Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan, ROC.
Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan, ROC; Department of Obstetrics and Gynecology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China.
Taiwan J Obstet Gynecol. 2020 Jan;59(1):43-50. doi: 10.1016/j.tjog.2019.11.006.
Few studies have investigated the long-term impact of synthetic mesh reconstructive surgery for pelvic organ prolapse (POP) on patient outcomes. This study aimed to examine the incidence and risk factors of mesh exposure and the subsequent requirement for surgical interventions due to mesh-related complications.
This retrospective study was conducted from November 2010 to April 2018. We recruited women with Pelvic Organ Prolapse Quantification (POP-Q) stage 3 or 4 who underwent mesh reconstructive surgery for POP, and enrolled 487 women who received transvaginal mesh (TVM) and 110 women who received laparoscopic abdominal sacrocolpopexy (LASC). Assessments included mesh exposure rate and mesh-related complications requiring surgical interventions in both groups.
In the LASC group, the overall mesh-related complication rate was 8.18% over a mean follow-up period of 18 months. Concomitant laparoscopic-assisted vaginal hysterectomy was associated with mesh exposure (OR = 9.240; 95% CI = 1.752-48.728). No patients in the concurrent supracervical hysterectomy group were exposed to mesh. In the single-incision TVM group, the overall rate of mesh-related complications was 3.29% over a mean follow-up period of 19 months. Concomitant total vaginal hysterectomy was also a risk factor for mesh exposure (OR = 4.799; 95% CI = 1.313-17.359).
Preserving the cervix or uterus decreased the rate of mesh exposure in those undergoing TVM and LASC surgery. The overall rate of mesh-related complications was low after up to 8 years of follow-up.
很少有研究调查用于治疗盆腔器官脱垂（POP）的合成网片重建手术对患者结局的长期影响。本研究旨在研究网片暴露的发生率和危险因素，以及因网片相关并发症而需要手术干预的后续情况。
这是一项回顾性研究，于 2010 年 11 月至 2018 年 4 月进行。我们招募了患有盆腔器官脱垂定量（POP-Q）第 3 或 4 期的女性，这些女性因 POP 而行网片重建手术，共有 487 名女性接受了经阴道网片（TVM），110 名女性接受了腹腔镜腹式骶骨阴道固定术（LASC）。评估包括两组的网片暴露率和需要手术干预的网片相关并发症。
在 LASC 组中，在平均 18 个月的随访期间，总网片相关并发症发生率为 8.18%。同时行腹腔镜辅助阴式子宫切除术与网片暴露相关（OR=9.240；95%CI=1.752-48.728）。同时行子宫次全切除术的患者中无网片暴露。在单切口 TVM 组中，在平均 19 个月的随访期间，总网片相关并发症发生率为 3.29%。同时行全阴道子宫切除术也是网片暴露的危险因素（OR=4.799；95%CI=1.313-17.359）。
在 TVM 和 LASC 手术中，保留宫颈或子宫可降低网片暴露率。在长达 8 年的随访后，总网片相关并发症发生率较低。
