应用合成网片经阴道重建术
阴道内放置合成网片进行重建是一种新的具有争议的修补盆腔脏器脱垂的手术方式。目前仅有很少量的证据支持常规使用合成网片重建阴道顶端。[3]Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol. 2001;184:1496-1501.http://www.ncbi.nlm.nih.gov/pubmed/11408873?tool=bestpractice.com[60]Sung VW, Rogers RG, Schaffer JI, et al; Society of Gynecologic Surgeons Systematic Review Group. Graft use in transvaginal pelvic organ prolapse repair: a systematic review. Obstet Gynecol. 2008;112:1131-1142.http://www.ncbi.nlm.nih.gov/pubmed/18978116?tool=bestpractice.com[61]Shah HN, Badlani GH. Mesh complications in female pelvic floor reconstructive surgery and their management: a systematic review. Indian J Urol. 2012;28:129-153.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424888/http://www.ncbi.nlm.nih.gov/pubmed/22919127?tool=bestpractice.com[62]Maher C, Feiner B, Baessler K, et al. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016;(2):CD012079.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012079/fullhttp://www.ncbi.nlm.nih.gov/pubmed/26858090?tool=bestpractice.com[63]Schimpf MO, Abed H, Sanses T, et al. Graft and mesh use in transvaginal prolapse repair: a systematic review. Obstet Gynecol. 2016;128:81-91.http://www.ncbi.nlm.nih.gov/pubmed/27275813?tool=bestpractice.com [ 
]In women with vaginal prolapse, what are the benefits and harms of transvaginal mesh or grafts compared with native tissue repair?https://cochranelibrary.com/cca/doi/10.1002/cca.1317/full显示答案
美国妇产科医师学会 (American College of Obstetricians and Gynecologists, ACOG) 推荐，患者在了解关于网片种类以及手术使用合成网片仍处于实验阶段的有限信息后，同意接受手术。[56]American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 176: pelvic organ prolapse. Obstet Gynecol. 2017;129:763-765.http://www.ncbi.nlm.nih.gov/pubmed/28333810?tool=bestpractice.com 英国国家健康与临床优选研究所 (NICE) 发表声明，在阴道壁内放置网片进行修补手术已经被证实优于传统手术，但是只用于患者同意、临床管理和审查工作都已经妥善安排的情况下。[59]National Institute for Health and Care Excellence. Surgical repair of vaginal wall prolapse using mesh. June 2008. http://www.nice.org.uk (last accessed 28 June 2017).http://www.nice.org.uk/guidance/IPG267 美国妇科医师学会系统回顾小组 (Society of Gynecologic Surgeons Systemic Review Group) 也发表了类似的声明。[64]Murphy M; Society of Gynecologic Surgeons Systematic Review Group. Clinical practice guidelines on vaginal graft use from the Society of Gynecologic Surgeons. Obstet Gynecol. 2008;112:1123-1130.http://www.ncbi.nlm.nih.gov/pubmed/18978115?tool=bestpractice.com[65]Falagas ME, Velakoulis S, Iavazzo C, et al. Mesh-related infections after pelvic organ prolapse repair surgery. Eur J Obstet Gynecol Reprod Biol. 2007;134:147-156.http://www.ncbi.nlm.nih.gov/pubmed/17459563?tool=bestpractice.com 使用手术网片/吊带治疗泌尿妇科脱垂时，将网片经阴道壁置入的做法目前在英国是被禁止的，同时正在进行一项针对这一做法的评价研究。2018 年 7 月，英国国民健康服务系统建议，若临床上是安全的，那么所有病例均应推迟此手术。 [50]NHS Improvement and NHS England. Vaginal mesh: high vigilance restruction period. Provider bulletin: 11 July 2018.美国食品药品监督管理局 (US Food and Drug Administration) 已接到数千份关于对盆腔器官脱垂进行经阴道网片修复后出现并发症的报告，包括由网片侵入周围组织导致的感染、出血、盆腔疼痛、性交疼痛、器官穿孔和泌尿问题。FDA 已颁布两份拟制命令，将这些器械从 II 类（中等风险）重新归类为 III 类（高风险）。FDA news release: requirements for surgical mesh repair 美国妇产科医师学会 (American College of Obstetricians and Gynecologists) 和美国妇科泌尿协会 (American Urogynecologic Society) 出版了关于治疗盆腔器官脱垂的阴道内放置网片的使用建议。[66]Committee on Gynecologic Practice. Committee Opinion no. 513: vaginal placement of synthetic mesh for pelvic organ prolapse. Obstet Gynecol. 2011;118:1459-1464.http://www.ncbi.nlm.nih.gov/pubmed/22105294?tool=bestpractice.com 美国妇科泌尿协会 (American Urogynecologic Society) 还出版了相关指南，授予那些计划在实践中进行网片修补的医生以特权和认证。[67]American Urogynecologic Society’s Guidelines Development Committee. Guidelines for providing privileges and credentials to physicians for transvaginal placement of surgical mesh for pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2012;18:194-197.http://www.ncbi.nlm.nih.gov/pubmed/22777366?tool=bestpractice.com
