腹腔镜阴道骶骨固定术后骶前感染一例并文献复习

Spondylodiscitis following Laparoscopic Sacrocolpopexy:A Case Report and Literature Review

阴道骶骨固定术临床应用多年,但网片相关并发症近年逐渐被关注。阴道骶骨固定术后骶前感染虽为该术式的罕见并发症,但临床处理困难,给患者造成较大痛苦。报告1例经阴道全子宫切除术联合腹腔镜阴道骶骨固定术后发现骶前感染病例,患者因阴道骶骨固定术后4个月自觉腰骶部疼痛并加重、影响活动就诊,妇科检查提示阴道残端黏膜缺损,余未见明显异常;盆腔、脊柱磁共振成像检查发现L5~S2椎体感染,剖腹探查发现网片部分感染,遂行感染网片移除术,术后给予抗生素、腹腔冲洗引流、局部涂抹雌激素乳膏辅助治疗后患者治愈。随访5年,未发现相关并发症和阴道穹窿脱垂复发。并以此罕见并发症的发生机制、临床评估、处理及预防等进行文献复习,以期提高临床医师对此并发症的认识。

Sacrocolpopexy has been applied in clinic for many years,but recently the complications associated with mesh were reported frequently.Spondylodiscitis is a rare complication of sacrocolpopexy.The clinical management is difficult and causes great pain to patients.A case of spondylodiscitis was reported 4 months after vaginal hysterectomy combined with laparoscopic sacrocolpopexy.The patient developed persistent pain of the lumbosacral portion,and the pain was worse and restricted the mobility.Gynecological examination indicated vaginal stump mucosal defects,and no obvious abnormalities were observed.Pelvic and spine MRI examination revealed presacral infection of L5-S2.Exploratory laparotomy was performed and partial infection of the mesh was found.The infected mesh was removed.Followed by the surgery,the patient was cured via antibiotics,peritoneal lavage and drainage and local application of estrogen cream.After 5 years of follow-up,no related complications and recurrence of vaginal prolapse were found.The mechanism,clinical evaluation,management and prevention of the complications were reviewed in order to improve clinicians′understanding of the complication.