CN110090090B - A combined method of intravaginal mesh cutting suitable for full pelvic floor reconstruction - Google Patents

Abstract

Translated fromChinese

本发明实施例公开了一种适用于全盆底重建术的阴道内网片裁剪组合方法，属于全盆底重建术技术领域。所述方法包括展开后路网片，根据患者宫颈长度，在后路网片下部进行弧形裁剪，使后路网片下部的长度和形态与宫颈吻合；前路网片的中后部与裁剪后的后路网片的上部重合叠放，使用不可吸收线在前路网片和后路网片的重合处进行外科打结以固定前路网片和后路网片，得到具有六翼网带的一体网片。所述一体网片在保证手术预后效果的前提下，可以有效减少阴道内切口长度，减少需要分离的组织间隙，减少术中出血，缩短手术时间，降低出现网片挛缩，网片疼痛，网片暴露，网片侵蚀等可能，有效减少并发症的发生，规避手术风险。

The embodiment of the invention discloses an intravaginal mesh cutting and combination method suitable for full pelvic floor reconstruction, which belongs to the technical field of full pelvic reconstruction. The method includes unfolding the posterior mesh sheet, and according to the length of the patient's cervix, cutting the lower part of the posterior mesh sheet in an arc shape so that the length and shape of the lower part of the posterior mesh sheet are consistent with the cervix; The upper parts of the rear mesh sheets are overlapped and stacked, and a non-absorbable thread is used to perform surgical knotting at the overlap of the anterior mesh sheet and the posterior mesh sheet to fix the anterior mesh sheet and the posterior mesh sheet to obtain a mesh with six wings. Integrated mesh with belt. Under the premise of ensuring the prognosis of the operation, the integrated mesh can effectively reduce the length of the incision in the vagina, reduce the tissue space to be separated, reduce intraoperative bleeding, shorten the operation time, and reduce the occurrence of mesh contracture, mesh pain, and mesh. Exposure, mesh erosion, etc. may effectively reduce the occurrence of complications and avoid surgical risks.

Description

Combined method for cutting mesh in vagina suitable for total pelvic floor reconstruction

Technical Field

The embodiment of the invention relates to the technical field of total pelvic floor reconstruction, in particular to a cutting and combining method for intra-vaginal meshes suitable for total pelvic floor reconstruction.

Background

With the progress of aging society, investigation shows that the incidence rate of pelvic organ prolapse of the aged women is increased year by year. The problems of urination disorder and defecation disorder of the patient caused by the urine absorption and defecation absorption seriously affect the life quality of the patient. The conventional operation modes for treating pelvic organ prolapse are vaginal hysterectomy and vaginal anterior and posterior wall repair, and the operation modes have high recurrence rate.

The total pelvic floor reconstruction operation refers to a pelvic floor reconstruction operation considering defects of a plurality of parts of the anterior pelvic cavity, the middle pelvic cavity and the posterior pelvic cavity, and the total pelvic floor reconstruction operation with the mesh is more and more widely applied because the pelvic organ prolapse problem can be thoroughly improved.

At present, the total pelvic floor reconstruction technology adopts two meshes to repair the defects of the pelvic floor. The front pelvic cavity mesh (namely the front path mesh) is arranged in a vesicovaginal gap, is respectively fixed at the position 1cm away from the pubic bone union and 1cm away from the ischial spine by the front wing and the middle wing, and the back pelvic cavity mesh (namely the back path mesh) is arranged in a rectovaginal gap and is fixed at the position 1cm away from the ischial spine by the sacrospinous ligament by the back wing. For patients with severe prolapse of anterior pelvic organ and light prolapse of posterior pelvic organ, the simple anterior pelvic reconstruction operation may cause recurrence of prolapse of posterior pelvic organ several years later, while the simultaneous anterior and posterior pelvic reconstruction operations require two intravaginal incisions of about 5cm in length to be opened in the vagina, and not only the bladder and vaginal gaps need to be separated, but also the rectum and vaginal gaps need to be separated. In addition, for patients with short vaginal lengths, excess mesh tissue within the vagina may present potential complications risks, such as mesh contracture, pain, mesh erosion and exposure.

Disclosure of Invention

Therefore, the embodiment of the invention provides a combined method for cutting a mesh in a vagina suitable for a total pelvic floor reconstruction operation, which aims to solve the problems in the prior art that the reconstruction operation of an anterior pelvic cavity is performed only, so that the prolapse of a posterior pelvic cavity organ can recur after years, or the reconstruction operation of the anterior pelvic cavity and the posterior pelvic cavity is performed simultaneously, so that the operation time is long, the bleeding is excessive during the operation, and potential complication risks are caused.

In order to achieve the above object, the embodiments of the present invention provide the following technical solutions:

according to a first aspect of the embodiments of the present invention, there is provided a combined method for cutting and trimming a mesh in a vagina suitable for a total pelvic floor reconstruction, the method including:

unfolding the posterior mesh, and performing arc-shaped cutting on the lower part of the posterior mesh according to the length of the cervix of the patient to ensure that the length and the shape of the lower part of the posterior mesh are matched with the cervix;

the middle rear part of the front net piece is overlapped with the upper part of the cut back net piece, surgical knotting is carried out at the overlapped part of the front net piece and the back net piece by using non-absorbable threads to fix the front net piece and the back net piece, and the integrated net piece with the six-wing net belt is obtained.

Further, when the middle rear part of the front net piece and the upper part of the cut back net piece are overlapped and stacked, the belt distance between the middle wing net belt of the front net piece and the back wing net belt of the back net piece is 0.8-1.2 cm.

The reserved distance is that the middle wing mesh belt of the anterior mesh sheet needs to penetrate out from the anterior part of the ischial spine at a distance of 1cm from the arcus tendineus of the pelvic fascia, and the back wing mesh belt of the posterior mesh sheet needs to penetrate out from the sacrospinous ligament at a distance of 1cm from the ischial spine, and a distance is reserved between the two wing belt penetrating points. In addition, the reserved distance can well cover the fornix of cervix uteri, and a good supporting effect is provided for the middle pelvic cavity.

Further, the non-absorbable thread comprises any one of nylon suture, polyester suture, and polypropylene suture.

Further, surgical knotting was performed at 4 corners and at the center of the overlapped portion of the anterior mesh sheet and the posterior mesh sheet using non-absorbable threads, respectively.

According to a second aspect of embodiments of the present invention, there is provided an intravaginal mesh resulting from the above-described tailored combination procedure, which mesh is suitable for total pelvic floor reconstruction.

The embodiment of the invention has the following advantages:

according to the embodiment of the invention, the traditional mesh sheets for the front and rear pelvic cavities are cut and combined to obtain the integrated mesh sheet, the mesh sheet can be freely cut according to the length and the shape of the cervix of a patient so as to be inosculated with the cervix, and the occurrence of operation complications can be effectively reduced. The integrated mesh sheet reserves a six-wing mesh belt capable of fixing the front and rear pelvic organs, and when the full pelvic floor reconstruction operation is performed, the mesh sheet can be placed only by cutting an incision with the length of about 5cm on the front wall of the vagina, so that the whole area of the mesh sheet is reduced, but the function is unchanged. On the premise of ensuring the prognosis effect of the operation, the incision length in the vagina can be effectively reduced, the tissue gap needing to be separated is reduced, the intraoperative hemorrhage is reduced, and the operation time is shortened. The dosage of the mesh which is put into the body is reduced, the possibility of mesh contracture, mesh pain, mesh exposure, mesh erosion and the like is effectively reduced, and the operation risk is effectively avoided.

Drawings

In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below. It should be apparent that the drawings in the following description are merely exemplary, and that other embodiments can be derived from the drawings provided by those of ordinary skill in the art without inventive effort.

The structures, ratios, sizes, and the like shown in the present specification are only used for matching with the contents disclosed in the specification, so as to be understood and read by those skilled in the art, and are not used to limit the conditions that the present invention can be implemented, so that the present invention has no technical significance, and any structural modifications, changes in the ratio relationship, or adjustments of the sizes, without affecting the effects and the achievable by the present invention, should still fall within the range that the technical contents disclosed in the present invention can cover.

Fig. 1 is a schematic structural view of a front mesh sheet before being cut and combined according to an embodiment of the present invention;

FIG. 2 is a schematic structural diagram of a posterior mesh sheet before being cut and combined according to an embodiment of the present invention;

FIG. 3 is a schematic structural diagram of a cut posterior mesh panel according to an embodiment of the present invention;

FIG. 4 is a cut and assembled unitary mesh sheet having a six-wing belt according to an embodiment of the present invention;

in the figure: 1. a front wing mesh belt of the front mesh sheet; 2. a middle wing mesh belt of the front net sheet; 3. the upper part of the front net sheet; 4. the lower part of the front net sheet; 5. a rear wing mesh belt of a rear net sheet; 6. the upper part of a back net sheet; 7. the lower part of a back net sheet; 8. and (4) sewing points.

Detailed Description

The present invention is described in terms of particular embodiments, other advantages and features of the invention will become apparent to those skilled in the art from the following disclosure, and it is to be understood that the described embodiments are merely exemplary of the invention and that it is not intended to limit the invention to the particular embodiments disclosed. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.

Examples

The anterior mesh and the posterior mesh used in this example were made by hermet HERNIAMESH, italy, and model numbers PM30830 and PM41230, respectively.

The combined method for cutting the mesh in the vagina suitable for the total pelvic floor reconstruction comprises the following steps:

step one, preparing a front mesh (shown in figure 1) and a back mesh (shown in figure 2).

And step two, unfolding the posterior mesh, and performing arc-shaped cutting on the lower part of the posterior mesh according to the length of the cervix of the patient to ensure that the length and the shape of the lower part of the posterior mesh are matched with the cervix, so as to obtain the posterior mesh shown in the figure 3 after cutting.

And step three, overlapping and stacking the middle rear part of the front net piece and the front part of the cut back net piece, wherein when the obtained integrated net piece is combined and stacked, as shown in figure 4, the belt distance between the middlewing net belt 2 of the front net piece and the backwing net belt 5 of the back net piece is 0.8-1.2 cm. Then, surgical knotting is performed at 4 corners and the center position (the sewing point 8 shown in fig. 4) of the overlapped part of the anterior mesh sheet and the posterior mesh sheet using a non-absorbable thread, for example, any one of nylon suture, polyester suture and polypropylene suture, to fix the anterior mesh sheet and the posterior mesh sheet, i.e., the integrated mesh sheet having the six-wing mesh belt.

Application example

1 clinical data

160 cases of female pelvic organ prolapse patients admitted to the department of the hospital in 2016, 5 months to 2018, 5 months are selected as study objects, the patients are 50-80 years old, and the average age (68.3 +/-3.27) is old. All patients were randomized into treatment and control groups of 80 patients each according to the treatment protocol. The general data of two groups of patients are compared, and the difference is not statistically significant (P is more than 0.05).

2 method of treatment

The patients in the treatment group incise an incision about 5cm on the anterior wall of the vagina, separate the bladder from the anterior wall of the vagina, place the integrated mesh sheet obtained by the embodiment of the invention, the front wing mesh belt and the middle wing mesh belt of the integrated mesh sheet are respectively fixed at the position 1cm away from the pubic symphysis and 1cm away from the ischial spine, the back wing mesh belt is fixed at the position 1cm away from the ischial spine of the sacrospinous ligament, the mesh sheet is fixed, the incision is sutured, and the operation is finished.

The control group patients adopt the traditional pelvic floor reconstruction operation, namely, the anterior pelvic floor reconstruction operation and the posterior pelvic floor reconstruction operation are performed simultaneously, two intravaginal incisions with the length of about 5cm are opened in the vagina, the bladder and the vaginal gaps are separated successively, the rectum and the vaginal gaps are separated, the anterior mesh sheet is placed in the bladder and vaginal gaps, the anterior mesh sheet and the posterior mesh sheet of the anterior mesh sheet are respectively fixed at the position 1cm away from the pubic bone union and 1cm away from the ischial spine of the pelvic fascia tendon arch, the posterior mesh sheet is placed in the rectum and the vaginal gaps, the posterior mesh sheet is fixed at the position 1cm away from the ischial spine of the sacrospinous ligament, the mesh sheet is fixed, the incisions are sutured, and the.

3 observation index

The time required for surgery, intraoperative bleeding, time to hospitalization, and incidence of complications were recorded for both groups of patients.

4 statistical methods

Data were processed using SPSS 19.0 statistical software.

5 results

Results are recorded in table 1 for two groups of patients after treatment.

TABLE 1

The results show that: the time required by the operation of the patients in the treatment group is (59 +/-13) minutes, the bleeding amount in the operation is (80 +/-17) mL, the hospitalization time is (4.4 +/-1.5) days, the time required by the operation of the patients in the control group is (75 +/-21) minutes, the bleeding amount in the operation is (97 +/-19) mL, the hospitalization time is (5.1 +/-1.2) days, and the evaluation indexes of the two groups have statistical significance (p is less than 0.05) compared, so that the total pelvic floor reconstruction operation performed by using the integrated mesh obtained by cutting and combining the embodiment of the invention can effectively reduce the bleeding amount in the operation, shorten the operation time and be beneficial to the recovery of the patients.

1 patient in the treatment group has urine retention, and the complication incidence rate is 1.25%; 1 case of urine retention, 1 case of pelvic floor chronic hematoma, 1 case of mesh contracture pain and 3.75% of complication incidence rate of patients in a control group show that the occurrence of complications can be effectively reduced by using the integral mesh obtained by cutting and combining the embodiment of the invention to carry out total pelvic floor reconstruction.

Although the invention has been described in detail above with reference to a general description and specific examples, it will be apparent to one skilled in the art that modifications or improvements may be made thereto based on the invention. Accordingly, such modifications and improvements are intended to be within the scope of the invention as claimed.

Claims (2)

Translated fromChinese

1.一种适用于全盆底重建术的阴道内网片裁剪组合方法，其特征在于，所述方法包括：1. a kind of intravaginal mesh clipping combination method applicable to full pelvic floor reconstruction, is characterized in that, described method comprises:展开后路网片，根据患者宫颈长度，在后路网片下部进行弧形裁剪，使后路网片下部的长度和形态与宫颈吻合；Expand the posterior mesh, according to the length of the patient's cervix, perform arc cutting at the lower part of the posterior mesh, so that the length and shape of the lower part of the posterior mesh are consistent with the cervix;前路网片的中后部与裁剪后的后路网片的上部重合叠放，使用不可吸收线在前路网片和后路网片的重合处进行外科打结以固定前路网片和后路网片，得到具有六翼网带的一体网片；The middle and rear parts of the anterior mesh and the upper part of the cut posterior mesh are superimposed and superimposed, and a non-absorbable thread is used to surgically knot the overlap of the anterior mesh and the posterior mesh to fix the anterior mesh and the posterior mesh. The rear road mesh is obtained to obtain an integrated mesh with six-wing mesh belt;前路网片的中后部与裁剪后的后路网片的上部进行重合叠放时，前路网片的中翼网带和后路网片的后翼网带的带间距为0.8-1.2cm；When the middle and rear parts of the front mesh and the upper part of the cut rear mesh are overlapped and stacked, the belt spacing between the front mesh belt and the rear mesh belt of the rear mesh is 0.8-1.2 cm;所述不可吸收线包括尼龙缝线、涤纶聚酯缝线、聚丙烯缝线中的任一种；The non-absorbable thread includes any one of nylon suture, polyester polyester suture, and polypropylene suture;使用不可吸收线分别在前路网片和后路网片的重合处的4个角处及中心位置进行外科打结。Use non-absorbable thread to tie surgical knots at the four corners and the center of the overlap of the anterior mesh and posterior mesh, respectively.2.一种适用于全盆底重建术的阴道内网片，其特征在于，由权利要求1所述的裁剪组合方法得到。2 . An intravaginal mesh suitable for full pelvic floor reconstruction, characterized in that it is obtained by the cutting and combining method of claim 1 .

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