| Background:Pelvic floor dysfunction (PFD) is refered to genital tract prolapse because of the defectiveness of the genital supportive tissue,and this result in the dysfunction of the pelvic floor. The treatments of the POP can be either conservative or surgical. The first choice for light POP is conservative, only when the treatment is invalid, should surgical treatment be undertaken. The surgical treatment of POP dates back to long time ago and boasts a great variety,the most typical of which is transvaginal hysterectomy(TVH) plus repair of vaginal anterior and posterior wall,Manchester surgery, and so on. Recently with the development of the anatomic understanding of the pelvic floor which emphasize the pelvic floor should be treat as a whole.,and the improvement of surgical instruments as well as the invention and application of new repair materials, the surgical treatment of PFD have been highly improved. The Prolift (Ethicon, Somerville, NJ, USA) polypropylene mesh is one of such synthetic graft kit that has become increasingly popular in clinic.Objective:To investigate the efficacy and safety of Total Prolift technique in the treatment of POP, and make a preliminary comaprison between the modified pelvic floor reconstruction surgery.Methods:1. We collected al 1 the domestic and abroad articles about Total Prolift technique for clinical summary analysis. The database included Pubmed, CNKI and CBM. In the library of Shandong UniVersity, we retrieved all the articles and evaluated, selected, checked and analyzed them.2.Index:general conditions of patients,operation-related index,post operation-related index,follow up index. 3.Comparison surgery:We collected all the domestic and abroad articles about the modified pelvic floor reconstruction for clinical sumary analysis,And comparied with total Prolift technique.4.Analysis methods:We use the case summary analysis.Because of the inconsistency in criterions of different papers and limited in randomized control trials, it is only a case summary descriptive analysis not a meta-analysis being be carried out here, which limits its scientificalness.Results:1. analysis of general conditions of patients in the Total Prolift technique:Aging,obesity,parity,menopause, UI/POP operation history etc, are risk factors of POP.2.the POP-Q stage of patients:stageⅡ17.03%,stageⅢ57.11%,stageⅣ25.85%3. analysis of operation-related index of the Total Prolift technique:the Total Prolift technique can be operated under local or general anesthesia,.it can be operated simultaneously. The operative time is 55-141 mins, the average amount of bleeding is 49.10-344ml.4.analysis of post operation-related index of the Total Prolift technique:indwelling catheter time is 1-5.6 days,mean in hospital time post-operation is 3.5-11 days.5. the safety of the Total Prolift technique:Perioperatively:injuries of bladder 1.98%,injuries of rectum 0.25% bleeding>400ml 0.87%, urinary system infection 2.48%.Recent follow up:tape erosion 9.86%, vioding difficulty 1.35%; pelvic pain 0.41%,dyspareunia 5%, groin discomfort or painl.89%.6. the efficacy of the Total Prolift technique:The objective cure rate is 76%-100%.7,the summary analysis of modified pelvic floor reconstruction:The operative time are 73.95%-95.1mins, the average amount of bleeding is 90.56-150ml, The efficacy of modified pelvic floor reconstruction is 80%-100%.The rate of injury of peripheral tissue is 0.2%.The rate of pelvic hematoma is 1.03%. urinary system infection 1.55%. vioding difficulty 2.06%. tape erosion 6.5%.pelvic pain 0.62%. dyspareunia 0.93%. Conclusion:1. Both the Total Prolift technique and the modified pelvic floor reconstruction are good efficiency and safety treatment for severe POP.2. There is no significant difference between the Total Prolift technique and the modified pelvic floor reconstruction in efficacy,complications and mesh related complications.3. The long-term efficacy and complications of the Total Prolift technique still need further studies. |
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