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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 李偉嘉 | 當陰道網膜移除時骨盆器官脫垂的復發 | 2015/9/30 下午 02:48:44 | 0 |
| 原 文 | 題 目 | Prolapse recurrence after transvaginal mesh removal |
| 作 者 | Rawlings T, Lavelle RS, Coskun B, Alhalabi F, Zimmern PE. | |
| 出 處 | J Urol | |
| 出版日期 | ||
| 評 論 | 骨盆腔器官脫垂的修補，對於許多泌尿科醫師或婦產科醫師而言，都覺得為難，傳統的手術如Kelly 手術，看似簡單，然而對於嚴重脫垂的患者，復發率高。而使用人造網膜修補，有潛在的合併症風險，此篇作者處理許多人造網膜植入的合併症，並移除網膜。然後報告術後病患骨盆脫垂復發的部位與比率，極具臨床價值。有趣的是，當發生網膜手術合併症因而移除網膜，追蹤2.5年後，約有62%的患者沒有產生骨盆器官脫垂的復發。而只有6%的病患會產生其他部位的復發。 | |
| abstract |
INTRODUCTION/OBJECTIVES: To determine the rate of pelvic organ prolapse (POP) recurrence after transvaginal mesh removal (TMR). METHODS: Following IRB approval, a longitudinally collected database of women undergoing TMR for complications after transvaginal mesh placement with at least 1 year minimum follow-up was queried for POP recurrence. Recurrent POP was defined as either > Stage 1 on examination or need for re-operation at the site of TMR. Outcome measures were based on POP-Q at last visit. Patients were grouped into 3 groups: 1 (Recurrent POP in same compartment as TMR), 2(Persistent POP), 3(POP in different compartment as TMR). RESULTS: From 2007-2013, 52 of 73 women met inclusion criteria. 73% presented with multiple indications for TMR. Mean interval between ion and removal was 45 months (10-165). Overall mean follow-up after TMR was 30 months (12-84). Group 1 (POP Recurrence) rate was 15% (6/40). Four patients underwent surgery for recurrent POP at mean 7 months (5-10). Two patients chose observation. The rate of POP Persistence (Group 2) was 23% (12/52) with 3 patients undergoing POP re-operation at mean 10 months (8-12). Group 3 (De novo/ Different compartment POP) rate was 6% (3/52), with 1 undergoing surgical repair at 52 months. CONCLUSIONS: At a mean of 2.5 years follow-up, 62% (32/52) did not have recurrent or persistent prolapse after TMR, and 85% (44/52) did not undergo any further procedures for POP. Specifically for POP in the same compartment as TMR, 12% had recurrence with 8% undergoing POP repair. |
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