|
|
|
|
Vojnosanitetski pregled 2011, vol. 68, br. 7, str. 583-588
|
|
|
Upotreba transvaginalne mrežice u korekciji prolapsa pelvičnih organa kao minimalno invazivnog hirurškog postupka
Klinički centar Srbije, Institut za ginekologiju i akušerstvo, Beograd
e-adresa: cvijiceva@yubc.net
SažetakUvod/Cilj. Prolaps genitalnih organa sa ili bez urinarne stres inkontinencije najčešći je zdravstveni problem starije ženske populacije i povećava se sa godinama starosti. Cilj rada bio je prikaz retrospektivne studije, koja analizira perioperativne i kasne postoperativne komplikacije kod upotrebe transvaginalne neresorptivne mrežice u rekontrukciji karličnog dna zbog prolapsa pelvičnih organa. Metode. Podaci su dobijeni retrospektivnom analizom 96 bolesnica koje su operisane u periodu septembar 2006 - januar 2010. Za korekciju spada korišćen je Prolift komplet proizvođača Gynecare, Ethicon, USA. Rezultati. Sve bolesnice imale su prolaps u stadijumu III ili IV. Prednji prolift ugrađen je kod 52 (54%) bolesnice, zadnji kod 32 (33%), a totalni kod 12 (13%) bolesnica. Imali smo samo jednu ozbiljnu intraoperativnu komplikaciju, povredu mokraćne bešike, koja je odmah prepoznata i sanirana. Drugih ozbiljnih intraoperativnih komplikacija nije bilo. Kasni neželjeni efekti, koji su se manifestovali tri meseca nakon operacije, bili su: erozija vagine kod devet (9,3%) bolesnica, retrakcija mrežice kod šest (6,2%) bolesnica, de novo inkontinencija kod pet (5,2%) bolesnica. Sve bolesnice bile su dostupne praćenju. Prosečno vreme praćenja iznosilo je 18,2 meseca (3-35). Uspešan ishod tretmana postignut je kod 93,75% bolesnica, a kod šest bolesnica (6,25%) pojavili su se recidivi. Zaključak. Upotreba neresorptivne polipropilenske mrežice predstavlja minimalno invazivnu i prilično sigurnu metodu za rekontrukciju karličnog dna. Iako ukupan morbiditet nije mali, napominjemo da je 69% bolesnica u studiji operisano zbog recidiva prethodne klasične operacije. Pored toga, ovo su prvi rezultati nove operativne tehnike bez prethodnog iskustva.
Ključne reči
|
|
|
|
Reference
|
|
 
|
Abdel-Fattah, M., Ramsay, I. (2008) Retrospective multicentre study of the new minimally invasive mesh repair devices for pelvic organ prolapse. BJOG, 115(1): 22-30
|
|
|
Aungst, M.J., Friedman, E.B., Pechmann, W.S., Horbach, N.S., Welgoss, J.A. (2009) De novo stress incontinence and pelvic muscle symptoms after transvaginal mesh repair. American journal of obstetrics and gynecology, 201(1): 73.e1-7
|
|
 5
|
Bump, R.C., Mattiasson, A., Bo, K., Brubaker, L.P., DeLancey, J.O., Klarskov, P., Shull, B.L., Smith, A.R. (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol, 175(1): 10-7
|
|
|
Cervigni, M., Natale, F., la Penna, C., Panei, M., Mako, A. (2008) Transvaginal cystocele repair with polypropylene mesh using a tension-free technique. International urogynecology journal and pelvic floor dysfunction, 19(4): 489-96
|
|
|
Clark, A.L., Gregory, T., Smith, V.J., Edwards, R. (2003) Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary incontinence. American journal of obstetrics and gynecology, 189(5): 1261-7
|
|
|
Collinet, P., Belot, F., Debodinance, P., Ha, D.E., Lucot, J., Cosson, M. (2006) Transvaginal mesh technique for pelvic organ prolapse repair: Mesh exposure management and risk factors. International urogynecology journal and pelvic floor dysfunction, 17(4): 315-20
|
|
4
|
de Leval, J. (2003) Novel surgical technique for the treatment of female stress urinary incontinence: Transobturator vaginal tape inside-out. Eur Urol, 44(6): 724-30
|
|
1
|
de Tayrac, R., Devoldere, G., Renaudie, J., Villard, P., Guilbaud, O., Eglin, G. (2007) Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study. International urogynecology journal and pelvic floor dysfunction, 18(3): 251-6
|
|
|
Dwyer, P.L., Reilly, B.O.A. (2004) Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh. BJOG, 111(8): 831-6
|
|
|
Fatton, B., Amblard, J., Debodinance, P., Cosson, M., Jacquetin, B. (2007) Transvaginal repair of genital prolapse: Preliminary results of a new tension-free vaginal mesh (Prolift technique): A case series multicentric study. International Urogynecology Journal, 18(7): 743-52
|
|
|
Gauruder-Burmester, A., Koutouzidou, P., Rohne, J., Gronewold, M., Tunn, R. (2007) Follow-up after polypropylene mesh repair of anterior and posterior compartments in patients with recurrent prolapse. International urogynecology journal and pelvic floor dysfunction, 18(9): 1059-64
|
|
|
Hiltunen, R., Nieminen, K., Takala, T., Heiskanen, E., Merikari, M., Niemi, K., i dr. (2007) Low-weight polypropylene mesh for anterior vaginal wall prolapse: A randomized controlled trial. Obstet Gynecol, 110(2 Pt 2): 455-62
|
|
1
|
Jacquetin, B., Cosson, M. (2009) Complications of vaginal mesh: our experience. International urogynecology journal and pelvic floor dysfunction, 20(8): 893-6
|
|
|
Migliari, R., de Angelis, M., Madeddu, G., Verdacchi, T. (2000) Tension-free vaginal mesh repair for anterior vaginal wall prolapse. European urology, 38(2): 151-5
|
|
|
Milani, R., Salvatore, S., Soligo, M., Pifarotti, P., Meschia, M., Cortese, M. (2005) Functional and anatomical outcome of anterior and posterior vaginal prolapse repair with prolene mesh. BJOG, 112(1): 107-11
|
|
3
|
Nichols, D.H. (1982) Sacrospinous fixation for massive eversion of the vagina. Am J Obstet Gynecol, 142(7): 901-4
|
|
1
|
Olsen, A.L., Smith, V.J., Bergstrom, J.O., Colling, J.C., Clark, A.L. (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstetrics and gynecology, 89(4): 501-6
|
|
|
Shah, D.K., Paul, E.M., Rastinehad, A.R., Eisenberg, E.R., Badlani, G.H. (2004) Short-term outcome analysis of total pelvic reconstruction with mesh: The vaginal approach. Journal of urology, 171(1): 261-3
|
|
|
Weber, A.M., Walters, M.D., Piedmonte, M.R., Ballard, L.A. (2001) Anterior colporrhaphy: A randomized trial of three surgical techniques. American journal of obstetrics and gynecology, 185(6): 1299-304; discussion 1304-6
|
|
|
|
|