| ObjectivePelvic organ prolapse(POP)is a non-organic lesion that does not threaten women’s lives,but it is known as "social cancer" in the academic world and has become a common disease affecting the quality of life of middle-aged and elderly women.With the aging of the global population,the POP problem has become increasingly prominent,and the diagnosis and treatment of the disease have attracted great attention.For the treatment of POP,there are non-surgical treatment and surgical treatment.Non-surgical treatment as a first-line treatment of POP has the advantages of safety,simplicity,and economy,but it is not effective for severe POP patients.For severe and symptomatic moderate POP patients,surgery is usually considered.Uterine prolapse is a prolapse of the middle pelvic organ caused by the first level defect of the vaginal support axis.There are many treatment methods for uterine prolapse.At present,the common surgical methods in our hospital include: laparoscopic high uterosacral ligament suspension(LHUS),laparoscopic high sacral ligament + round ligament suspension,Laparoscopic sacral colpopexy(LSC)has achieved good results.There are limited comparative reports on the three surgical methods at home and abroad,and the evaluation criteria and methods are vague and one-sided.In this paper,the clinical data of 105 surgical patients admitted to the hospital were retrospectively analyzed,and the three surgical procedures were systematically and comprehensively reviewed from the perioperative conditions,subjective outcomes,objective outcomes,complications,postoperative recurrence and reoperation.The evaluation aims to provide a clinical reference for the surgical treatment of prolapse of middle pelvic organs.MethodsA total of 105 POP-QⅡ-Ⅲ symptomatic uterine prolapse patients diagnosed and treated in the Gynecology Center of Qingdao City Hospital from June 2013 to June 2018,who had undergone three surgical procedures and completed at least one year of follow-up were selected for retrospective review the study.Among 105 patients,menopausal patients underwent laparoscopic hysterectomy with double appendages,and those without menopause and ovarian lesions underwent laparoscopic hysterectomy with double salpingectomy.Among them,31 patients underwent high uterosacral ligament suspension were group A,45 patients underwent high uterosacral ligament + round ligament suspension were group B,and 29 patients underwent sacral colpopexy were group C.Collect the complete medical records of 105 patients,analyze the general data and perioperative indicators of the three groups of patients;use pelvic floor impact of questionnaire-short form 7(PFIQ-7),pelvic organ prolapse/urinary incontinence sexual questionnaire 12(PISQ-12),and subjective cure rate to evaluate the operation of the pelvic floor disorder Subjective curative effect;evaluate the objective curative effect of surgery by the position of POP-Q indicator point after operation.The perioperative conditions,subjective outcomes,objective outcomes,complications,postoperative recurrence and reoperation rates of the three surgical methods were compared and analyzed.Results1.There was no significant difference in operation time,intraoperative blood loss,postoperative hospital stay,proportion of vaginal anterior and posterior wall repair,and incidence of acute urinary retention among the three groups(P> 0.05).There were no serious complications such as injury of bladder,ureter,rectum and large vessels during operation in the three groups.A total of 5 patients experienced acute urinary retention after removing the ureter.3 patients post-urinary test for negative residual urine was granted discharge.2.The preoperative PFIQ-7 and PISQ-12 scores were not significantly different between the three groups.The PFIQ-7 and PISQ-12 scores of the three groups of patients were significantly improved at 6 months and 1 year after operation,and the differences were statistically significant(P <0.05).There was no significant difference in PFIQ-7 and PISQ-12 scores at 6 months and 1 year after operation between the three groups(P> 0.05).The improvement of PFIQ-7 and PISQ-12 scores at 1 year after operation in the three groups was better than that at 6 months after operation(P <0.05).3.Aa,Ba,C,Ap,Bp points and total vaginal length(TVL)before operation were not statistically different between the three groups(P> 0.05).The Aa,Ba,C,Ap,and Bp points of the three groups were significantly improved after the operation,and the difference was statistically significant(P <0.05).The average TVL of the three groups was not significantly shorter than that before the operation(P> 0.05).There were no statistically significant differences between the measured values of Aa,Ba,Ap and Bp points of the three groups after operation.However,the difference in C-point values between the three groups at 1 year after surgery was statistically significant.The C-point values at 1 year after operation in groups B and C were better than those in group A,and the differences between groups B and C were not significant.4.In group A,there were 2 cases of low back pain,1 case of new urinary incontinence;group B,1 case of low back pain,1 case of lower abdominal pain,2 cases of new urinary incontinence;group C,1 case of low back pain,1 case of intercourse pain,Two cases of newly developed urinary incontinence,and one case of mesh exposure.The pain symptoms of the patients were all mild,and gradually eased from 8 months to 1 year after surgery.In one patient with exposed mesh and painful intercourse,some of the mesh was cut out,and estriol ointment was applied locally.The prognosis was good.The incidence of postoperative complications among the three groups was not statistically different(P> 0.05).5.After 1 year of follow-up,31 patients in group A had 2 cases of anterior vaginal wall prolapse Ⅱ degree and 1 case had posterior vaginal wall prolapse Ⅱ degree 1 case;45 patients in group B had 2 cases of anterior vaginal wall prolapse Ⅱ degree;C A total of 29 patients in the group developed prolapse of anterior vaginal wall in 1 case.There was no statistically significant difference in recurrence rate among the three groups(P>0.05).Among the 6 relapsed patients,5 asymptomatic patients underwent pelvic floor rehabilitation and kegel training,and their condition did not progress.During follow-up,1 symptomatic patient in group A underwent anterior vaginal wall repair.The reoperation rate is low.Conclusion1.Laparoscopic high uterosacral ligament suspension,high uterosacral ligament combined with round ligament suspension,and sacral colpopexy,can significantly improve the patient’s quality of life and sexual life after surgery,the subjective effect is satisfactory;achieved an ideal anatomy reset,the objective effect is affirmed.The three surgical procedures are all effective for the treatment of moderate to severe uterine prolapse.2.High uterosacral ligament combined with round ligament suspension and sacral colpopexy,the surgical effect on the vaginal tip suspension is better than simple high uterosacral ligament suspension.However,there was no significant difference in the recent relapse rate and reoperation rate between the three.3.The three surgical methods have less intraoperative complications,less bleeding,less trauma,and faster recovery,low recurrence rate,low reoperation rate after surgery. |
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