Inoue Hiromi, Nakamura Ryoko, Sekiguchi Yuki, Kohata Yutaka, Fukuda Takanori, Oonuma Kazuya, Uzawa Yosie, Watanabe Remi
Urogynecology Center, Shonan Kamakura General Hospital, Kamakura, Japan.
LUNA Pelvic Floor Total Support Clinic, Women's Clinic LUNA Group, Yokohama, Japan.
Cent European J Urol. 2021;74(4):552-562. doi: 10.5173/ceju.2021.0208. Epub 2021 Nov 18.
Japan's ageing crisis has brought major prolapse and incontinence problems. We hypothesized the problem was collagen leaching out of ligaments which support organs and could be corrected by the TFS (Tissue Fixation System) minisling which uses 7 mm wide tapes to create new collagen for ligament reinforcement.We analysed our 10-year experience (2009-2019) with TFS minisling prolapse repair with regard to one main question: "Is this technology of benefit to the ageing Japanese population?".
Retrospective analysis from two tertiary referral units; 3100 tapes were implanted (variously) into cardinal, uterosacral, arcus tendineus fascia pelvis (ATFP), perineal body ligaments of 960 Japanese women (mean age 69.6 years), to repair POPQ 3 or 4 degree prolapse (918/960), 50% under local anesthesia/sedation, remainder general/spinal anesthesia.
Patient discharge within 24 hours indicated minimal intra-operative problems. Prolapse cure at 12 months reached 90%. Complications requiring intervention were infected rectal perforation by tape, 3 delayed ileus complications. Eroded tapes (2.4-3.5%) were trimmed in the clinic. De novo long-term pain and major urine loss were virtually absent.
The TFS system works by restoring ligament support (pubourethral, ATFP, cardinal, uterosacral, perineal body), differently from mesh sheets which work by blocking organ descent, which can lead to fibrosis of the vagina, and may cause chronic pain and massive incontinence. We had no such problems, because tapes have small volume, are applied transversely, with little vaginal contact. Specific ligament reinforcement with collagenopoietic tapes seems to be an important new direction for aged women with major prolapse, with high cure rate, acceptable complications, low erosions and virtually no long-term pain.
日本的老龄化危机带来了严重的脏器脱垂和尿失禁问题。我们推测问题在于支撑器官的韧带中胶原蛋白的渗出，而使用7毫米宽的胶带创建新的胶原蛋白以加强韧带的组织固定系统（TFS）微型吊带可以纠正这一问题。我们分析了我们在2009年至2019年期间使用TFS微型吊带进行脱垂修复的10年经验，围绕一个主要问题：“这项技术对老龄化的日本人群有益吗？”
来自两个三级转诊单位的回顾性分析；将3100条胶带（以不同方式）植入960名日本女性（平均年龄69.6岁）的主韧带、子宫骶韧带、盆腱膜弓（ATFP）、会阴体韧带，以修复盆腔器官脱垂定量分期（POPQ）3度或4度脱垂（918/960），50%在局部麻醉/镇静下进行，其余在全身麻醉/脊髓麻醉下进行。
24小时内出院表明术中问题极少。12个月时脱垂治愈率达到90%。需要干预的并发症包括胶带导致的感染性直肠穿孔、3例迟发性肠梗阻并发症。在诊所对侵蚀的胶带（2.4 - 3.5%）进行了修剪。几乎没有新发的长期疼痛和严重尿失禁。
TFS系统通过恢复韧带支撑（耻骨尿道韧带、ATFP、主韧带、子宫骶韧带、会阴体韧带）起作用，与通过阻止器官下降起作用的网片不同，网片可能导致阴道纤维化，并可能引起慢性疼痛和大量尿失禁。我们没有此类问题，因为胶带体积小，横向应用，与阴道接触少。用促胶原生成胶带进行特定的韧带加强似乎是重度脱垂老年女性的一个重要新方向，治愈率高，并发症可接受，侵蚀率低，几乎没有长期疼痛。
