经阴道植入网片侵蚀与暴露原因探讨

Discussion on causes of erosion and exposure of transvaginal mesh

目前,经阴道植入网片(transvaginal mesh,TVM)的盆底重建手术,网片的暴露、侵蚀问题受到了越来越多的关注。其主要风险因素包括患者的自身因素、网片材料、网片植入的位置、术者的经验技巧、手术过程、术后管理等。网片的类型种类较多,其材料、孔径大小均对网片的侵蚀与暴露有不同的影响。医生的手术技巧和经验是网片侵蚀、暴露的保护性因素,规范的手术操作在减少并发症的发生中有重要作用。患者的年龄、糖尿病史均与网片的侵蚀、暴露显著相关,其体重指数(BMI)、盆底手术史对网片侵蚀、暴露的影响尚存在争议。深入了解网片侵蚀与暴露发生的原因,对合理应用网片、采取有效措施预防减少并发症发生,以及处理并发症、提高治疗效果有着重要的意义。

Recently,the exposure and erosion of mesh have attracted more and more attention in pelvic floor reconstruction with transvaginal mesh implantation.The main risk factors include the patient’s own factors,the mesh material,the location of the mesh implant,the surgeon’s experience and skills,the surgical process,and postoperative management.There are many types of mesh,and their materials and pore size have different effects on the erosion and exposure of mesh.The operation skill and experience of doctors are the protective factors of mesh erosion and exposure.Standardized operation plays an important role in reducing the occurrence of complications.The age and diabetes history of the patients are significantly related to the mesh erosion and exposure.The influence of body mass index and the history of pelvic floor surgery on the mesh erosion and exposure is still controversial.Understanding the causes of mesh exposure and erosion is of great significance to the rational application of mesh,effective prevention and reduction of complications,treatment of complications and improvement of treatment effect.