Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China.
BMC Womens Health. 2021 Jan 30;21(1):46. doi: 10.1186/s12905-021-01192-w.
The purpose of this study was to investigate the relevant factors of pain after transvaginal mesh (TVM) surgery for the treatment of pelvic organ prolapse and to analyse the management and relief of the pain.
A multicentre retrospective study of a clinical database of patients who underwent TVM surgery was conducted, and pain related aspects were analysed.
A total of 1855 patients were included in the study. We divided the patients into two groups: pain-free (1805 patients) and pain (50 patients) group. The incidence of pain after TVM surgery was 2.70%, with a median occurrence time of 7.5 months. Pain mainly involved the vagina, perineum, buttocks, groin, inner thighs, and lower abdomen. Excessive intraoperative blood loss (OR = 1.284, 95% CI 0.868-2.401) and postoperative anatomic failure (OR = 1.577, 95% CI 0.952-3.104) were analysed as risk factors with statistical significance. Mesh exposure rate in the pain group was 38%, showing a significant difference between the groups (P < 0.01). Forty patients underwent non-surgical treatment, with a relief rate of 40.0%, 33 patients received surgical treatment, 15 underwent partial mesh removal, and 18 underwent complete mesh removal, with a relief rate of 84.8%. The total relief rate was 88% within all 50 patients suffering from pain.
Excessive intraoperative bleeding and unsatisfactory postoperative anatomic outcomes can increase the risk of postoperative pain; mesh exposure is also associated with the pain. Most patients can get pain relief with proper management, more than half of whom may need mesh removal with differing approach.
本研究旨在探讨经阴道网片（TVM）手术治疗盆腔器官脱垂后疼痛的相关因素，并分析疼痛的管理和缓解方法。
对接受 TVM 手术的患者进行多中心回顾性临床数据库研究，并分析疼痛相关方面。
共纳入 1855 例患者。我们将患者分为两组：无痛（1805 例）和疼痛（50 例）组。TVM 手术后疼痛的发生率为 2.70%，中位发生时间为 7.5 个月。疼痛主要涉及阴道、会阴、臀部、腹股沟、大腿内侧和下腹部。术中出血量过多（OR=1.284，95%CI 0.868-2.401）和术后解剖学失败（OR=1.577，95%CI 0.952-3.104）被分析为有统计学意义的危险因素。疼痛组的网片暴露率为 38%，两组间差异有统计学意义（P<0.01）。40 例患者接受非手术治疗，缓解率为 40.0%，33 例患者接受手术治疗，15 例患者行部分网片切除，18 例患者行完全网片切除，缓解率为 84.8%。所有 50 例疼痛患者中，总缓解率为 88%。
术中出血量过多和术后解剖学结果不满意可增加术后疼痛风险；网片暴露也与疼痛有关。大多数患者可通过适当的管理缓解疼痛，超过一半的患者可能需要不同方法的网片切除。
