Efficacy and safety of transvaginal mesh repair in a cohort with a minimum of 10-year follow-up  

作　　者：Zhibo Zhang Jianbin Guo Weijie Tian Ye Zhang Yuelun Zhang Tianshu Sun Jiali Duan Xinmiao Bao Yuan Wang Yang Ye Qianqian Gao Honghui Shi Abraham Nick Morse Juan Chen Lan Zhu 

机构地区：[1]Departmentof Obstetrics and Gynecology,Peking Union MedicalCollege Hospital,Chinese Academyof Medical Sciences&Peking Union MedicalCollege,National Clinical Research Center for Obstetricand Gynecologic Diseases,Beijing 100730,China [2]Department of Gynecology,Guizhou Provincial People’s Hospital,Medical College of Guizhou University,Guiyang 550002,China [3]Department of Obstetrics and Gynecology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China [4]Medical Research Center,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China [5]Medical Doctor Program,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China [6]Department of Pathology,Peking Union Medical College Hospital,Beijing 100730,China [7]Tufts University School of Medicine,Boston MA 02111,USA

出　　处：《Science China(Life Sciences)》2024年第5期1061-1068,共8页中国科学（生命科学英文版）

基　　金：supported by the National Natural Science Foundation of China(81830043,81771561);the National High Level Hospital Clinical Research Funding(2022-PUMCH-A-113,2022-PUMCH-C-031);the National Key Research and Development Program of China(2018YFC2002201);the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2020-PT320-003)。

摘　　要：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 stageⅢ–Ⅳsymptomatic 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.

关 键 词：COMPLICATION EFFICACY long-term follow-up pelvic organ prolapse safety transvaginal mesh 

分 类 号：R713[医药卫生—妇产科学]