The Medium-and Long-term Efficacy Of Transvaginal Mesh Pelvic Floor Reconstruction And The Discuss Of Operation

Objective To analyze the medium-and long-term efficacy of transvaginal mesh pelvic floor reconstruction with or without uterus preservation on patients after surgery.Methods Seventy-six patients with pelvic floor organ prolapse who underwent surgical treatment from January 2010 to December 2016 were selected as the research objects.Divided into two groups:uterus conservation group(UC)and concomitant hysterectomy group(CH),38 cases in each group.The perioperative indicators and the changes of POP-Q scores before operation,6 months after operation,1 year after operation and 5 years after operation were used as the objective curative effect.Comparing the two groups of patients with Pelvic Floor Disorder Scale(PFDI-20),Pelvic Floor Disorder Impact Simple Questionnaire(PFIQ-7)and Pelvic Organ Prolapse/Urinary Incontinence Quality of Life Questionnaire(PISQ-12)related scores as the subjective curative effect.Results The number of days of hospitalization in the UC and CH groups[(7.53±2.15)d vs(9.55±2.20)d,P<0.001].Bleeding volume during operation[(33.29±29.51)mL vs(104.74±68.13)mL,P<0.001].Duration of surgery[(101.97±27.28)min vs(149.08±37.97)min,P<0.001].Postoperative exhaust time[(51.68±15.35)h vs(62.84±17.52)h,P=0.004].Indwelling urinary catheter time[(2.97±0.89)d vs(4.03±1.00)d,P<0.001].The perioperative indexes of the patients in the UC were better than those in the CH,and the difference was statistically significant.About POP-Q indexing in the UC and CH groups:before operation[three degrees accounted for 92.1%,four degrees accounted for 7.9%vs three degrees accounted for 89.5%,four degrees accounted for 10.5%,P=0.692].After operation[0 degree accounted for 86.8%,one degree accounted for 13.2%vs 0 degree accounted for 84.2%,one degree accounted for 15.8%,P=0.744].There was no statistically significant difference in the POP-Q scores of the two groups before operation and after operation.The POP-Q scores of the two groups after operation were improved compared with those before operation.About PFDI-20 scores,UC group vs CH group:before operation[94.85±23.25vs96.22±23.40,P=0.799],6 months after operation[19.87±7.80vs24.07±12.45,P=0.083],1 year after operation[10.69±6.12vs10.31±6.60,P=0.793],5 years after operation[10.17±5.93vs9.81±5.80,P=0.792].In the UC group:before operation vs 6 months after operation[94.85±23.25vs19.87±7.80,P<0.001],6 months after operation vs 1 year after operation[19.87±7.80vs10.69±6.12,P<0.001],1 year after operation vs 5 years after operation[10.69±6.12vs10.17±5.93,P=0.063].In the CH group:before operation vs 6 months after operation[96.22±23.40vs24.07±12.45,P<0.001],6 months after operation vs 1 year after operation[24.07±12.45vs10.31±6.60,P<0.001],1 year after operation vs 5 years after operation[10.31±6.60vs9.81±5.80,P=0.068].About PFIQ-7scores,UC group vs CH group:before operation[176.07±31.58vs185.59±33.92,P=0.209],6 months after operation[51.63±22.70vs48.87±13.86,P=0.525],1 year after operation[7.14±10.55vs7.14±9.44,P=1.000],5 years after operation[6.14±9.71vs6.77±9.04,P=0.772].In the UC group:before operation vs 6 months after operation[176.07±31.58vs51.63±22.70,P<0.001],6 months after operation vs 1 year after operation[51.63±22.70vs7.14±10.55,P<0.001],1 year after operation vs 5 years after operation[7.14±10.55vs6.14±9.71,P=0.088].In the CH group:before operation vs 6 months after operation[185.59±33.92vs48.871±13.86,P<0.001],6 months after operation vs 1 year after operation[48.87±13.86vs7.14±9.44,P<0.001],1 year after operation vs 5 years after operation[7.14±9.44vs6.77±9.04,P=0.083].There was no significant difference in PFDI-20 and PFIQ-7 scores between the two groups before operation,6 months after operation,1 year after operation and 5 years after operation.6 months after operation compared with before operation,1 year after operation compared with 6 months after operation have significantly improved.About PISQ-12 scores,UC group vs CH group:before operation[19.13±3.63vs18.47±3.01,P=0.393],6 months after operation[40.26±4.31vs29.18±2.05,P<0.001],1 year after operation[40.21±4.47vs29.21±2.06,P<0.001],5 years after operation[40.00±4.63vs32.47±3.25,P<0.001].In the UC group:before operation vs 6 months after operation[19.13±3.63vs40.26±4.31,P<0.001],6 months after operation vs 1 year after operation[40.26±4.31vs40.21±4.47,P=0.571],1 year after operation vs 5 years after operation[40.21±4.47vs40.00±4.63,P=0.019].In the CH group:before operation vs 6 months after operation[18.47±3.01vs29.18±2.05,P<0.001],6 months after operation vs 1 year after operation[29.18±2.05vs29.21±2.06,P=0.324],1 year after operation vs 5 years after operation[29.21±2.06vs32.47±3.25,P<0.001].There was no significant difference in PISQ-12 scores between the two groups before operation,the PISQ-12 score of the UC at 6 months,1 year and 5 years after the operation was better than those of the CH,6 months after operation compared with preoperative,5 years after operation compared with 1 year after operation have significantly improved.In the medium and long term follow up,there were 3 cases of pelvic infection and 6cases of dysuria after transvaginal mesh pelvic floor reconstruction,the rest were normal.Conclusion The use of mesh in transvaginal mesh pelvic floor reconstruction is safe and effective.Whether to retain the uterus during transvaginal mesh pelvic floor reconstruction does not affect the postoperative efficacy,but retaining the uterus can improve preoperative indicators and improve the quality of patients’ sexual life.