Lo Tsia-Shu, Yusoff Faridah Mohd, Kao Chuan-Chi, Jaili Sukanda, Uy Patrimonio Ma Clarissa
Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China; Division of Urogynaecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China.
Department of Obstetrics and Gynaecology, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia; Fellow of the Division of Urogynaecology, Department of Obstetrics & Gynaecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China.
Taiwan J Obstet Gynecol. 2017 Jun;56(3):346-352. doi: 10.1016/j.tjog.2017.04.015.
Transvaginal mesh anterior-posterior (TVM-AP) provides better cure rates in the surgical treatment of vaginal cuff eversion than anterior transvaginal mesh combined with sacrospinous ligament fixation (TVM-A). We determine the outcomes after TVM-A and TVM-AP surgeries in advanced vaginal cuff prolapse.
The charts of 796 women who underwent pelvic organ prolapse (POP) surgery from July 2006 to January 2012 in Chang Gung Memorial Hospitals were reviewed. We included women who presented with advanced cuff eversion and treated with TVM surgery. Data were analysed after three years post-surgery. Descriptive statistics were used for demographic and perioperative data. The paired-samples t test was used for comparison of preoperative and postoperative continuous data. The outcomes measured were objective cure (POP-Q stage ≤ 1) and subjective cure (negative response to question 2 and 3 on POPDI-6).
A total of 97 patients was analysed. 61 patients had TVM-A and 36 patients had TVM-AP insertion. Mean follow-up was 52 months. The objective cure rate for TVM-AP was significantly higher than TVM-A, 94.4% versus 80.3%. TVM-AP also showed a higher subjective cure rate (91.7%) though there was no significant difference from TVM-A (p = 0.260). The mesh extrusion rate was low at 3.1% with no major complications seen. In TVM-A the blood loss was lesser and the operation time was shorter.
TVM-AP showed better objective cure rate than TVM-A at 52 months. However, TVM-A is less invasive in comparison with an acceptably good cure rates.
在阴道袖口外翻的手术治疗中，经阴道前后网片（TVM-AP）比经阴道前路网片联合骶棘韧带固定术（TVM-A）的治愈率更高。我们确定了在晚期阴道袖口脱垂中TVM-A和TVM-AP手术后的结局。
回顾了2006年7月至2012年1月在长庚纪念医院接受盆腔器官脱垂（POP）手术的796名女性的病历。我们纳入了出现晚期袖口外翻并接受TVM手术治疗的女性。术后三年进行数据分析。描述性统计用于人口统计学和围手术期数据。配对样本t检验用于术前和术后连续数据的比较。测量的结局指标为客观治愈（盆腔器官脱垂定量分期系统（POP-Q）≤1期）和主观治愈（对盆腔器官脱垂-6问卷中问题2和3的回答为阴性）。
共分析了97例患者。61例患者接受了TVM-A手术，36例患者植入了TVM-AP。平均随访时间为52个月。TVM-AP的客观治愈率显著高于TVM-A，分别为94.4%和80.3%。TVM-AP的主观治愈率也较高（91.7%），尽管与TVM-A相比无显著差异（p = 0.260）。网片挤出率较低，为3.1%，未观察到重大并发症。在TVM-A手术中，失血量较少，手术时间较短。
在52个月时，TVM-AP的客观治愈率优于TVM-A。然而，与可接受的良好治愈率相比，TVM-A的侵入性较小。
