Chiang Ching-Hsiang, Hsu Chun-Shuo, Ding Dah-Ching
Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan.
School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
J Clin Med. 2021 Apr 27;10(9):1888. doi: 10.3390/jcm10091888.
The aim of this study was to compare the clinical outcomes of transvaginal mesh (TVM) surgery with and without midline fascial plication for anterior prolapse repair. This is a prospective randomized trial in a teaching hospital. This study compared patients with anterior vaginal wall prolapse (POP-Q Ba > -1) who were randomly assigned to either transvaginal mesh (TVM, Avaulta Solo, CR Bard. Inc., Covington, GA, USA polypropylene mesh delivery system) (group A, n = 32) or TVM with concomitant midline fascial plication (group B, n = 32). The outcomes of anatomy correction and life quality were evaluated using a pelvic organ prolapse quantification system and questionnaires. Sixty-four patients were included from January 2011 through April 2014 in this study. Group A had a mean age of 63.7 years and a body mass index (BMI) of 25.4 kg/m. Group B had a mean age of 62.9 years and a BMI of 25.4. The mean follow-up duration was 18.6 months (range 12-50). At the 12-month follow-up, anatomic recurrence was higher in Group A (5/31, 16.1%) than in Group B (1/30, 3.3%) but without statistical significance ( = 0.19). Improvements in symptoms and quality of life were not significantly different between the two groups. Mesh extrusion was detected in three of 61 patients (4.9%): two from group A (6.7%) and one from Group B (3.2%). TVM with concomitant midline fascia repair for anterior vaginal prolapse had a comparable anterior support and mesh exposure rate compared with TVM alone. Trial Registration: IRB-B09904021.
本研究的目的是比较经阴道网片（TVM）手术联合和不联合中线筋膜折叠术治疗前盆腔脏器脱垂的临床效果。这是一项在教学医院进行的前瞻性随机试验。本研究比较了阴道前壁脱垂（POP-Q Ba > -1）的患者，这些患者被随机分配至经阴道网片组（TVM，Avaulta Solo，美国科温顿CR巴德公司聚丙烯网片输送系统）（A组，n = 32）或经阴道网片联合中线筋膜折叠术组（B组，n = 32）。使用盆腔器官脱垂定量系统和问卷对解剖结构矫正和生活质量的结果进行评估。2011年1月至2014年4月，本研究共纳入64例患者。A组平均年龄63.7岁，体重指数（BMI）为25.4 kg/m²。B组平均年龄62.9岁，BMI为25.4。平均随访时间为18.6个月（范围12 - 50个月）。在12个月的随访中，A组的解剖学复发率（5/31，16.1%）高于B组（1/30，3.3%），但无统计学意义（P = 0.19）。两组症状和生活质量的改善无显著差异。61例患者中有3例（4.9%）检测到网片外露：A组2例（6.7%），B组1例（3.2%）。与单纯TVM相比，经阴道网片联合中线筋膜修复术治疗阴道前壁脱垂具有相似的前壁支撑效果和网片外露率。试验注册号：IRB - B09904021。
