Li Li, Wang Xiaoyuan, Park Ji Young, Chen Hao, Wang Yiying, Zheng Wenxin
Department of Pathology, Shandong University, School of Medicine, Jinan, Shandong, 250012, PR China; Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, 85724, USA; Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, 85724, USA; Department of Obstetrics and Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, 250014, PR China.
Hum Pathol. 2017 Nov;69:46-54. doi: 10.1016/j.humpath.2017.07.020. Epub 2017 Sep 29.
In light of the legal issues and the shortage of data on histopathological findings, we summarized our experience on how explanted vaginal mesh specimens were managed in a surgical pathology practice during the last 5 years. Clinical history and pathology reports were collected from 155 women undergoing transvaginal tape excision. The degree of chronic inflammation, fibrosis, foreign-body giant cell reactions, the number of capillary vessels and nerve fibers, and the presence or absence of adipose tissue were recorded. Among the 155 patients, 65 (41.9%) were active medicolegal cases, with a significant increase in recent years. The main medical indications for mesh excision were pelvic pain, mesh erosion, voiding dysfunction, genital organ prolapse, and vaginal bleeding. In most cases, mild to moderate chronic inflammation with a mild degree of foreign-body giant cell reaction and minimal to mild fibrosis were found in explanted mesh specimens. The specimens were well vascularized without any evidence of nerve abnormality. Patient age correlated negatively with vaginal pain (P = .007) but positively with erosion (P = .005). In addition, the presence of adipose tissue within the explanted mesh correlated significantly with pelvic pain (P = .016). Overall, there was good tissue integration in all specimens. Considering the significant increase in the number of lawsuits in recent years, we recommend that all explanted vaginal mesh specimens be examined microscopically as well as grossly. A list of microscopic findings, including the presence or absence of adipose tissue, is suggested.
鉴于法律问题以及组织病理学结果的数据短缺，我们总结了过去5年在外科病理学实践中处理取出的阴道网片标本的经验。收集了155例接受经阴道吊带切除术的女性的临床病史和病理报告。记录慢性炎症程度、纤维化程度、异物巨细胞反应、毛细血管和神经纤维数量以及脂肪组织的有无。在这155例患者中，65例（41.9%）是正在进行的医疗法律案件，近年来显著增加。网片切除的主要医学指征是盆腔疼痛、网片侵蚀、排尿功能障碍、生殖器官脱垂和阴道出血。在大多数情况下，取出的网片标本中发现轻度至中度慢性炎症，伴有轻度异物巨细胞反应和轻度至中度纤维化。标本血管化良好，没有任何神经异常的证据。患者年龄与阴道疼痛呈负相关（P = 0.007），但与侵蚀呈正相关（P = 0.005）。此外，取出的网片中脂肪组织的存在与盆腔疼痛显著相关（P = 0.016）。总体而言，所有标本的组织整合良好。考虑到近年来诉讼数量的显著增加，我们建议对所有取出的阴道网片标本进行肉眼和显微镜检查。建议列出显微镜检查结果清单，包括脂肪组织的有无。
