Clinical Analysis Of Three Operation Methods In Treating Pelvic Organ Prolapse

Backgroud: Pelvic floor dysfunction(PFD)refers to the pelvic floor supporting tissue structure damage,weakness,pelvic floor tissue degeneration or pelvic floor congenital dysplasia caused by pelvic organ transposition disease.Including pelvic organ prolapse(POP),stress urinary incontinence(SUI),and chronic pelvic pain.The disease has a serious impact on women's physical and psychological health and quality of life,hindering work and social activities.With the degree of concern for their own disease increased because of pelvic floor dysfunction patients gradually increased,the non operative treatment has small trauma,low cost,simple,but the patient is not easy to insist for a long time,and in severe POP patients with poor effect on moderate and severe POP patients usually need to use surgical treatment.POP surgical treatment has a long history,a wide range of one of the most classic surgery is the traditional vaginal hysterectomy + vaginal anteroposterior wall repair,but the traditional surgical methods have a high recurrence rate.With the in-depth study of the pelvic floor anatomy,researchers found that simply removing the prolapsed organs did not solve the prolapse from the root cause,but aggravated the damage to the pelvic floor.With the rapid development of medical technology,the continuous improvement of surgical equipment,the extensive application of new materials,the principles of surgical treatment of POP have changed,and a new surgical method has been derived.At present,the most typical surgical procedures are pelvic floor reconstruction,including transvaginal modified pelvic floor reconstruction and laparoscopic vaginal sacral colpopexy(LSC).The new surgical approach is to use Synthetic materials to repair the pelvic floor defects of the organization to restore the normal pelvic anatomy to restore normal pelvic floor function.This study analyzed from January 2010 to January 2016 due to pelvic organ prolapse in Hefei Maternal and Child Health Hospital gynecology line of traditional vaginal hysterectomy double attachment + vaginal anterior and posterior wall repair,modified pelvic floor reconstruction,laparoscopic Total hysterectomy with double attachment removal + vaginal stump sacral fixation operation of 122 patients,the three groups of patients were analyzed during the perioperative and postoperative follow-up and other clinical data to explore the clinical efficacy of three different surgical methods.Methods: A total of 122 patients with gynecological pelvic organ prolapse underwent surgical treatment from January 2010 to January 2016 were enrolled in this study.One of the traditional vaginal hysterectomy plus vaginal anterior and posterior wall repair in 50 cases(grand A),modified pelvic floor reconstruction in 51 cases(grand B),laparoscopic hysterectomy + vaginal stump sacral fixation in 21 cases(grand C),a retrospective analysis of patients with general information,compare the operation time and bleeding volume perioperative parameters were compared;postoperative complications were compared;The use of pelvic floor quality of life questionnaire short table(pelvic floor distress inventory-short form 20,PFDI-20;pelvic floor impact questionnaire 7,PFIQ-7)comparing the three surgical methods on the quality of life of patients in the near future.Results:(1)There was no significant difference between the three groups in menopausal age,number of vaginal delivery,POP-Q staging and combined stress urinary incontinence(P> 0.05),and the average age was statistically significant(P <0.05),C group patients the youngest.(2)There was no significant difference in postoperative ureteral indwelling time,hospitalization days and acute urinary retention between the three groups(P> 0.05),but there was a significant difference in operation time and intraoperative bleeding.The operation time of C group was longer than that of the other two groups,Blood loss less than the other two groups,the difference was statistically significant(P <0.05).(3)There was no significant difference in PFDI-20 and PFIQ-7 scores between the three groups before operation(P> 0.05).The score of PFDI-20 in group A was the highest at 6 months after operation(P <0.05)After 12 months,the scores of PFDI-20 and PFIQ-7 in group A were the highest,and the lowest in group C,the difference was statistically significant(P <0.05).(4)There was significant difference in the incidence of postoperative pain and discomfort between the three groups(P <0.05),one case of low back pain in group A,one case of back pain,one case of lower abdominal pain and two cases of hip pain discomfort after operation in group C,1 case of pelvic pain,2 cases of lower extremity pain and 4 cases of low back pain;the incidence of postoperative sexual pain in the three groups was statistically significant(P <0.05),postoperative pain in groups A and B were different degrees of sexual intercourse pain,And the postoperative sexual life recovery was better in group C.The mesh erosion rate was 9.80% in group B and 4.76% in group C,with no significant difference between the two groups(P> 0.05).The cure rate,There was no significant difference in incontinence(P> 0.05),and the cure rate in group C was 100%.Conclusion: All the three surgical methods are effective methods for the treatment of pelvic organ prolapse,but each has its advantages and disadvantages.Laparoscopic sacrectomy surgery less bleeding,less trauma,less impact on postoperative sex life,high cure rate,but the operation is relatively short,difficult operation,the incidence of postoperative pain is high,Long-term postoperative complications and its impact on the long-term quality of life still need a large sample of prospective studies for further analysis.Improved pelvic floor reconstruction pelvic floor anatomy and functional structure better,but the incidence of mesh-related complications is high,to correctly grasp the indications.Although the recurrence rate of traditional surgery is high,but the economy safe and effective,there is no risk of mesh exposure,erosion,can not be denied.Clinicians should fully communicate with patients the surgical advantages and disadvantages of various surgical procedures,according to the patient's age,sex life requirements and general condition,economic conditions,select the appropriate surgical approach.