盆底重建术后网片或吊带暴露及复发再入院临床分析

目的 探讨盆底重建术后网片或吊带暴露及复发再入院原因及防治方法.方法 收集2008年1月至2020年1月于大连市妇幼保健院因盆腔器官脱垂(POP)、压力性尿失禁(SUI)应用网片或吊带手术治疗,术后因网片或吊带暴露及复发再入院治疗的12例患者临床资料,回顾性分析再入院原因及防治方法.结果 再入院原因:网片或吊带暴露占5...     

自裁T形网片腹腔镜下子宫颈或阴道残端腹壁悬吊术治疗盆腔器官脱垂疗效分析

目的 探讨自裁T形网片腹腔镜下子宫颈或阴道前腹膜外悬吊术治疗盆腔器官脱垂(POP)的疗效.方法 收集福建医科大学附属闽东医院2017年3月至2019年5月因POP需要手术治疗的患者共140例.分为研究组80例:施行自裁T形网片腹腔镜下子宫颈或阴道腹壁悬吊术;对照组60例:施行传统的阴式子宫切除+阴道前后壁修补术.结果 ...     

盆底重建手术网片相关并发症的预防与处理

<正>妇女一生中有11%~19%的风险行盆底修复手术,而盆腔器官脱垂(pelvic organ prolapse,POP)传统修复手术是在已经薄弱和缺陷的筋膜、结缔组织及韧带上进行悬吊和修补,再次手术的风险高。近年来使用移植物尤其是合成网片的盆底重建手术降低了传统修复手术的复发率,改善了压力性尿失禁(stress urinary incontinence,SUI)和POP患者的生活质量。但与网片及合成材料吊带相关的     

如何理解经阴道植入网片手术的专家共识

近年来,经阴道植入网片（transvaginal mesh,TVM）手术的临床应用价值引起国际学术界的广泛争论。2019年底中华医学会妇产科学分会妇科盆底学组专家对原盆腔器官脱垂（pelvic organ prolapse,POP）诊治草案进行了讨论、更新和完善,形成了新的诊疗指南。全面理解制定本指南的背景及内涵,特别是提高对网片问题由来、TVM手术临床存在的问题及其应用的前景与挑战等关键问题的认知,有助于临床医生在POP防治中做出合理的临床决策。     

如何理解经阴道植入网片手术的专家共识

近年来,经阴道植入网片（transvaginal mesh,TVM）手术的临床应用价值引起国际学术界的广泛争论。2019年底中华医学会妇产科学分会妇科盆底学组专家对原盆腔器官脱垂（pelvic organ prolapse,POP）诊治草案进行了讨论、更新和完善,形成了新的诊疗指南。全面理解制定本指南的背景及内涵,特别是提高对网片问题由来、TVM手术临床存在的问题及其应用的前景与挑战等关键问题的认知,有助于临床医生在POP防治中做出合理的临床决策。     

LeFort阴道封闭术治疗老年女性重度盆腔脏器脱垂的临床疗效

目的:探讨LeFort阴道封闭术治疗老年女性重度盆腔脏器脱垂(POP)的临床有效性和安全性.方法:选择2010年01月至2019年12月符合纳入条件的施行抗POP手术的老年(≥60岁)患者107例,POP-Q分期均≥Ⅲ期,其中LeFort阴道封闭术组36例、阴道全封闭术组13例、经阴道植入网片盆底重建术组58例.分析3...     

骶骨阴道固定术治疗盆腔器官脱垂的并发症及处理进展

盆腔器官脱垂(POP)是中老年女性常见疾病,为盆底功能障碍性疾病之一,其严重影响了女性的健康和生活质量。骶骨阴道固定术为治疗顶端脱垂首选手术方式,已被国际认可,随着该术式广泛开展,相关的并发症,近期包括出血、感染、周围脏器损伤、血栓形成等,远期包括肠道损伤、排尿异常、盆腔痛、复发、网片相关并发症、骶骨骨髓炎等,逐渐显现并引起关注,对应解决方案需要临床医生在盆底手术领域积累经验,相互交流,共同探讨解决方案。     

经阴道植入网片盆底重建术后网片侵蚀的诊疗进展

近年来合成聚丙烯网片的盆底重建术广泛应用于盆腔器官脱垂(POP)的治疗,网片侵蚀为其并发症之一,主要临床表现为阴道不规则流液、性交不适、慢性疼痛等,正确认识和处理网片侵蚀对于更好地指导临床工作至关重要。     

轻型钛化聚丙烯网片在改良全盆底重建术中的近期临床结局分析

目的评价应用轻型钛化聚丙烯网片行协和式改良全盆底重建术治疗重度盆腔器官脱垂(POP)的临床结局。方法选取北京协和医院2015年8月至2016年12月收治的重度盆腔器官脱垂并应用轻型钛化聚丙烯网片行协和式改良全盆底重建术的患者18例,评价围手术期及术后12个月内各项治疗评价指标的变化及并发症的发生情况。结果手术时间为(87.2±17.8)min;术中出血(69.4±25.1)mL;64.7%(11/17)的患者术后次日晨拔除尿管,且残余尿量100 mL;无术中严重并发症及术后无并发症发生;术后住院(4.8±1.3)d。平均随访时间10.9个月(4~17个月)。客观治愈率达100%,主观满意度达94.1%;术后无网片暴露及侵蚀发生,5.6%(1/18)的患者术后出现新发轻度压力性尿失禁。结论应用轻型钛化聚丙烯网片行协和式改良全盆底重建术对前中盆腔POP近期疗效肯定,术后网片相关并发症的发生率低。     

替代物治疗盆底功能障碍性疾病的应用前景

目前用于治疗盆底功能障碍性疾病（pelvic floor dysfunction，PFD）的替代物主要是指网片，根据材料分为人工合成网片、生物补片和组织工程学网片。中重度盆腔器官脱垂（pelvic organ prolapse，POP）和压力性尿失禁（stress urinary incontinence，SUI）使用网片的手术方法包括经阴道植入网片（transvaginal mesh implantation，TVM）手术、阴道骶骨固定术（sacrocolpopexy，SC）和无张力尿道中段吊带术（mid-urethralslings，MUS），网片的并发症使网片手术陷入争论。文章通过论述网片手术现状、网片材质、手术操作的改进、生物力学的发展和监管随访机制的建立，探讨网片在PFD中的应用。     

Mesh Exposure After Robot-Assisted Laparoscopic Pelvic Floor Surgery: A Prospective Cohort Study

Study Objective

To prospectively evaluate the mesh exposure rate after robot-assisted laparoscopic pelvic floor surgery for the treatment of female pelvic organ prolapse (POP) in a large cohort.

Mesh-related complications in single-incision transvaginal mesh (TVM) and laparoscopic abdominal sacrocolpopexy (LASC)

ObjectiveFew studies have investigated the long-term impact of synthetic mesh reconstructive surgery for pelvic organ prolapse (POP) on patient outcomes. This study aimed to examine the incidence and risk factors of mesh exposure and the subsequent requirement for surgical interventions due to mesh-related complications.Materials and methodsThis retrospective study was conducted from November 2010 to April 2018. We recruited women with Pelvic Organ Prolapse Quantification (POP-Q) stage 3 or 4 who underwent mesh reconstructive surgery for POP, and enrolled 487 women who received transvaginal mesh (TVM) and 110 women who received laparoscopic abdominal sacrocolpopexy (LASC). Assessments included mesh exposure rate and mesh-related complications requiring surgical interventions in both groups.ResultsIn the LASC group, the overall mesh-related complication rate was 8.18% over a mean follow-up period of 18 months. Concomitant laparoscopic-assisted vaginal hysterectomy was associated with mesh exposure (OR = 9.240; 95% CI = 1.752–48.728). No patients in the concurrent supracervical hysterectomy group were exposed to mesh. In the single-incision TVM group, the overall rate of mesh-related complications was 3.29% over a mean follow-up period of 19 months. Concomitant total vaginal hysterectomy was also a risk factor for mesh exposure (OR = 4.799; 95% CI = 1.313–17.359).ConclusionPreserving the cervix or uterus decreased the rate of mesh exposure in those undergoing TVM and LASC surgery. The overall rate of mesh-related complications was low after up to 8 years of follow-up.     

Assessment and initial management of mesh complications

Synthetic polypropylene mesh have been used in the surgical management of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) since 1990's. However, following patients'-led campaign with concerns regarding the complications associated with mesh, their use in surgical management of SUI and/or POP has been controversial. Complications associated with these mesh implants include chronic pain, vaginal mesh exposure, perforation into organs, infections and sinus tract formation. In April, 2019, the NICE guideline (NG123) provided an evidence review for management of mesh complications. Following Independent Medicine and Medical Devices Safety Review (IMMDS) publication in 2020, a network of specialized complex mesh centres across the UK have been set up. All patients with mesh-related complications should receive specialist multidisciplinary care in these centres. In this review, we outline the assessment and initial management of patients who present with mesh-related complications. Assessment and management options should be tailored per individual cases. Assessment includes clinical assessment and investigations including radiological imaging. All management options including no treatment, conservative, medical and surgical treatment, including minimally invasive treatment with the pros and cons of every option should be offered and patient should be actively involved in their decision making in a “shared-decision making” manner.     

Mesh-related infections after pelvic organ prolapse repair surgery

The use of vaginal meshes has been an advance in the surgical management of women with pelvic organ prolapse. We reviewed the literature to synthesize the evidence regarding the infectious complications related to this new type of foreign body. We searched PubMed, current contents, and references of initially identified relevant articles and extracted data regarding the incidence, clinical manifestation, and management of vaginal mesh-related infections. The incidence of mesh-related infections and erosion ranged from 0 to 8%, and 0 to 33%, respectively, in the published studies. Various factors influence the development of vaginal mesh-related infectious complications such as the kind of biomedical material (e.g. filament structure, pore size) of the mesh, the type of procedure, the preventive measures taken, and the age and underlying comorbidity of the treated women. Non-specific pelvic pain, persistent vaginal discharge or bleeding, dyspareunia, and urinary or faecal incontinence are the most common manifestation of vaginal mesh-related infection. Clinical examination may reveal induration of the vaginal incision, vaginal granulation tissue, draining sinus tracts, and prosthesis erosion or rejection. Various pathogens have been implicated, including Gram-positive and Gram-negative aerobic and anaerobic bacteria. The management of mesh-related infections in women who underwent pelvic organ reconstruction is combined surgical and medical treatment. Although the use of vaginal meshes has become a new effective method of pelvic organ prolapse surgery clinicians should be aware of the various post-operative complications, including mesh-related infections.     

Laparoscopic Removal of Mesh Used in Pelvic Floor Surgery

Various meshes are being used widely in clinical practice for pelvic reconstructive surgery despite the lack of evidence of their long-term safety and efficacy. Management of complications such as mesh erosion and dysparuenia can be challenging. Most mesh-related complications can probably be managed successfully via the transvaginal route; however, this may be impossible if surgical access is poor. This case report demonstrates the successful laparoscopic removal of mesh after several failed attempts via the vaginal route.     

组织工程补片及3D打印技术在盆腔重建手术中的应用前景

手术是重度盆腔器官脱垂主要的治疗方式。目前补片是盆底手术的焦点,聚丙烯补片虽能明显减低复发率,但有侵蚀、暴露、感染等副反应,生物源性补片虽有很好的组织相容性,但支持能力不强。目前,应用组织工程学及3D打印技术开发研制新型补片是研究热点。文章综述了目前国内外组织工程补片的研究现状及应用前景。     

Risk of mesh extrusion and other mesh-related complications after laparoscopic sacral colpopexy with or without concurrent laparoscopic-assisted vaginal hysterectomy: experience of 402 patients

STUDY OBJECTIVE: To estimate the incidence of mesh-related complications including mesh erosion/extrusion rates in patients undergoing laparoscopic sacral colpopexy, with or without concurrent hysterectomy, using macroporous soft polypropylene mesh. DESIGN: Historical cohort study (Canadian Task Force classification II-2). SETTING: Private urogynecology clinic. PATIENTS: A total of 446 consecutive patients with uterovaginal or vaginal vault prolapse underwent laparoscopic sacral colpopexy with use of macroporous soft polypropylene mesh from January 2003 through January 2007. In all, 402 consecutive patients met enrollment criteria. Two groups of patients were identified: (1) those receiving concurrent hysterectomy (n = 130); and (2) those with a history of hysterectomy (n = 272). INTERVENTIONS: Patients were treated with laparoscopic sacral colpopexy with use of macroporous soft polypropylene mesh in conjunction with other laparoscopic and/or vaginal procedures. MEASUREMENTS AND MAIN RESULTS: Data were collected in the form of chart reviews and patient questionnaires. Comparisons were made between groups 1 and 2. Patient demographics, history, mesh erosion/extrusion rates, and mesh-related complications were analyzed. Length of follow-up was 1 to 54 months with a median follow-up time of 12 months. No statistically significant differences existed between 2 groups in rates of mesh erosion/extrusion or other mesh-related complications. Overall vaginal mesh erosion/extrusion rate was 1.2% (95% CI 0.5%-2.7%) with an associated mesh revision rate of 1.2% (95% CI 0.5%-2.7%). Patients with concurrent hysterectomy had an erosion/extrusion rate of 2.3% (3/130) as compared with 0.7% (2/272) in patients with a history of hysterectomy, p = .18. No cases of mesh erosion through organs and tissues other than vaginal mucosa were observed. Cuff abscess occurred in 1 patient with concurrent hysterectomy, with an overall infection rate of 0.3% (95% CI 0.01%-1.2%). One more patient developed an inflammatory reaction to the mesh. Excision of exposed mesh was performed in all 5 patients with mesh extrusion. Vaginal approach to excision was uniformly used. Laparoscopic removal of the entire mesh took place in 4 patients with persistent pelvic pain, in 1 patient with cuff abscess, and in one patient with a questionable mesh reaction. An estimated 975 to 17 000 patients were required in each group to achieve power to detect a statistically significant difference in rate of mesh-related complications in this study. CONCLUSION: Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1% in our study. No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy. The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study.     

The efficacy and complications of using transvaginal mesh to treat pelvic organ prolapse in Taiwan: A 10-year review

Transvaginal mesh (TVM) insertion for the treatment of pelvic organ prolapse (POP) is significantly associated with lower failure rates, although its use remains controversial due to the potential risk of mesh-related complications. In this review, we collected the published literature regarding the use of TVM to treat POP in an attempt to assess both the efficacy and complications related to TVM usage in Taiwan.We searched 25 English language articles using PubMed related to TVM in Taiwan from 2010 to 2019. The present article focuses on the efficacy and complications of TVM and analyzes the data.There were 25 studies on TVM selected for this review. Regarding their success rate, 21 out of the 22 studies (95.5%) had more than a 90% objective success rate. Twenty studies (90.9%) had less than 10% major complications of TVM. Twenty out of the 25 studies (80.0%) had 5% or less mesh exposure. For self-cut TVM and the later single-incision TVM, both the complication rates and exposure rates decreased. The rate of de novo dyspareunia ranged from 2.6% to 14.3%, and the incidence decreased yearly from 2011 to 2019.This review showed both the high treatment efficacy and low complication rate of TVM usage for the short-term treatment of POP in Taiwan. However, a longer-term study is needed to draw a conclusion regarding the safety of this treatment.     

Modern role of sacrospinous ligament fixation for pelvic organ prolapse surgery—A systemic review

Pelvic organ prolapse (POP) is a common condition in women. Women with POP often experience pelvic discomfort, urinary and fecal problems, sexual dysfunction, and an overall decrease in their quality of life. Surgical treatment is a feasible option if conservative management fails. Various surgical techniques have been proposed to correct POP with or without the use of graft material. Owing to recent U.S. Food and Drug Administration warnings about mesh-related complications, sacrospinous ligament fixation (SSF), as a traditional vaginal procedure, may play an important role again. To answer this question and evaluate quantitatively the efficacy of SSF in POP, we conducted a systemic review of the available data about SSF and POP. Interventions had to include SSF as a point of attachment. To eliminate confounding bias and effect modification, at least one arm must include SSF without mesh or graft. All follow-up periods were allowed. Information on the following parameters was extracted and entered into a database: study design, type of intervention, number of patients, follow-up in months, cure rate, recurrence rate, intra/postoperative complications, and/or uni/bilateral, preventive/therapeutic, or concomitant procedures. Published papers from the years 1995 to 2011 were selected for analysis.