CN110090090B - Combined method for cutting mesh in vagina suitable for total pelvic floor reconstruction - Google Patents
Combined method for cutting mesh in vagina suitable for total pelvic floor reconstruction Download PDFInfo
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- CN110090090B CN110090090B CN201910369119.9A CN201910369119A CN110090090B CN 110090090 B CN110090090 B CN 110090090B CN 201910369119 A CN201910369119 A CN 201910369119A CN 110090090 B CN110090090 B CN 110090090B
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/0063—Implantable repair or support meshes, e.g. hernia meshes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2240/00—Manufacturing or designing of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2240/001—Designing or manufacturing processes
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Abstract
The embodiment of the invention discloses a cutting and combining method for an intra-vaginal mesh suitable for a total pelvic floor reconstruction technique, and belongs to the technical field of the total pelvic floor reconstruction technique. The method comprises the steps of unfolding a posterior mesh, and performing arc-shaped cutting on the lower part of the posterior mesh according to the length of the cervix of a 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. On the premise of ensuring the prognosis effect of the operation, the integrated mesh can effectively reduce the incision length in the vagina, reduce the tissue gap needing to be separated, reduce the bleeding in the operation, shorten the operation time, reduce the possibility of mesh contracture, mesh pain, mesh exposure, mesh erosion and the like, effectively reduce the occurrence of complications and avoid the operation risk.
Description
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 middle wing net belt 2 of the front net piece and the back wing 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)
1. A combined method for cutting and combining a mesh in vagina suitable for a total pelvic floor reconstruction technique, which is characterized by comprising the following steps:
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;
superposing and stacking the middle rear part of the front net sheet and the upper part of the cut back net sheet, and performing surgical knotting at the superposed part of the front net sheet and the back net sheet by using a non-absorbable line to fix the front net sheet and the back net sheet to obtain an integrated net sheet with a six-wing net belt;
when the middle rear part of the front net piece and the upper part of the cut back net piece are superposed, the belt distance between the middle wing mesh belt of the front net piece and the back wing mesh belt of the back net piece is 0.8-1.2 cm;
the non-absorbable thread comprises any one of nylon suture, polyester suture and polypropylene suture;
surgical knotting was performed at 4 corners and the center position of the coincidence of the anterior mesh and the posterior mesh, respectively, using non-absorbable threads.
2. An intravaginal mesh suitable for total pelvic floor reconstruction, obtainable by the combined cutting method of claim 1.
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| CN201910369119.9A CN110090090B (en) | 2019-05-05 | 2019-05-05 | Combined method for cutting mesh in vagina suitable for total pelvic floor reconstruction |
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| CN201910369119.9A CN110090090B (en) | 2019-05-05 | 2019-05-05 | Combined method for cutting mesh in vagina suitable for total pelvic floor reconstruction |
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| CN110090090B true CN110090090B (en) | 2021-07-09 |
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Family Cites Families (16)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| DE19544162C1 (en) * | 1995-11-17 | 1997-04-24 | Ethicon Gmbh | Implant for suspension of the bladder in urinary incontinence in women |
| WO2003073960A1 (en) * | 2002-03-01 | 2003-09-12 | Ethicon, Inc. | Method and apparatus for treating pelvic organ prolapses in female patients |
| CN2696551Y (en) * | 2004-04-23 | 2005-05-04 | 童晓文 | Suspension auxiliary chip for treating prolapse of uterus and vaginal fornix |
| DE102004025404A1 (en) * | 2004-05-24 | 2005-12-22 | Serag-Wiessner Kg | Implant for suspension of the bladder in urinary incontinence of the woman |
| WO2007109062A2 (en) * | 2006-03-15 | 2007-09-27 | C.R. Bard, Inc. | Implants for the treatment of pelvic floor disorders |
| US9078727B2 (en) * | 2006-03-16 | 2015-07-14 | Boston Scientific Scimed, Inc. | System and method for treating tissue wall prolapse |
| WO2007118260A1 (en) * | 2006-04-14 | 2007-10-25 | Ami Agency For Medical Innovations Gmbh | Implantable mesh for surgical reconstruction in the area of the pelvic floor |
| WO2009086446A1 (en) * | 2007-12-28 | 2009-07-09 | Boston Scientific Scimed, Inc. | Meshes of variable construction |
| US8430807B2 (en) * | 2007-12-28 | 2013-04-30 | Boston Scientific Scimed, Inc. | Devices and methods for treating pelvic floor dysfunctions |
| US20100152530A1 (en) * | 2008-12-15 | 2010-06-17 | Mark Timmer | Biocompatible Fiber Based Device for Guided Tissue Regeneration |
| CN201394059Y (en) * | 2009-04-30 | 2010-02-03 | 南京医科大学附属南京第一医院 | Suspended mesh for female pelvic floor organ prolapse |
| CN203388960U (en) * | 2013-06-28 | 2014-01-15 | 南京市妇幼保健院 | Suspension mesh for treating female uterus and vaginae anterior prolapsus and stress incontinence |
| CN105012048B (en) * | 2014-04-18 | 2018-02-13 | 林鹤雄 | Support the implant of provagina wall prolapsing organ |
| CN205054532U (en) * | 2015-10-13 | 2016-03-02 | 戴志远 | A inguinal ligament suspends net piece in midair that is used for women's pelvic floor organ to prolapse |
| CN205814481U (en) * | 2016-05-18 | 2016-12-21 | 戴志远 | For repairing the auxiliary device of female pelvic organ prolapse |
| IT201700105278A1 (en) * | 2017-09-20 | 2019-03-20 | Nardo Tola | Network surgical device for laparoscopic use |
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