목적: 중앙부의 결함이 있는 방광탈의 교정은 전질벽 재건술 중에서도 전질벽 협축술을 시행하게 된다. 전질벽 협출술의 방법으로는 접근 방법에 따라 질식과 복식이 있고 최근 들어 합성 재료를 이용하는 방법도 있는데, 질식 전질벽 협축술, prolene mesh를 이용한 질식 전질벽 협축술과 복식 전질벽 협축술에 따른 수술 성적을 비교하고자 한다. 연구방법: 1999년 3월부터 2005년 5월까지 본원에서 전질벽 협축술을 시행 받은 환자 중에서 1년 이상 추적 관찰을 시행한 138명을 대상으로 의무 기록을 후향적으로 분석하였다. 이들을 질식 전질벽 협축술을 받은 환자, prolene mesh를 이용한 질식 전질벽 협축술을 받은 환자 그리고, 복식 전질벽 협축술을 시행 받은 환자 세 그룹으로 나누어 비교하였다. 결과: 세 그룹의 환자 수는 각각 72명, 28명, 38명이었으며, 연령, 폐경 여부, 분만력, 체질량 지수, 내외과적 질병력과 추적 관찰 기간 등은 차이를 보이지 않았다. 발열, 질미란, 배뇨근 부전증 발생 유무는 차이가 없었고 질방광루의 발생은 없었으나, 수술 후 요로 감염 발생 빈도는 prolene mesh를 이용한 질식 전질벽 협축술을 받은 환자에서 많았고. 수술 후 상처 감염, 수술 전후 혈색소의 차이, 수술 시간과 재발은 복식 전질벽 협축술을 받은 환자에서 많았다 (p<0.05). 결론: 중앙부 결함의 전질벽 재건술에 있어 고전적 방법의 질식 전질벽 협축술이 prolene mesh를 이용한 질식 전질벽 협축술과 복식 전질벽 협축술에 비해 합병증과 재발 면에서 가장 뛰어난 것으로 나타났다.

Objective: As for the method of surgical correlation of the central type of anterior vaginal wall defects, there are anterior repair, anterior repair with prolene mesh, and internal anterior repair. The object of this study was to compare the recurrence rates, complications and the clinical efficacy of the three surgical procedures. Methods: We identified one hundred and thirty-eight patients who underwent operations for the central type of anterior vaginal wall defects from March 1999 to May 2005. We retrospectively collected data from the medical records and reviewed the outcomes. We investigated the characteristics of patients, recurrence rates and complication rates for the results, and compared them by ANOVA test and Kruskal-Wallis test. Results: The number of cases of anterior repair, anterior repair with the mesh, and internal anterior repair were seventy-two, twenty-eight and thirty-eight consecutively. There was no significant difference in the characteristics of age, menopause status, parity, BMI (Body mass index) and history of pelvic surgery and the medico-surgical illness among the three groups. There were statistically no significant differences in fever, vaginal erosion, detrusor overactivity and voiding difficulty after the operations. The incidence of the postoperative urinary tract infections was increased significantly in the group of the anterior repair with prolene mesh (p=0.018), and drop in hemoglobin, operation time and wound infection were increased significantly in the group of the internal anterior repair (p=0.0001, 0.004 and p=0.028). The recurrence rate of the disease was significantly higher in internal anterior repair group than in anterior repair or anterior repair with the mesh groups (18.4% vs. 1.4% and 0%). The recurrence rate was increased in proportion to the duration after the surgery. Conclusion: The recurrence rate of the disease after internal anterior repair was significantly higher than when anterior repair or anterior repair with the mesh was done. As for the complications, urinary tract infection was increased after the anterior repair with prolene mesh and drop in hemoglobin and wound infection were increased after the internal anterior repair. We concluded that the conventional anterior repair is more suitable method for the correction of the central type of anterior vaginal wall defects than anterior repair with mesh and internal anterior repair.