Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan.
J Formos Med Assoc. 2019 Dec;118(12):1623-1632. doi: 10.1016/j.jfma.2019.08.034. Epub 2019 Sep 18.
BACKGROUND/PURPOSE: The most suitable surgical technique for pelvic organ prolapse (POP) remains undetermined. The aim of this study was to compare clinical outcomes of the tailored transvaginal mesh (TVM) surgery and vaginal native tissue repair (NTR) surgery for POP.
Between November 2011 and August 2014, medical records of 339 women receiving POP surgeries were reviewed.
Compared with the NTR group (n = 169), the use of TVM surgery (n = 170) was a predictor for longer operation time (coefficient = 25.2 min, P < 0.001) and larger blood loss (coefficient = 79.9 mL, P < 0.001) by multivariable analysis. However, a higher recurrence rate of cystoceles (log-rank test, P = 0.001) was found in the NTR group, compared with the TVM group; but not apical prolapse (P = 0.32) or rectocele (P = 0.45). Multivariable analysis revealed that the TVM surgery (hazard ratio = 0.24, 95% confidence interval = 0.09-0.64, P = 0.004) and old age (hazard ratio = 1.07, 95% confidence interval = 1.02-1.11, P = 0.005) were independent predictors for the recurrence of cystoceles. Based on the receiver operating characteristic curve (ROC) analysis, the cut-off age value was 64 years with an ROC area of 0.65. In women with intact uterus (n = 162), the recurrence rate of cystoceles was lower in the TVM group (log-rank test, P = 0.0001), compared with the NTR group. However, there was no between-group difference in the recurrence rate of cystoceles in women with prior or concomitant hysterectomy (n = 177, P = 0.17).
In women with intact uterus, the TVM group has a lower recurrence rate of cystoceles than the NTR group. In addition, old age, especially more than 64 years old, is a risk factor for cystocele recurrence.
背景/目的：对于盆腔器官脱垂（POP），最合适的手术技术仍未确定。本研究的目的是比较经阴道量身定制补片手术（TVM）和阴道固有组织修复术（NTR）治疗 POP 的临床效果。
2011 年 11 月至 2014 年 8 月，回顾了 339 名接受 POP 手术的女性的病历。
与 NTR 组（n=169）相比，TVM 手术（n=170）的使用是手术时间延长（系数=25.2 分钟，P<0.001）和出血量增加（系数=79.9 毫升，P<0.001）的预测因素。然而，多变量分析显示，NTR 组的膀胱膨出复发率（对数秩检验，P=0.001）高于 TVM 组，但阴道顶端膨出（P=0.32）或直肠膨出（P=0.45）则不然。多变量分析显示，TVM 手术（风险比=0.24，95%置信区间=0.09-0.64，P=0.004）和年龄较大（风险比=1.07，95%置信区间=1.02-1.11，P=0.005）是膀胱膨出复发的独立预测因素。基于受试者工作特征曲线（ROC）分析，截点年龄值为 64 岁，ROC 面积为 0.65。在子宫完整的女性（n=162）中，与 NTR 组相比，TVM 组膀胱膨出的复发率较低（对数秩检验，P=0.0001）。然而，在有或无既往子宫切除术的女性（n=177）中，两组间膀胱膨出的复发率无差异（P=0.17）。
在子宫完整的女性中，TVM 组膀胱膨出的复发率低于 NTR 组。此外，年龄较大，尤其是 64 岁以上，是膀胱膨出复发的危险因素。
