Gillor Moshe, Langer Susanne, Dietz Hans Peter
Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, 2750, Australia.
Kaplan Medical Center, Affiliated to the Hebrew University and Hadassah School of Medicine in Jerusalem, Rehovot, Israel.
Int Urogynecol J. 2019 Sep;30(9):1581-1585. doi: 10.1007/s00192-019-03921-0. Epub 2019 Mar 23.
Our primary objective was to describe long-term outcomes after posterior colporrhaphy with and without mesh augmentation.
This was a retrospective study including 93 patients after posterior colporrhaphy (native tissue in 39 and synthetic mesh augmented in 54). The indication was symptoms of prolapse with clinical posterior vaginal wall prolapse. Mesh augmentation and concomitant prolapse operations were performed at the surgeon's discretion. Patients underwent interview, clinical examination and 4D pelvic floor ultrasound. Imaging analysis was done with the reviewer blinded against all other data. Generalized linear modeling was used to compare groups with logistic regression for binary and linear regression for continuous outcomes.
Patients were seen on average 5.3 years after surgery and described persistent symptoms of prolapse in 32% and of obstructed defecation in 33%. Clinical recurrence (Bp ≥ -1) was seen in 20%, while sonographic recurrence (rectal ampulla descent to ≥ 15 mm below the symphysis pubis) was noted in 12%. A true rectocele was diagnosed in 33% of patients. No major differences in outcomes were found between those who underwent native tissue and those who had a mesh-augmented repair.
Mesh augmentation was not superior to native tissue posterior colporrhaphy, and both were only moderately effective in eliminating a true rectocele and symptoms of obstructed defecation 5 years after reconstructive surgery.
我们的主要目的是描述后路阴道修补术（有无网片增强）后的长期结果。
这是一项回顾性研究，纳入了93例行后路阴道修补术的患者（39例使用天然组织，54例使用合成网片增强）。手术指征为脱垂症状伴临床阴道后壁脱垂。网片增强及同期脱垂手术由外科医生酌情进行。患者接受了访谈、临床检查和四维盆底超声检查。影像分析由审阅者在对所有其他数据不知情的情况下进行。采用广义线性模型，通过二元逻辑回归和连续结果的线性回归对各组进行比较。
患者术后平均随访5.3年，32%的患者描述有持续的脱垂症状，33%的患者有排便障碍症状。临床复发（膀胱阴道隔≥ -1）发生率为20%，而超声复发（直肠壶腹下降至耻骨联合下方≥ 15 mm）发生率为12%。33%的患者被诊断为真性直肠膨出。接受天然组织修补和网片增强修补的患者在结果上没有发现重大差异。
网片增强并不优于天然组织后路阴道修补术，两者在重建手术后5年消除真性直肠膨出和排便障碍症状方面均仅具有中等疗效。
