盆底重建术后合成网片或吊带相关疼痛的处理和结局分析

Treatment and outcome of polypropylene mesh or tape related pain after reconstructive pelvicsurgery

目的探讨盆底重建术后合成网片或吊带相关疼痛的处理方法和治疗结局。方法收集2007年1月-2014年12月间北京大学人民医院收治的因盆底重建术后合成网片或吊带相关疼痛行再次手术治疗的患者共12例进行回顾性分析，探讨其一般临床特点、盆底重建术后网片或吊带的相关并发症、再次手术方式及治疗结局。结果（1）一般临床特点：12例患者的中位年龄为54岁（43-74岁）；中位阴道分娩次数为2次（1-5次）；盆底重建术的手术方式：行阴道网片植入术9例（其中5例同时行尿道中段悬吊术），直肠表面网片植入＋尿道中段悬吊术1例，阴道骶骨固定术2例。（2）盆底重建术后网片或吊带的相关并发症：12例患者盆底重建术后均有疼痛并发症，包括性交痛、会阴痛、排便及排尿痛等；同时伴有的其他并发症有阴道排液或流血7例、伴侣性交不适1例。从初次盆底手术（即盆底重建术）到出现疼痛症状的平均时间为21个月（0—48个月），白初次盆底手术到因疼痛症状而就诊的平均时间为30个月（1-72个月）。（3）再次手术的方式及治疗结局：12例均行网片或吊带去除术。其中，10例为阴式手术，均为网片部分去除术；2例为腹腔镜手术，其中1例行网片完全去除＋吊带部分去除术，1例行网片完全去除术。网片或吊带去除术前、后视觉模拟疼痛量表（VAS）评分分别为（7．1±2．2）、（0．9±1．9）分，两者比较，差异有统计学意义（P〈0．01），疼痛改善平均为6．2分。结论疼痛是导致盆底手术后患者要求取出网片或吊带的主要原因之一；再次手术治疗可采用阴式或腹腔镜下行网片或吊带部分或全部去除术，可明显改善疼痛等症状。

Objective To investigate clinical treatment and outcome of mesh-related pain after pelvic floor reconstruction. Methods Twelve patients were referred to Peking University People＇s Hospital for post-operation pain related to polypropylene mesh or tape used in pelvic floor reconstruction and received reoperation from January 2007 to December 2014. The demographic characteristics, clinical manifestation, operation method and follow-up outcome were retrospectively analyzed, and current literature was also reviewed. Results （ 1 ）General information： the median age was 54 years old （range 43-74 years old）. The median vaginal delivery times was 2 （range 1-5）. Initial pelvic floor operation procedures included 4 cases vaginal mesh, 5 cases vaginal mesh plus tension-free vaginal tape （TVT）, 1 case rectal surface mesh implantation, and 2 cases sacrocolpopexy. （2） Related complications： all 12 patients had pain-related post- operation symptoms including dyspareunia, perineal pain, urination and defecation difficulty. Seven patients also complicated with other symptoms including discharge and bleeding. Mean time from first operation to medical consultation was 30 months （range 1-72 months）. （3） Reoperation results： all 12 patients received reoperation on mesh revision or tape, 10 cases of them reoperated by vaginal approach, while the other 2 cases by laparoscopy. The range of the mesh or tape depended on tender or firm tissue and scar by palpation. The visual analogue scale （VAS） was significantly improved, which was 7.1±2.2 pre-operation, and 0.9 ±1.9 post-operation （95% Cl： 4.48±7.86, P〈0.01）. Conclusions Pain is one of the reason whypatients was removal of the mesh or tape after pelvic floor reconstruction operation. The surgery procedure may be considered as partial or entire mesh or tape excision by vaginal or abdominal way. Mesh or tape removal surgery could relieve related pain and other complications, and the VAS score was significantly improved after surgical management.