Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang Road, Shanghai, 200090, China.
Int Urogynecol J. 2021 Apr;32(4):905-911. doi: 10.1007/s00192-020-04418-x. Epub 2020 Jul 31.
To demonstrate the outcomes of pelvic reconstruction using Y-shaped mesh in patients with multiple-compartment pelvic organ prolapse via transvaginal single-port laparoscopy.
We conducted a retrospective case series study. Patients diagnosed with severe multiple-compartment prolapse were enrolled between July 1, 2017, and March 31, 2020. Patients underwent transvaginal single-port laparoscopic pelvic reconstruction with Y-shaped mesh. Baseline data and perioperative results were collected. Patients were followed up with the POP-Q score, Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12). T-test was used for statistical analysis.
Operations were successful in all 93 patients without conversion or serious complications. Mean operative time was 132.70 ± 28.02 min and estimated blood loss was 110.65 ± 56.31 ml. VAS pain score was 2.91 ± 1.16 and cosmetic score was 9.20 ± 0.60. During 1-33 months of follow-up, no recurrence or mesh exposure was observed. Five patients suffered from de novo SUI, six had constipation, two had dyspareunia, and one had persistent pelvic pain. The pre- and postoperative Aa point was +2.13 ± 1.23 vs. -2.91 ± 0.28 (P < 0.05), C point was 2.63 ± 2.41 vs. -6.86 ± 0.69 (P < 0.05), and Ap point was -0.26 ± 1.79 vs. -2.97 ± 0.16 (P < 0.05). The PFDI-20 score was 76.81 ± 32.06 vs. 18.18 ± 20.25 (P < 0.05), while the PISQ-12 score was 34.30 ± 4.17 vs. 37.20 ± 2.60 (P < 0.05), which suggested significant improvements in both physical prolapse and quality of life after surgery.
Transvaginal single-port laparoscopic pelvic reconstruction with Y-shaped mesh is a feasible, effective and safe treatment option for severe multiple-compartment prolapse. Patients may benefit from its mild pain level and good cosmetic effect as well as only minor mesh-related complications.
本研究旨在通过经阴道单孔腹腔镜技术演示 Y 形网片在治疗多部位盆腔器官脱垂患者中的应用效果。
我们进行了一项回顾性病例系列研究。2017 年 7 月 1 日至 2020 年 3 月 31 日期间，我们收治了患有严重多部位脱垂的患者。所有患者均接受经阴道单孔腹腔镜 Y 形网片盆底重建术。收集基线数据和围手术期结果。使用 POP-Q 评分、盆腔器官脱垂/尿失禁性功能问卷（PISQ-12）和盆腔器官脱垂困扰问卷（PFDI-20）对患者进行随访。采用 t 检验进行统计学分析。
93 例患者手术均获成功，无中转开腹或严重并发症发生。平均手术时间为 132.70±28.02 分钟，估计出血量为 110.65±56.31 毫升。术后视觉模拟评分（VAS）疼痛评分为 2.91±1.16，美容评分 9.20±0.60。术后 1-33 个月随访，无复发或网片外露。5 例患者新发压力性尿失禁，6 例患者便秘，2 例患者性交困难，1 例患者持续性盆腔疼痛。术前 Aa 点为+2.13±1.23，术后为-2.91±0.28（P<0.05）；C 点术前为 2.63±2.41，术后为-6.86±0.69（P<0.05）；Ap 点术前为-0.26±1.79，术后为-2.97±0.16（P<0.05）。PFDI-20 评分术前为 76.81±32.06，术后为 18.18±20.25（P<0.05）；PISQ-12 评分术前为 34.30±4.17，术后为 37.20±2.60（P<0.05）。提示术后患者的躯体脱垂和生活质量均显著改善。
经阴道单孔腹腔镜 Y 形网片盆底重建术是治疗严重多部位脱垂的一种可行、有效且安全的方法。该术式具有疼痛轻、美容效果好、网片相关并发症少等优点。
