腹腔镜骶骨固定术中单网片与双网片加强的腔室特异性结局：回顾性队列研究
该回顾性队列研究纳入897例2015-2024年接受腹腔镜骶骨固定术的患者，比较单网片（n=560）与双网片（n=337）加强的长期结局。双网片组与单网片组在加强腔室的解剖失败无生存率相似（92.6% vs. 92.7%；
要点
- 双网片与单网片在加强腔室的解剖失败率相似（92.6% vs. 92.7%）。
- 单网片组非加强腔室解剖失败风险显著增加（调整HR 38.13）。
- 单网片组主观失败风险更高（调整HR 4.88），但网片相关并发症无差异。
核心结论
- 腹腔镜骶骨固定术中，加强腔室的耐久性在单网片与双网片组间相似。
- 单网片加强与非加强腔室的失败和再手术风险升高相关，导致复合结局和主观结局较差，但未增加网片相关并发症。
研究设计与样本
- 回顾性队列研究，单中心三级转诊中心，纳入2015至2024年接受腹腔镜骶骨固定术的女性897例。
- 按索引手术中行单网片（前壁或后壁，n=560）或双网片（前壁和后壁，n=337）加强分组。
主要发现
- 网片配置与加强腔室的解剖失败无关联（调整HR 0.84；95%CI 0.47-1.49）。
- 非加强腔室的解剖失败仅发生于单网片组；Firth惩罚Cox回归显示单网片加强与非加强腔室解剖失败风险显著增加相关（调整HR 38.13；95%CI 3.70-86,989.61）。
- 非加强腔室的再手术仅见于单网片组（调整HR 38.23；95%CI 3.78-5269.73）。
- 单网片组主观失败风险更高（调整HR 4.88；95%CI 1.19-20.0），复合失败和主观失败更常见；网片相关并发症两组均少见且相当。
临床怎么用
- 对于接受腹腔镜骶骨固定术的患者，双网片加强可能降低非加强腔室的失败和再手术风险，但需结合个体情况权衡。
- 单网片加强时，应关注非加强腔室的解剖失败和主观失败风险，加强术后随访。
局限性
- 回顾性队列设计，可能存在选择偏倚和混杂。
- 单中心研究，结果外推需谨慎。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: To compare long-term anatomical, subjective, and surgical outcomes of single-mesh and double-mesh reinforcement for laparoscopic sacrocolpopexy (LSC) by focusing on compartment-specific failure and reoperation. DESIGN: Retrospective cohort study. SETTING: Single tertiary referral center. PARTICIPANTS: Women (n = 897) who underwent LSC-based apical prolapse surgery between 2015 and 2024. INTERVENTIONS: Patients were classified according to whether single-mesh (anterior-only or posterior-only mesh; n = 560) or double-mesh (anterior and posterior mesh; n = 337) reinforcement was performed during the index surgery. RESULTS: The primary outcome was time to anatomical failure (AF) in the reinforced compartment (n = 54 patients). Secondary outcomes included AF in nonreinforced compartments, subjective failure (SF), composite failure (CF), reoperation for recurrent prolapse, and mesh-related complications. The AF-free survival rate in the double-mesh group was similar to that in the single-mesh group (92.6% vs. 92.7%; log-rank p = .95). The mesh configuration was not associated with AF in the reinforced compartment (adjusted hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.47-1.49). AF in nonreinforced compartments occurred exclusively in the single-mesh group. Firth's penalized Cox regression demonstrated a substantially increased risk of AF in nonreinforced compartments associated with single-mesh reinforcement (adjusted HR, 38.13; 95% CI, 3.70-86,989.61). Reoperation in nonreinforced compartments was limited to the single-mesh group (adjusted HR, 38.23; 95% CI, 3.78-5269.73). CF and SF were more frequent in the single-mesh group. The single-mesh group had a higher risk of SF (adjusted HR, 4.88; 95% CI, 1.19-20.0). Mesh-related complications were infrequent and comparable between groups. CONCLUSION: Reinforced compartment durability after LSC was similar between groups. Single-mesh reinforcement was associated with higher risks of failure and reoperation, which led to inferior composite and subjective outcomes without increased mesh-related complications.
引用
- Sato H, Otsuka S, Sugita K, et al. Compartment-Specific Outcomes of Single-Mesh and Double-Mesh Reinforcement in Laparoscopic Sacrocolpopexy: A Retrospective Cohort Study. J Minim Invasive Gynecol. 2026. PMID: 42019577. doi:10.1016/j.jmig.2026.04.011
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。