Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, 100730, China.
Department of Gynecology, Guizhou Provincial People's Hospital, Medical College of Guizhou University, Guiyang, 550002, China.
Sci China Life Sci. 2024 May;67(5):1061-1068. doi: 10.1007/s11427-023-2508-x. Epub 2024 Feb 26.
Although transvaginal mesh (TVM) repair is no longer used in some countries, long-term outcomes after TVM surgery are of great importance globally. However, reports with follow-up >10 years are limited. Thus, this study aimed to report outcomes in a prospective cohort with at least 10 years of follow-up. Women with stage III-IV symptomatic prolapse were approached consecutively from 2008 to 2013 at one tertiary hospital. The main outcome measure was symptomatic failure. Secondary outcomes included anatomic failure, recurrence, patient satisfaction, complications, and reoperation. The Kaplan-Meier curve was used to estimate the cumulative failure rate. Of the 121 patients enrolled in the study, 103 (85.1%) completed a median follow-up of 11 years. The estimated probability rates of symptomatic and anatomic failure were 17.6% and 8.8% in 11 years, respectively. The estimated incidence of symptomatic failure increased by 8.2% between 5 and 11 years; however, the corresponding rate for anatomic failure was 3.7%. The most common complication was vaginal mesh exposure, and its estimated probability increased from 19.3% to 28.4% from 5 to 11 years, respectively. Office trimming resolved 80.0% of vaginal exposures. These patients did not report decreased overall satisfaction. Patients with vaginal mesh exposure requiring>3 office procedures or mesh removal in the operating room (5.8% by 11 years) had lower satisfaction rates (P<0.01) and were defined as having severe mesh exposure. The rates of postoperative pain, reoperation, and Patient Global Impression of Improvement ⩾2 were 2.5%, 3.3%, and 94.2%, respectively. The results of this study implied that TVM treatment gradually increased the symptomatic failure rate but provided durable anatomical support of the vaginal wall. Vaginal mesh exposure was common in women who were largely not sexually active; however, 80% of the cases could be managed in the outpatient clinic, which did not affect patient satisfaction.
尽管经阴道网片（TVM）修复在一些国家已不再使用，但 TVM 手术后的长期结果在全球范围内仍具有重要意义。然而，随访时间>10 年的报道有限。因此，本研究旨在报告至少 10 年随访的前瞻性队列研究的结果。从 2008 年到 2013 年，一家三级医院连续对 III-IV 期有症状脱垂的女性进行了前瞻性研究。主要观察指标是症状失败。次要结果包括解剖学失败、复发、患者满意度、并发症和再次手术。采用 Kaplan-Meier 曲线估计累积失败率。在这项研究中，121 名患者中有 103 名（85.1%）完成了中位数为 11 年的随访。11 年内，症状性和解剖学失败的估计概率分别为 17.6%和 8.8%。5 至 11 年内，症状性失败的发生率增加了 8.2%；然而，相应的解剖学失败率为 3.7%。最常见的并发症是阴道网片暴露，其估计概率从 5 年的 19.3%增加到 11 年的 28.4%。办公室修剪解决了 80.0%的阴道暴露问题。这些患者并没有报告总体满意度降低。需要>3 次办公室处理或在手术室移除阴道网片的阴道网片暴露患者（11 年内为 5.8%）的满意度较低（P<0.01），被定义为严重的网片暴露。术后疼痛、再次手术和患者整体改善印象≥2 的发生率分别为 2.5%、3.3%和 94.2%。本研究结果表明，TVM 治疗逐渐增加了症状性失败率，但为阴道壁提供了持久的解剖学支撑。阴道网片暴露在大多数无性生活的女性中很常见；然而，80%的病例可以在门诊进行管理，这并不影响患者的满意度。
