盆底修补术后聚丙烯网片阴道暴露的组织学观察

目的：探讨使用聚丙烯网片行盆底修补术后发生网片暴露的局部组织病理学变化.方法：2004年5月-2011年12月于解放军总医院第一附属医院妇产科采用聚丙烯网片经阴道盆底修补治疗盆底功能障碍并于术后发生网片阴道暴露的患者18例,对局部暴露的网片进行切除,采用光镜和扫描电镜观察局部的组织学变化和暴露网片的变化.结果：经阴道网片盆底重建术后12个月发生网片暴露18例,其中临床阴道检查中可见明显感染者5例,仅见纤维结缔组织增生者13例.对18例阴道局部切除的网片进行光镜观察后发现,16例可见网片周围结缔组织中有白细胞或巨噬细胞浸润,另2例未见白细胞浸润.扫描电镜检查发现18例中12例暴露的网片存在明显聚丙烯纤维丝表面降解和横向断裂现象.结论：阴道组织内网片周围炎症反应引起的纤维生物降解可能是导致阴道植入网片发生暴露的原因之一.

Microscopic observation on exposed polypropylene mesh in transvaginal pelvic reconstructive surgery

Objective：To explore the microscopic changes in exposed polypropylene mesh after transvaginal pelvic reconstructive surgery. Methods.. Eighteen cases with exposure of polypropylene mesh in vagina after transvaginal pelvic reconstruction performed from May 2004 to December 2011 were studied. Exposed meshes were removed and examined with light microscope and electronic microscope. Results.. Exposed mesh in 18 cases were found within 12 months after surgery. Obvious infection was found in 5 cases. Obvious fiberosis was seen in re- maining 13 cases. HE staining revealed that the connective tissues around the mesh were filled with leucocytes and macrophages in 16 cases, but not in the rest 2 cases. Electronic scanrdng microscopy showed surface degradation and broken fibers in the infected mesh in 12 cases. Conclusions.. The biological degradation of polypropylene mesh is produced by the surrounding inflammation, and it may be partly responsible for the transvaginal mesh exposure after the repair of pelvic organ prolapse.