Comparative Analysis Of Efficacy Of Three Kinds Of Surgical Methods In Treating Pelvic Organ Prolapse

Background and objective:Pelvic organ prolapse is a common and frequently-occurring disease in middle-aged and elderly women.With the aging of China's population and the improvement of people's demand for quality of life,the incidence of pelvic organ prolapse is getting higher and higher,and more and more patients choose to seek medical help.At present,there are numerous surgical methods for prolapse.Based on the characteristics of this disease,the high recurrence rate after the operation has always been a major problem for clinicians and patients,Finding a safe and effective procedure is the direction of our exploration.In this paper,we retrospectively analyze three surgical procedures for treating pelvic organ prolapse,statistically analyze the operative correlation,therapeutic effect,complications and impact of patients' sexual quality,and discuss the clinical efficacy,advantages and disadvantages of the three surgical procedures.Matrials and Methods:A total of 93 patients with pelvic organ prolapse who have undergone operation in China union Japan Hospital of jilin university from January 2008 to June 2019 were retrospectively analyzed.They were divided into three groups according to surgical methods.There are 28 cases in study group,which implemented Laparoscopic hysterectomy and bilateral adnexectomy,anterior and posterior vaginal repair,and vaginal stump round ligament suspension;There are 35 cases in control group 1,which implemented pelvic floor reconstruction surgery with transvaginal mesh(including total pelvic floor reconstruction and modified pelvic floor reconstruction).Control group 2 is 30 cases,the implementation was traditional vaginal hysterectomy ± repairing of anterior and posterior vaginal wall.The operation was completed by the doctors of the same level,the operation went smoothly,and the patients were cured and discharged from hospital.The preoperative general data characteristics,operation time,postoperative exhaust time,postoperative indwelling catheterization time,postoperative hospitalization time,perioperative complications,objective recurrence rate,subjective complications and the influence of different operation methods on the patients' sexual life quality were compared among the three groups,to further explore the clinical efficacy of the three surgical methods.One-way anova,nonparametric tests,Chi-square,Fisher's exact test and K-M curve were used for statistical analysis.P<0.05 was considered statistically significant.Results:1.There were no statistically significant differences in preoperative general information(age,parity,menopause time,prolapse time,stage of prolapse degree and other comorbidities)among the three groups.2.There were no statistically significant differences in operation time,postoperative hospital stay and the incidence of perioperative complications among the three groups;There were statistically significant differences in postoperative exhaust time,indwelling catheter time and the incidence of surgical-related complications.The study group had the longest postoperative exhaust time and postoperative indwelling catheterization time,while the control group had the highest incidence of perioperative surgery-related complications.3.A total of 87 patients were followed up within 1 year after surgery,and there was no statistically significant difference in sexual life satisfaction,total complications and objective recurrence rates at 3 months and 6 months after surgery among the three groups during the postoperative follow-up.While there was statistically significant difference in the incidence of postoperative mesh-related complications(P=0.001),and there was statistically significant difference in anatomical recurrence rates at 12 months(P=0.030),with the lowest recurrence rate in the study group and the highest recurrence rate in the control 2 group.In addition,the K-M curve of recurrence was different,and the differences of anatomic unrecurrence rate between the three groups were statistically significant(P=0.015).Conclusion:1.Laparoscopic total hysterectomy and bilateral adnexectomy ± anterior and posterior wall repair of vagina and vaginal apical suspension with round ligamentum;Pelvic floor reconstruction with transvaginal mesh placement;Traditional vaginal hysterectomy±vaginal wall repair are all effective methods for the treatment of POP.2.The short-term anatomical cure rate is higher after pelvic floor reconstruction with transvaginal mesh,but the perioperative and postoperative Mesh-related complication rates are higher.3.Laparoscopic total hysterectomy and bilateral adnexectomy ± anterior and posterior wall repair of the vagina and round ligament suspension of the vaginal stump has low recurrence rate in the near term,but its long-term efficacy needs further follow-up study.