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中华妇幼临床医学杂志(电子版) ›› 2025, Vol. 21 ›› Issue (03) : 257 -265. doi: 10.3877/cma.j.issn.1673-5250.2025.03.002

标准·方案·指南

《使用合成网片的盆腔器官脱垂手术后并发症的诊断和管理:法国临床实践指南》要点解读
杨姝瑞, 罗灿, 牛晓宇()   
  1. 四川大学华西第二医院妇产科、出生缺陷与相关妇儿疾病教育部重点实验室,成都 610041
  • 收稿日期:2025-03-22 修回日期:2025-05-19 出版日期:2025-06-01
  • 通信作者: 牛晓宇

Key points interpretation of the Diagnosis and Management of Complications Following Pelvic Organ Prolapse Surgery Using a Synthetic Mesh: French National Guidelines for Clinical Practice

Shurui Yang, Can Luo, Xiaoyu Niu()   

  1. Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610044, Sichuan Province, China
  • Received:2025-03-22 Revised:2025-05-19 Published:2025-06-01
  • Corresponding author: Xiaoyu Niu
  • Supported by:
    National Key Research and Development Program of China(2021YFC2009100); Project of Health Commission of Sichuan Province(21ZD002); Project of Science and Technology Department of Sichuan Province(2023YFS0024)
引用本文:

杨姝瑞, 罗灿, 牛晓宇. 《使用合成网片的盆腔器官脱垂手术后并发症的诊断和管理:法国临床实践指南》要点解读[J/OL]. 中华妇幼临床医学杂志(电子版), 2025, 21(03): 257-265.

Shurui Yang, Can Luo, Xiaoyu Niu. Key points interpretation of the Diagnosis and Management of Complications Following Pelvic Organ Prolapse Surgery Using a Synthetic Mesh: French National Guidelines for Clinical Practice[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2025, 21(03): 257-265.

随着全球老龄化形势日渐严峻,盆腔脏器脱垂(POP)发病率呈逐年升高趋势,严重影响女性患者的身心健康和生活质量。手术是目前重度POP患者最主要治疗方式,网片在POP手术中应用极为广泛,在长期及短期随访临床研究中均取得满意疗效。虽然POP围术期与使用合成不可吸收网片相关并发症并不常见,但是一旦发生,患者症状可能很严重,并极大降低患者术后生活质量。既往发布的国内外相关指南及专家共识,如《盆底重建手术网片或吊带暴露并发症诊治的中国专家共识》,主要关注网片暴露的识别及处理。2024年法国国家卫生管理局在全球首次发布《使用合成网片的盆腔器官脱垂手术后并发症的诊断和管理:法国临床实践指南》(Diagnosis and Management of Complications Following Pelvic Organ Prolapse Surgery Using a Synthetic Mesh: French National Guidelines for Clinical Practice)(以下简称为《本指南》),为POP手术后网片相关并发症管理的临床实践指南,填补了本领域无系统全面介绍POP手术后网片相关并发症管理指南及专家共识的空白。笔者拟就《本指南》关于POP手术后网片导致泌尿系统、肛肠系统相关并发症及其管理,POP手术网片暴露、网片导致感染相关并发症及其管理,POP手术后网片导致相关术后疼痛、术后性生活困难、出血和血肿、阴道壁损伤并发症及其管理等要点进行专业解读,旨在为我国临床医师诊治使用网片的POP手术后网片相关并发症提供指导和参考。

With the global aging trend intensifying, the incidence of pelvic organ prolapse (POP) is rising annually, profoundly impacting the physical and mental health and quality of life of female patients. Surgery is currently the primary treatment for severe POP. Mesh is widely used in POP surgery, yielding satisfactory outcomes in both long-term and short-term follow-up clinical studies. While complications related to mesh in POP surgery are not common, they can be severe and significantly reduce the postoperative quality of life for POP patients. Previous domestic and international relevant guidelines and expert consensus, such as Chinese Expert Consensus on the Diagnosis and Treatment of Mesh or Sling Exposure Complications After Pelvic Floor Reconstructive Surgery, mainly focus on the identification and treatment of mesh exposure. In 2024, the French National Health Authority published the world′s first clinical practice guidelines on the management of postoperative mesh complications in POP, which was Diagnosis and Management of Complications Following Pelvic Organ Prolapse Surgery Using a Synthetic Mesh: French National Guidelines for Clinical Practice (hereinafter referred to as " This Guideline" ). This Guideline is a clinical practice guideline for the management of mesh-related complications after POP surgery, filling the gap of the lack of systematic and comprehensive guidelines and expert consensus on the management of mesh-related complications after POP surgery. The authors intend to provide a professional interpretation of the key points of The Guidelines regarding mesh-induced complications of the urinary system and anorectal system after POP surgery and their management; mesh exposure after POP surgery, mesh-induced infection-related complications and their management; mesh-induced postoperative pain, postoperative sexual difficulties, bleeding and hematoma, vaginal wall injury complications and their management, etc., aiming to provide guidance and reference for Chinese clinicians to manage postoperative complications of POP surgery using mesh.

图1 POP术后患者阴道聚丙烯网片暴露的处理流程图注:POP为盆腔脏器脱垂。MDT为多学科协作诊疗
图2 POP术后患者阴道聚酯网片暴露的处理流程图注:POP为盆腔脏器脱垂。MDT为多学科协作诊疗
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