Yang Junfang, Zhang Kun, Han Jinsong, Wang Yiting, Yao Ying, Wang Huifang
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
Department of Obstetrics and Gynecology, First Hospital of Qinhuangdao, Qinhuangdao, China.
Gynecol Obstet Invest. 2022;87(1):30-37. doi: 10.1159/000520979. Epub 2021 Nov 24.
This study aims to evaluate the risk factors for subjective recurrence and complications of patients who underwent transvaginal synthetic mesh surgery.
This retrospective cohort study included patients who received transvaginal mesh (TVM) surgery between January 2005 and June 2019.
The information of patients was collected, including basic characteristics, subjective recurrence, and mesh-related complications. The clinical characteristics of patients with and without subjective recurrence were compared. The sexual activities of patients before and after the operation were recorded. SPSS 20.0 was used for the statistical analysis.
A total of 257 patients were included. Among them, 62 (24.1%) patients were lost to follow-up. The median follow-up time was 80 months (12 months, 170 months). Finally, 195 patients were followed up, 11 (5.6%) patients had a subjective recurrence of pelvic organ prolapse, and 26 (13.3%) patients had mesh-related complications (11 patients with de novo pain and 15 patients with mesh exposure). We found significant differences in age (68.9 ± 5.1 vs. 63.4 ± 5.8 years old), years of postmenopause (17.5 ± 6.3 vs. 13.3 ± 6.9 years), previous hysterectomy (27.3% vs. 6.0%), and concomitant hysterectomy (45.5% vs. 81.0%) between patients with and without subjective recurrence (p < 0.05). The mesh exposure proportion of patients with total vaginal mesh (47.6%) was significantly higher than that with anterior vaginal mesh (2.9%) (p < 0.05). Furthermore, 6.7% of sexually active patients reported de novo dyspareunia.
The investigators could only record the subjective recurrence of patients, and thus there is a lack of objective recurrence data.
Age, years of postmenopause, and previous hysterectomy are risk factors for subjective recurrence of TVM surgery; however, concomitant hysterectomy is a protective factor. Mesh exposure is the most common complication, especially for total vaginal mesh repair surgery.
本研究旨在评估接受经阴道合成网片手术患者主观复发及并发症的危险因素。
这项回顾性队列研究纳入了2005年1月至2019年6月期间接受经阴道网片（TVM）手术的患者。
收集患者信息，包括基本特征、主观复发情况及与网片相关的并发症。比较有和无主观复发患者的临床特征。记录患者手术前后的性行为情况。采用SPSS 20.0进行统计分析。
共纳入257例患者。其中，62例（24.1%）患者失访。中位随访时间为80个月（12个月，170个月）。最终，195例患者完成随访，11例（5.6%）患者出现盆腔器官脱垂主观复发，26例（13.3%）患者出现与网片相关的并发症（11例新发疼痛，15例网片暴露）。我们发现有和无主观复发患者在年龄（68.9±5.1岁 vs. 63.4±5.8岁）、绝经后年限（17.5±6.3年 vs. 13.3±6.9年）、既往子宫切除术（27.3% vs. 6.0%）及同期子宫切除术（45.5% vs. 81.0%）方面存在显著差异（p<0.05）。全阴道网片患者的网片暴露比例（47.6%）显著高于前阴道网片患者（2.9%）（p<0.05）。此外，6.7%有性行为的患者报告有新发性交困难。
研究者仅能记录患者的主观复发情况，因此缺乏客观复发数据。
年龄、绝经后年限及既往子宫切除术是TVM手术主观复发的危险因素；然而，同期子宫切除术是保护因素。网片暴露是最常见的并发症，尤其是全阴道网片修复手术。
