| Object To investigate the clinical significance of "bridge" repair of vaginal posterior wall, mesh repair of vaginal posterior wall and modified repair of vaginal posterior wall on the treatment of vaginal posterior wall prolapse. To provide the basis individually for patients with clinical vaginal posterior wall prolapse of surgical treatment.Method This study selected 90 patients with POP who had received surgery treatment from June,2006 to August,2010 in Ningxia Medical University. All their POP-Q stage were II～IV, they were randomly divided into three groups: 30 cases were in "bridge" group received "bridge" repair of vaginal posterior wall; 30 cases were in mesh group received mesh repair of vaginal posterior wall; 30 cases were in "Tong" group received modified repair of vaginal posterior wall. Analyse the clinical materials, surgical way, situations during the operation, recovery after the operation, curative effect and complications of this 90 patients, follow up, get the recurrence rate and quality of life, carry on statistics to get significance.Result (1) General clinical data: Between "bridge" group, mesh group,and "Tong" group, there were no significance difference in the aspects such as age, body mass index, delivery ways, delivery times, menopause, and the degree of POP. (2) Operation time: The average operation time of "bridge" group was 23.13±2.57min; The average operation time of mesh group was 27.9±3.52min; The average operation time of "Tong" group was 22.9±2.39 min. There was significant difference of operation time between "bridge" group and mesh group (P<0.05); there was no significant difference of operation time between "bridge" group and "Tong" group P(>0.05); There was significant difference of operation time between "bridge" group and mesh group (P<0.05). The average operation time of "bridge" group and "Tong" group were significantly shorter than mesh group. (3) Bleeding during the operation: For "bridge" group the average amount of bleeding was 37.37±7.42ml; For mesh group the average amount of bleeding was 85.28±14.64ml; For "Tong" group the average amount of bleeding was 40.68±6.12ml. There was significant difference between "bridge" group and mesh group (P<0.05); there was no significant difference between "bridge" group and "Tong" group (P>0.05); There was significant difference between "bridge" group and mesh group (P<0.05). The amount of bleeding of "bridge" group and "Tong" group were significantly lower than mesh group. (4) Indwelling catheter time: in "bridge" group, the indwelling catheter time was 2.65±0.36 days; in mesh group, the indwelling catheter time was 2.61±0.43 days ; in "Tong" group, the indwelling catheter time was 2.64±0.36 days. There were no significance between the three groups (P>0.05). (5) Mean in hospital time: For "bridge" group, it was 8.41±0.72 days; for mesh group, it was 8.42±0.84 days; for "Tong" group, it was 8.29±0.68 days. There were no significance between the three groups (P>0.05). (6) Complications after the operation: In "bridge" group, no complication appeared; in "Tong" group, also no complication appeared; in mesh group, there were five complications appeared, four cases were mesh erosion of vaginal posterior wall, one patient appeared hip pain sitting, last about three months. The complication of mesh group was more than "bridge" group and "Tong" group, there were significance differences (P<0.05).(7)Vaginal length: The average vaginal length before and after operation was 6.76±0.32cm, 6.91±0.29cm for "bridge" group; The average vaginal length before and after operation was 6.83±0.34cm, 7.02±0.33cm for mesh group; the average vaginal length before and after operation was 6.8±0.32cm, 6.97±0.31cm. There were no significance differences before and after the operation between this three groups (P>0.05). (8) Recurrence rate: In the "bridge" group, there were four cases recurred, the recurrence rate is 13.3%, and the cure rate is 86.7%; in the mesh group, there was no case recurred, the cure rate is 100%;in the "Tong" group, there was one case recurred, the recurrence rate is 3.3%, and the cure rate is 96.7%. There were no significance differences between this three groups (P>0.05). (9) The impact on the quality of sexual life: In the "bridge" group and the "Tong" group, there was one case of complaint about the lowering of the quality of sexual life; in the mesh group, there were four cases of complaint about the lowering of the quality of sexual life. There were no significance differences between this three groups (P>0.05).Conclusions (1) The "bridge" repair of vaginal posterior wall, mesh repair of vaginal posterior wall and modified repair of vaginal posterior wall are effective surgical ways in treating vaginal posterior wall prolapse; (2)For the patient who was POPIII～IV of vaginal posterior wall prolapse, the curative of the mesh repair of vaginal posterior wall is batter,the recurrence rate is lower,but the complication after the operation is higher, should be cautious for the patient who was young and need sexual life. (3) The modified repair of vaginal posterior wall is simpler, less effect to the quality of sexual life, the short-term treatment is stable, but long-term treatment still need further observation. |
PDF Full Text Request