Cadenbach-Blome Tina, Grebe Markus, Mengel Mathias, Pauli Friedrich, Greser Angelika, Fünfgeld Christian
Asklepios Klinik Altona, Hamburg, Germany.
Städtisches Krankenhaus, Dresden, Germany.
Geburtshilfe Frauenheilkd. 2019 Sep;79(9):959-968. doi: 10.1055/a-0984-6614. Epub 2019 Sep 11.
Patients who suffer from pelvic organ prolapse can experience severe limitations in their quality of life. To improve the quality of life of women affected and achieve a stable reconstruction, surgical therapy is often indispensable. In conventional prolapse surgery, the rate of recurrence is high. For this reason, alloplastic mesh has been implanted increasingly in recent years to reconstruct the anatomy of the pelvic floor organs. Even if the anatomical result can be significantly improved as a result, the mesh-induced complications have been the subject of controversial discussion. In this national, multicentre study, the quality of life, anatomical result as well as the rate of complications following the implantation of an alloplastic mesh for the correction of a cystocele were investigated. Fifty-four patients with symptomatic ≥ grade II were included in this prospective, national, multicentre study. The study participants were implanted with a titanised polypropylene mesh (TiLOOP PRO A, pfm medical ag). The follow-up observation period was 12 months. Primary as well as repeat procedures were taken into account. The anatomic result of the pelvic floor reconstruction was quantified using the POP-Q system. Data on quality of life and sexuality were collected using validated questionnaires. All complications which occurred were documented and evaluated by an independent committee. On average, the patients were in line with the census. An improvement in quality of life was able to be determined during the study in all domains investigated (p < 0.001, Wilcoxon test). Minus incorrect entries and incorrect reports, a total of 19 reports of adverse events in 15 patients were evaluated by the end of the study. The rate of recurrence in the anterior compartment was 4.3%. In the reconstruction of the anatomical position of the pelvic floor organs given the presence of a symptomatic cystocele, the implantation of a third-generation alloplastic mesh achieves very good results. Affected patients benefit from the anatomical stability as well as a significant improvement in quality of life, whereby the risks are justifiable.
患有盆腔器官脱垂的患者生活质量会受到严重限制。为提高受影响女性的生活质量并实现稳定的重建，手术治疗通常必不可少。在传统的脱垂手术中，复发率很高。因此，近年来异体网片越来越多地被用于盆底器官解剖结构的重建。即便由此可显著改善解剖学结果，但网片引发的并发症一直是备受争议的话题。在这项全国性多中心研究中，对用于纠正膀胱膨出的异体网片植入后的生活质量、解剖学结果以及并发症发生率进行了调查。54例症状≥II级的患者被纳入这项前瞻性全国多中心研究。研究参与者植入了经钛化处理的聚丙烯网片（TiLOOP PRO A，pfm medical ag公司）。随访观察期为12个月。纳入了初次手术以及再次手术的情况。采用POP-Q系统对盆底重建的解剖学结果进行量化。使用经过验证的问卷收集生活质量和性功能方面的数据。所有发生的并发症均由一个独立委员会记录并评估。平均而言，患者与人口普查情况相符。在研究期间，所有调查领域的生活质量均有改善（p < 0.001，Wilcoxon检验）。扣除错误录入和错误报告，到研究结束时共评估了15例患者的19例不良事件报告。前盆腔的复发率为4.3%。在存在有症状膀胱膨出的情况下进行盆底器官解剖位置的重建时，植入第三代异体网片可取得非常好的效果。受影响的患者受益于解剖学稳定性以及生活质量的显著改善，且风险是合理可接受的。
