The Significance Of Uterus Conservation In Pelvic Reconstructive Surgery And Its Clinical Research

Objective: Through the review and follow-up with the uterus conservation group and concomitant hysterectomy group in preoperative, intraoperative, and metaoperation, to compare the two sets of patients'differences in intraoperative condition, postoperative recovery preoperative the variation of qualities, and so on. Then to evaluate the significance of uterus conservation in pelvic reconstructive surgery. Thereby it can offer the theory accordance for clinical doctors to choose the best operation types for patients.Methods:1 The study subject: From Dec.2006 to Dec. 2008, 29 patients with pelvic organ prolapse ( POP-Q stageⅢ~Ⅳ) under went pelvic reconstructive surgery with synthetic mesh were studied in Shijiazhuang City Apriori Hospital. Except patients of fundus vaginae prolapse, 27 patients consistent with the conditions to put in the groups.2 The groups and diagnosis criteria: Put into two groups. Pelvioscopy, B Type Vagina Ultrasound, Patholigy of Endometrium, Cervical Cytological Examination, etc. to show benign lesion. And it should be put into concomitant hysterectomy group. The one whose those examinations were normal should be put into uterus conservation group. General information comparing the two groups is no significant difference. 15 patients were put into concomitant hysterectoncy group. They were treated with hysterectomia and whole pelvic cavity ventrofixation from vagina. 10 of them were also treated with improvement TVT-O operation because of Stress Urinary Incontinence(SUI) (to comfirmed by cough stress and Marshall-bonney test); 12 patients were put into uterus conservation gtoup. They were reserved the uterus and trested with whole pelvic cavity ventrofixation from vagina. 9 of them were also treated with improvement TVT-O operation because of SUI (diagnosis with the former). Diagnosis criteria:ⅢGrade: Prolapse of the farthest point over the maidenhead plane of 1cm, but no more than the total vaginal length of 2cm[Quantitative values>1cm~<+(TVL-2)cm].ⅣGrade: Lower genital tract prolapse complete eversion, prolapse of the far point at least TVL-2cm[Quantitative values?+(TVL-2) cm].Most of the cases, the edge of prolapse should be cervical or vaginal stump inⅣGrade. SUI : Cough stress test :also named Stress test, scilicet experimental bladder filling, it can procure information of detrusor muscle's activity, understand capacity of bladder, measure residual urine, and understand urethral closed function by pressure experiment. Marshall-bonney test: also named Mashall-Marchett test, it is to bring up two sides of urethral orifice, but do not oppress urethra and instruct patients to cough hardly and then no urine to flow outward is masculine.3 Preoperative Preparation: All patients were treated with Pelvioscopy, B Type Vagina Ultrasound, Patholigy of Endometrium, Cervical Cytological Examination, etc. and remove adnexa uteri's structural malignant diseases. If patients complicating hysteromyoma endomembrane or affection (innocence)should be treated with hysterectomy; others uterus conservation. Did bowel preparation 2 days before surgery, oral laxatives 1 day before surgery and cleansing enema.4 Operation schema: The whole pelvic floor ventrofixation including: Vesico-vaginal fascia reconstruction, cardinal ligament, bladder neck ligament, sacro-ligament ventrofixation and recto-vaginal septum reconstruction. To treat SUI with improvement TVT-O surgery.5 Special equipment used for operation: Mesh using the United States Johnson & Johnson Gyne mesh (10×15cm). Special instrument: Puncture cone researched and inventied by Professor Xiaowen Tong and made by Shanghai Qingtai Medical Devices company.6 Follow-up visit: Patients were to recheck 2 months later after operation, every 6 months to recheck after operation. Content including subjective sensation of patients, routine pelvioscopy, etc. to record POP-Q Staging conditions of patients. No massive objects prolapsing from vagina was subjective healing well. At pelvioscopy, breathholding and add abdominal pressure, POP-Q nadir was the judgement of objective healing well. Assessment standard: none prolapse or anatomy relationship recovered gratification,POP-Q<ⅡGrade was objective healing well,≥ⅡGrade was recrudescence.7 Statistical method: To analyze the results by means of the SPSS13.0.Results:No significant differences emerged in demographic and clinical characteristics between the UC and CH groups. The mean ages were 55.80±7.75 years (CH group) and 54.42±5.71 years (UC group)(P>0.05). Mean operating time was significantly less in UC group (86.25±7.30minutes) vs (118.60±17.55 minutes) in CH group(P<0.01). Mean intra-operative blood loss was obviously less in UC group (230.33±39.03ml) than in CH group (369.93±32.63 ml) (P<0.05), so did the hospital stay and antibiotic usage (P<0.05).No significant differences existed in POP-Q scores of Aa, Ba, C, D, Ap and Bp between CH and UC group preoperatively(P>0.05). These scores decreased significantly after pelvic reconstructive surgery (P<0.05), demonstratd an obvious collection of prolapses. There were no significant differences of each postoperative single score between the two groups (P>0.05), showing that the two groups had similar result. The mean follow-up time was 9.96months(2~24months), with a follow-up rate of 100%.The recent objective cure rate was100%,subjective cure rate was 100% with no reported a low-grade cystocele recurrence in CH group. The recent objective rate was 100% and subjective cure rate were100% in UC group. None had recurrence. None had Infection. Only one case had mesh erosion and infection occurred.Conclusion:Uterus conservation play a role in pelvic reconstructive surgery with a similar result compared with that in concomitant hysterectomy group. Uterus conservation group has shorter operating times and less blood loss which maybe useful in controlling the perioperative risk of the older patients. However, more follow-up is needed to observe the long-term effectiveness and complication.