大（平均年龄 ± 标准差：64 ± 11 岁 vs. 60 ± 12 岁，p <0.001），合并症更多（56% vs. 47%，p <0.001）。两组的网片与非网片手术时间（97 ± 67 分钟 vs. 95 ± 53 分钟，p = 0.2）和平均住院时间（1.3 ± 2.4 天 vs. 1.4 ± 1.3 天，p = 0.2）相似。无网片与有网片的尿路感染发生率（3.8% vs. 3.5%）最高。无网片死亡率（0% vs. 0.3%，p = 0.04）和总体手术并发症发生率（1.8% vs. 3.9%，p <0.001）更高。多变量分析显示，ASA® 3 级或以上（OR 1.4，p = 0.01）、手术时间较长（OR 1.004，p <0.001）和使用网片（OR 1.32，p = 0.05）与更高的发病率相关。患者合并症、手术医生专业和伴随手术并未增加并发症的风险。
固有组织修复的应用比网片修复更为常见。ASA 分级、手术时间和网片使用与术后发病率增加相关。这些结果表明，在阴道前修补术中使用网片会增加并发症的风险，尽管每种手术的总体风险较低。
