盆底修复聚丙烯网片植入阴道内局部炎症反应的病理学研究

Pathological Study of Implanted MESH in Vagina after Pelvic Reconstruction Surgery

目的:探讨盆底修复术中聚丙烯网片植入阴道后局部病理学变化。方法:采集自2004年5月至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(Pelvic Floor Dysfunction,PFD)术后发生网片阴道暴露的样本18例,对局部暴露的网片进行切除,并进行病理学观察,总结阴道局部炎症反应的特点。结果:8例发生于手术后1个月内,组织反应以急性炎症反应为主,表现为粒细胞增多,后期在周围逐渐出现巨噬细胞,肉芽组织形成,毛细血管增生;9例1-6个月发生者转为慢性炎症反应,表现为成纤维细胞和淋巴细胞增多,6个月以上发生暴露1例,部分组织出现鳞状上皮增生。结论:聚丙烯网片植入阴道暴露局部组织分为急性反应期、慢性反应期、鳞状上皮增生期,6个月后可见纤维组织增生,胶原增加,炎细胞减少,10月后上皮结构基本同正常鳞状上皮。

Objective： To explore the pathological reaction around exposed mesh vagina after pelvic reconstruction surgery with Mesh implantation. Methods： 18 cases were collected in which mesh polypropylene mesh exposure occurred after transvaginal pelvic reconstruction from May 2004 to Dee 2011 in the First Affiliated Hospital of Chinese PLA General Hospital. Exposed mesh was removed and examined by histopathology. Reuslts： 8 cases of Mesh exposure occurred in 1 month and the pathology study showed acute inflammation reaction, including granulocyte accumulation as well as macrophage and granulation tissue formation, capillary proliferation at the later stage. 9 eases occurred after 1 month and showed chronic inflammation reaction, including fibroblast and leucocytes increased. 1 case occurred after 6 months and showed squamous epithelial cell proliferation. Conelnsion： The local pathological reaction of Polypropylene Mesh implantation includes acute and chronic inflammation reaction as well as squamous epithelial proliferation. Fibroplastic proliferation, collagen increase and inflammatory cell decrease were detected after 6 months. The epithelium is similar with squamous epithelial cell after 10 months.