Gynemesh聚丙烯补片在盆底重建中的应用效果

BACKGROUND: Gynemesh is a polypropylene fabric woven by monofilament polypropylene shaped into a flat form, with a strong tensile strength, small foreign body reaction and good biocompatibility. OBJECTIVE: To investigate the effect of Gynemesh on pelvic floor reconstruction. METHODS: Gynemesh was prepared by the chemical reduction method in the liquid-phase, and observed histologically. Then its thickness, elongation at break, tensile strength, and elasticity modulus were detected. Eight female New Zealand rabbits were used to make pelvic floor dysfunction models by a vaginal balloon, and randomly assigned into experimental group (pelvic floor reconstruction using Gynemesh) or control group (vaginal wall repair and hysterectomy), respectively. Thirty days post surgery, the Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Floor Distress Inventory (PFDI-20) were detected and compared between two groups. RESULTS AND CONCLUSION:The Gynemesh had a thickness of (0.37±0.14) mm, an elongation at break of (25.35±2.68)%, a tensile strength of (7.69±1.17) MPa, and an elastic modulus of (0.007±0.008) GPa. Under the light microscope, a large amount of pink collagen fibers arranged neatly on the Gynemesh, but no blue nuclear material and residual cells existed. Under the scanning electron microscope, the fibers were tightly packed with no residual cells on the Gynemesh. At 30 days after surgery, the Gynemesh was not degraded and no erosion reaction occurred in the experimental group. Moreover, the experimental group had a lower incidence of complications compared with the control group (P < 0.05). These findings indicate that the Gynemesh has good biological performance and it is an ideal material for pelvic floor reconstruction.     

聚丙烯补片修复老年女性前盆腔器官功能障碍

背景：补片类材料最早应用在腹部疝气修补重建中,后来证明其可成功应用在阴道手术中,因此逐渐在老年妇科盆底重建中也逐渐开始推广应用。目的：分析聚丙烯补片应用于老年女性前盆腔器官重建的临床效果。方法：纳入老年女性前盆底功能障碍Ⅲ、Ⅳ期患者24例,按照患者意愿选择治疗方式,其中12例选择聚丙烯补片进行前盆腔器官重建(试验组),另12例进行传统的单纯改良阴道旁修补治疗(对照组)。修复后随访12个月,观察患者临床症状缓解、伤口愈合、盆腔脏器脱出分期及主观功能障碍指数评分。结果与结论：两组修复后的临床症状均明显缓解,无感染、伤口愈合不良等不良反应。随访12个月时,两组的主观功能障碍指数评分均低于修复前(P < 0.05),且试验组低于对照组(P < 0.05);试验组盆腔脏器脱出分期Ⅰ期8例、Ⅱ期4例,对照组盆腔脏器脱出分期Ⅰ期7例、Ⅱ期2例、Ⅲ期2例、Ⅳ期1例,试验组脏器脱出程度低于对照组(P < 0.05)。表明聚丙烯补片修补应用于老年女性前盆腔器官重建安全有效,且复发率低。  中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

生物补片材料在盆底功能重建中的应用

背景：盆底结构缺陷、损伤以及功能障碍可以导致盆腔脏器膨出,外科治疗是主要方法,随着盆底缺陷修复和功能重建技术的发展,生物补片材料成为重要的盆底筋膜组织替代物,在盆底功能重建中的应用越来越广泛。 目的：对生物补片材料在盆底功能重建应用研究的文献资料趋势进行多层次探讨分析。 方法：以电子检索方式对万方数据库2007-01/2011-12有关生物补片材料在盆底功能重建应用研究的文献进行分析,采用检索词为“补片(patch);盆底功能重建(pelvic functional reconstruction);盆腔脏器膨出(pelvic organ bulging);生物材料(biomaterial)”,运用数据库中自带的分析功能和Excel软件绘制图表的功能,分析文献年度命中数、出版时间及数量、学科类别、基金资助、博硕士学位论文、会议论文和专利信息,以及不同补片材料临床应用效果比较。 结果与结论：在万方数据库学术期刊收录的2007/2011文献中,共检索到30篇相关文献。5年来补片材料研究文献的年度命中数处于明显的上升趋势,生物补片材料在盆底功能重建应用研究的文献量处于平稳状态;《中国组织工程研究与临床康复》杂志在生物补片材料盆底功能重建应用研究领域发稿较多;文献的关键词主要有盆腔脏器脱垂、聚丙烯补片和生物相容性,可见生物补片材料在盆腔脏器脱垂疾病中的应用较多,以聚丙烯补片材料的研究为主,突出研究材料的生物相容性。通过文献计量学方法对万方数据库关于生物补片材料在盆底功能重建应用研究的文献分析,为中国从事生物补片材料在盆腔脏器膨出基础研究和临床医务工作者进一步确定科研思路提供有价值的参考。     

Prolift网片与聚丙烯网片在全盆底重建治疗中的对比

BACKGROUND: A large number of studies focused on mesh application in the whole pelvic floor reconstructive surgery, but the comparative research on the Prolift mesh and polypropylene mesh (Gynemesh) in the whole pelvic floor reconstruction is rarely reported. OBJECTIVE: To compare the Prolift mesh with Gynemesh in the whole pelvic floor reconstructive surgery. METHODS: Totally 90 female patients with pelvic organ prolapse were enrolled, aged 40 to 80 years old, and were randomly divided into Prolift group and Gynemesh group, who were subjected to full pelvic floor reconstruction with Prolift mesh or Gynemesh, respectively. Afterwards, operation time, intraoperative blood loss, postoperative vaginal bleeding, hematoma, local paresthesia, urinary retention, overactive bladder, residual urine, postoperative incision infection, mesh exposure and postoperative quality of life were compared in two groups. RESULTS AND CONCLUSION: No hematoma, local paresthesia, urinary retention and rejection reactions appeared in both two groups. The operation time, intraoperative blood residual urine, length of stay, catheter retention time had no significant differences between two groups. In the Prolift group, one case had a small amount of vaginal bleeding, one case had overactive bladder, five cases had mesh exposure at the anterior wall of vaginal, and two cases had light stress urinary incontinence; in the Gynemesh group, no vaginal bleeding, overactive bladder and stress urinary incontinence occurred, but four cases had mesh exposure at the anterior wall of vaginal. Additionally, the scores on the quality of life in the two groups at the last follow-up were significantly lower than those before surgery (P < 0.05), but there was no significant difference between the two groups (P > 0.05). These results demonstrate that both Prolift system and Gynemesh are safe and effective for the whole pelvic floor reconstruction, resulting in few postoperative complications. Patients can quickly recover, and obtain satisfactory outcomes.     

补片在妇产科疾病中的临床应用及其生物相容性

背景：生物补片是重要的盆底组织替代物,能够替代薄弱受损的盆底筋膜组织,在盆底重建中的应用越来越广泛,但有关其疗效及生物相容性研究却少有报道。 目的：探讨生物补片在妇产科疾病中的临床应用及其生物相容性。 方法：应用计算机检索1990-01/2011-02 PubMed数据库及维普数据库有关生物补片在妇产科疾病中的临床应用及其生物相容性方面的相关文献,英文检索词“obstetrics,gynecology diseases,treatment”,中文检索词为“补片,妇产科疾病,治疗”。检索文献量总计192篇,最终纳入符合标准的文献22篇。 结果与结论：盆底修复及重建的材料作为盆底组织替代物能替代薄弱受损的盆底筋膜组织,目前大致包括生物材料、人工合成材料两类。各种修补材料均有优缺点。在各种类型植入物中,自体组织、同种异体移植物、异种移植物植入后易感染,磨损,生物相容性较差,作为重建材料并不合适。合成的可吸收补片材料坚固,应用方便,但可能发生感染、排斥和侵蚀等并发症,生物相容性较差。合成的不可吸收补片和脱细胞补片感染发生率低,并发症少,生物相容性较好。但应用哪种补片材料更佳及远期疗效等均有待于延长随访时间、大规模前瞻性病例对照研究加以验证。 关键词：重度盆腔脏器脱垂;全盆底重建;补片;生物材料;人工合成材料;综述文献 doi:10.3969/j.issn.1673-8225.2012.12.038     

应用聚丙烯网片行全盆底重建术

目的探讨应用聚丙烯网片行全盆底重建术的可行性及有效性。方法我院2006年9月～2007年10月对36例盆腔器官脱垂的患者应用聚丙烯网片重建膀胱阴道筋膜、主、骶韧带及阴道直肠筋膜,对合并有压力性尿失禁的患者同时行经闭孔无张力尿道中段悬吊术。结果手术时间为（80&#177;23）min,术中出血量为（100&#177;28）ml,无一例膀胱、尿道、直肠、血管损伤。术后随访3～15个月,患者盆腔器官脱垂全部得以纠正,术前症状消失。术后无复发,均未出现感染、网片侵蚀等并发症,大小便正常。结论应用聚丙烯网片行全盆底重建术是一种微创又经济的手术方式,从近期效果来看,是可行有效的,远期效果有待进一步观察。     

盆底补片用于骶棘韧带固定术的临床疗效

目的探讨盆底补片用于骶棘韧带固定术(SSLF)对盆底支持结构的有效性和安全性。方法选取64例中盆腔缺陷患者,采用双盲法随机分为观察组(31例)和对照组(33例)。观察组采用“Y”形补片实施SSLF,对照组采用传统SSLF。比较2组患者围术期相关指标、并发症、手术前后阴道轴向变化、POP-Q分期以及Aa、Ap、Ba、Bp、C指示点位置变化。采用盆底障碍影响简易问卷7(PFIQ-7)、盆底功能障碍问卷简短版20(PFDI-20)、视觉模拟量表(VAS)及POP-Q分期评价疗效。结果所有患者均顺利完成手术。观察组手术时间、术中出血量均短/少于对照组(P<0.05),2组患者并发症、肛门排气时间、尿管留置时间、住院时间比较,差异无统计学意义(P>0.05)。术后6、12个月POP-Q分期以及Aa、Ba、Ap、Bp、C指示点位置组间比较差异均无统计学意义(P>0.05);观察组阴道轴向右侧偏离角度小于对照组,差异有统计学意义(P<0.05);2组患者PFIQ-7和PFDI-20评分较术前均下降(P<0.05),但组间比较差异无统计学意义(P>0.05)。结论SSLF采用补片重建阴道顶端的盆底支持结构,可克服坐骨棘深藏、术野狭窄、操作困难等问题,且具有快捷、微创、治愈率高的特点,对于全身状况欠佳的中盆腔缺陷患者安全、有效。     

CNKI数据库中补片在女性盆底重建应用中的文献计量学研究**

背景：补片材料在盆底修复外科的应用早已得到了肯定,并已引起越来越多研究者的关注。 目的：利用CNKI数据库文献检索功能,深度分析补片在女性盆底重建中的应用文献资料趋势,进行多层次探讨分析。 设计：文献计量学分析。 资料提取：以“妇产科(obstetrics and gynecology),盆底(pelvic floor),重建(reconstruction),补片(mesh),聚丙烯(polypropylene)”为关键词,检索CNKI数据库2002-01/2011-12的相关文献,并分析结果,以文字和图表的形式进行统计和计量分析,描述其分布特征。 入选标准：纳入标准：①补片在女性盆底重建中的应用相关的研究论文。②Gynemesh补片在女性盆底重建中的应用相关的研究论文。③Prolift网片在女性盆底重建中的应用相关的研究论文。排除标准：①与文章目的无关的文献。②重复研究的文献。 主要数据判定指标：以出版时间、来源期刊、学科类别、来源数据库、研究机构,以及发表文献的作者分布进行相关分析。 结果：CNKI数据库2002/2011收录的文献中共检索到147篇补片在女性盆底重建中的应用相关文献,在时间分布上文献数量总体呈上升趋势,《中国实用妇科与产科杂志》和《中国妇幼保健》杂志发表文献量较多,6篇,占全部文献的4.08%。 结论：通过文献计量学方法对来源于CNKI数据库关于补片在女性盆底重建中的应用文献进行分析,为了解该领域的概貌、现状和研究者进一步确定热点难点提供了有价值的参考。关键词：补片;Gynemesh聚丙烯补片;妇产科;盆底;重建;Prolift网片;文献计量分析 doi:10.3969/j.issn.1673-8225.2012.16.032     

Y形网片在女性盆底功能疾病中的应用

BACKGROUND: The Y-shaped mesh graft material weaved using lightweight polypropylen has the appropriate porosity, which not only can make the vaginal tissues grow and fuse rapidly on the mesh, but also can maintain good biological strength to ensure the fixed strength for the presacral suspension. OBJECTIVE: To retrospectively analyze the clinical effect of Y-shaped mesh for the biological function reconstruction of the female pelvic floor. METHODS: Ten female cases of pelvic floor dysfunction were enrolled, aged 37-73 years, and all were given the treatment of sacral colposuspension under laparoscopy. Then perioperative complications were recorded; patients were followed up regularly to record the Pelvic Organ Prolapse Quantification (POP-Q) score at different time points; and the subjective satisfaction was investigated using the Pelvic Floor Impact Questionnaire (PFIQ-7). RESULTS AND CONCLUSION: After at least 6-month follow-up, no postoperative pelvic infection, nerve damage and complications appeared, the patients healed well, and no mesh erosion, infection and other adverse reactions occurred. The POP-Q and PFIQ-7 scores at 1, 3 and 6 months after repair were significantly improved than those before repair (P < 0.05). These results suggest that the Y-shaped biological mesh repairing female midpelvic floor dysfunction has good biocompatibility, and can restore the anatomy of the pelvic floor.     

A comparison of different pelvic reconstruction surgeries using mesh for pelvic organ prolapse patients

This study was carried out in order to compare the effects in different surgeries using mesh in pelvic organ prolapse patients whose leading points were C. Thirty-nine patients were categorized into 3 groups: group A pelvic reconstruction with hysterectomy; group B hysterectomy prior to pelvic reconstruction; and group C pelvic reconstruction with uterus preserved. At first visit, POP-Q stage was determined, and age, BMI, admission days, operation time, post-operative stage and complications were observed and results were analyzed and compared. All patients who were operated upon converted to stage one month following the operation, and no further change was observed except in one patient. Group admission days were not significantly different, but tended to be lower in group C. Group average operation times between 'group A and B' and 'group A and C' were statistically different. No significant difference was observed in post-operative complications between the groups, but 3 members of group A developed erosion, whereas no erosion occurred in groups B and C. Pelvic reconstruction using mesh is a highly efficient method of treating pelvic organ prolapse. Improvements in stage and post-operative complications were not significantly different in the groups. However, uteropexy showed a shorter operation time, fewer admission days, and less erosion due to mesh than conventional pelvic reconstruction with hysterectomy.     

Sexual function after anterior vaginal wall prolapse surgery

OBJECTIVE:

The aim of this study was to compare female sexual function after surgical treatment of anterior vaginal prolapse with either small intestine submucosa grafting or traditional colporrhaphy.

METHODS:

Subjects were randomly assigned, preoperatively, to the small intestine submucosa graft (n = 29) or traditional colporrhaphy (n = 27) treatment group. Postoperative outcomes were analyzed at 12 months. The Female Sexual Function Index questionnaire was used to assess sexual function. Data were compared with independent samples or a paired Student''s t-test. ClinicalTrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT00827528","term_id":"NCT00827528"}}NCT00827528.

RESULTS:

In the small intestine submucosa group, the total mean Female Sexual Function Index score increased from 15.5±7.2 to 24.4±7.5 (p<0.001). In the traditional colporrhaphy group, the total mean Female Sexual Function Index score increased from 15.3±6.8 to 24.2±7.0 (p<0.001). Improvements were noted in the domains of desire, arousal, lubrication, orgasm, satisfaction, and pain. There were no differences between the two groups at the 12-month follow-up.

CONCLUSIONS:

Small intestine submucosa repair and traditional colporrhaphy both improved sexual function postoperatively. However, no differences were observed between the two techniques.     

Novel hybrid mesh surgery combines sacrocolpopexy with transvaginal mesh placement for pelvic organ prolapse

Mesh surgeries, such as sacrocolpopexy and transvaginal mesh surgery, are commonly used to treat pelvic organ prolapse. Although mesh surgeries have a high success rate, they are unsuitable for some patients. For a patient with pelvic organ prolapse and highly calcified multiple fibroids, we performed hybrid sacrocolpopexy combined with transvaginal mesh surgery with a method modified for the patient's condition. Three months after surgery, the results were highly satisfactory. This approach is simple, secure, and versatile for patients who are not good candidates for conventional mesh surgeries. This novel hybrid mesh surgery is an option for treating various types of pelvic organ prolapse.     

Comparison of pelvic floor muscle strength evaluations in nulliparous and primiparous women: a prospective study

OBJECTIVE:

This study aimed to compare the pelvic floor muscle strength of nulliparous and primiparous women.

METHODS:

A total of 100 women were prospectively distributed into two groups: Group 1 (G1) (n = 50) included healthy nulliparous women, and Group 2 (G2) (n = 50) included healthy primiparous women. Pelvic floor muscle strength was subjectively evaluated using transvaginal digital palpation. Pelvic floor muscle strength was objectively assessed using a portable perineometer. All of the parameters were evaluated simultaneously in G1 and were evaluated in G2 during the 20^th and 36^th weeks of pregnancy and 45 days after delivery.

RESULTS:

In G2, 14 women were excluded because they left the study before the follow-up evaluation. The median age was 23 years in G1 and 22 years in G2; there was no significant difference between the groups. The average body mass index was 21.7 kg/m² in G1 and 25.0 kg/m² in G2; there was a significant difference between the groups (p = 0.0004). In G2, transvaginal digital palpation evaluation showed significant impairments of pelvic floor muscle strength at the 36^th week of pregnancy (p = 0.0006) and 45 days after vaginal delivery (p = 0.0001) compared to G1. Objective evaluations of pelvic floor muscle strength in G2 revealed a significant decrease 45 days after vaginal delivery compared to nulliparous patients.

CONCLUSION:

Pregnancy and vaginal delivery may cause weakness of the pelvic floor muscles.     

子宫主韧带中弹性蛋白、赖氨酰氧化酶表达与盆底器官膨出的关系

目的：检测女性盆底器官膨出（POP）患者子宫主韧带中弹性蛋白（elastin）和赖氨酰氧化酶（LOX）表达,探讨两种基因与POP发生发展的关系。方法：选择因子宫脱垂而行全子宫切除术的患者60例,同期选择因妇科良性疾病、无压力性尿失禁（SUI）或POP行全子宫切除术患者60例作为对照。于手术中取子宫主韧带,采用逆转录-聚合酶链式反应（RT-PCR）法测定elastin、LOX mRNA的表达,免疫蛋白印迹法（Western blotting）检测两种蛋白表达。结果：无论绝经与否,POP组子宫主韧带中elastin、LOX mRNA及其蛋白表达明显低于对照组,POP组中绝经后患者elastin、LOX mRNA及其蛋白表达明显低于绝经前患者,差异显著（P<0.05）;子宫主韧带elastin mRNA及蛋白表达变化与LOX相应水平呈明显的直线正相关（r＝0.9959,r＝0.9708,P<0.05）。结论:POP患者子宫主韧带elastin表达减弱影响弹性纤维形成, LOX表达减弱可能通过影响胶原与弹性纤维的交联亦使盆腔支持结构稳定性降低,从而导致POP的发生;绝经后女性体内雌激素水平的降低可能通过影响LOX的表达,进而参与POP的发生。     

Fibulin-5 (FBLN5) gene polymorphism is associated with pelvic organ prolapse

Objective

FBLN5 encodes a key protein of elastic fiber matrix assembly and function that contributes to maintaining pelvic support and plays the important role in the pathophysiology of pelvic organ prolapse (POP). The aim of the study was to investigate whether there is an association between common single-nucleotide polymorphisms (SNPs) of the FBLN5 gene and POP.

Study design

A total of eleven tag SNPs of the FBLN5 gene were genotyped using the polymerase chain reaction with confronting two-pair primers (PCR-CTPP) in 210 patients with POP (stages III–IV) and 292 controls with no even minimal POP.

Results

We revealed significant associations of tag SNPs rs2018736 and rs12589592 with POP. The top association signal was found for SNP rs2018736 (protective effect for the minor allele A) in the entire set: p = 0.0026, OR = 0.42, 95% CI: 0.24–0.75; in the stratum with pelvic floor trauma: p = 0.0018, OR = 0.27, 95% CI: 0.11–0.64; and in the stratum with fetal macrosomia: p = 0.013, OR = 0.14, 95% CI: 0.03–0.71. The results of the haplotype analyses were consistent with the single SNP analysis. In the strata without perineal trauma and fetal macrosomia effects were non-significant, possibly, due to the smaller effect sizes.

Conclusions

Current data provide, for the first time, strong evidence that common SNPs of the FBLN5 gene are associated with POP especially after pelvic floor injury.