Clinical Analysis Of Different Colpocleisis Treatments Of Severe Pelvic Organ Prolapse In The Elderly Women

Objective:Colpocleisis treatments includes LeFort colpocleisis,new vulvovaginal semi-sealing(SVP)and total colpocleisis.This study analyzes and compares three colpocleisis for evaluating the advantages and disadvantages in the treatments of severe pelvic organ prolapse in the elderly women.MethodsFrom March 2019 to February 2023,the candidates of this study were elderly female patients affected with severe pelvic organ prolapse form four hospitals.Group A(Lefort vaginal semi-sealing)includes 25 cases,Group B(new vulvovaginal semi-sealing)includes 10 cases,and Group C(total vaginal sealing)includes 25 cases.The clinical data of patients’ preoperative,perioperative and postoperative recovery were analyzed and summarized.Results:1.1.Compared with the general data of patients,there was no statistically significant difference in the age,BMI,times of pregnancy and childbirth,menopausal peroid and number of combined internal complications among the three groups(P>0.05),and the data were compared.2.Perioperative data.2.1 Intraoperative bleeding was 80(50-100)ml in group A,22.5(20-52.5)ml in group B,and 100(50-175)ml in group C;The difference between Group B and Group A and Group C was statistically significant(P<0.05);Operation time:120(105-135)min in Group A,37.5(28.7-67.5)min in Group B,and 95(75-130)min in Group C.There were significant differences between Group B,Group A and Group C(P<0.05);The duration of indwelling catheter after operation was 3(2-4)days in Group A,3.5(2.75-3.5)days in Group B,and 2(2-5)days in Group C.There was no significant difference among the three groups(P>0.05);Hospitalization days:7(6-8.5)days in Group A,5(5-9.25)days in Group B,and 5(5-6)days in Group C.There were significant differences between Group A and Group B and C(P<0.05).2.2 Combined surgery:in group A,19 cases(76%)underwent combined hysterectomy,and 1 case(4%)underwent anti-incontinence surgery;In group B,there were 0 cases of combined hysterectomy and 2 cases of combined urinary incontinence surgery(20%);In group C,26 cases(100%)were combined with hysterectomy,and 3 cases(11.5%)were combined with urinary incontinence surgery.There was no statistically significant difference in combined urinary incontinence surgery among the three groups(P>0.05),but there was statistically significant difference in combined hysterectomy(P<0.05).2.3 Recent postoperative complicationsIn group A,postoperative pain and swelling sensation occurred in 1 case(4%)and venous thrombosis in 1 case(4%);In group B,1 patient(10%)suffered pain and bloating postoperatively;There was 1 case of infection(3.8%),1 case of bladder organ injury(3.8%),and 1 case ofcerebral infarction(3.8%)in Group C.There was no significant difference in the total number of complications among the three groups(P<0.05).2.4.PFDI-20 score of pelvic floor questionnaire:91.36 ± 17.96 before operation and 9 ± 9.38 after operation in group A;Group B:228.1 ± 29.01 before operation,9.53 ± 3.62 after operation;Group C:195.1 ± 37.24 before operation,19.16 ± 10.75 after operation.There were significant differences in preoperative and postoperative scores among the three groups(P<0.05).2.5 Postoperative follow-up:30.5(12-46)months in Group A,13.4(2-23)months in Group B,and 30.8(21-42)months in Group C.There was 1 case of recurrence in Group A and Group C,and the recurrence rate of prolapse was 4%.There was no recurrence in Group B,and the difference was not statistically significant(P>0.05).There were 4 cases(16%)of new urinary incontinence in Group A,none in Group B,and 5 cases(19.2%)in Group C(P>0.05).Conclusion:1.Compared with the other two methods,the new vulvovaginal semi-sealing operation reduces the amount of bleeding during operation and is suitable for promotion.There was no significant difference in complications and prolapse recurrence rate among the three groups.For elderly patients with severe POP who cannot tolerate long-term surgery,the new SVP is preferred.2.If there are no uterine lesions,there is no need to remove the uterus during the LEFORT colpocleisis and the New vulvovaginal semi-sealing.3.For patients with moderate or severe stress urinary incontinence before surgery,the middle segment of the urethra should be performed simultaneously during the surgery.