| Pelvic organ prolapsed(POP) is the descent of vagina, bladder, uterus or bowels through the defected vaginal wall due to the injury of supportive tissues.Epidemiologic survey displayed that the incidence of POP is 30 ~ 40%. In China,with the population aging process developing rapidly, there is an increasing occurrence of POP. Not only do POP(grade III–IV) negatively impact women’s social activities but also have great influence on patients’ physical and mental. The goals of treatment include anatomical reconstruction of the pelvic floor and regaining normal functionality of bladder and bowel. Eventually improve women’s quality of life. Rate of recurrence with traditional treatment which using weak native tissue always higher. With the rapid development of medical level, the surgical techniques of POP are gradually changing over time. In 2004, transvaginal mesh was first used to treatment POP in clinical application, gradually become one of the main treatment means of POP. The operation is not only convenient operation, and postoperative recurrence rate significantly decreased. But the postoperative complications were significantly increased. From 2008 to 2011, the United States food and drug administration has twice alerted the security of transvaginal mesh repair systems.Particularly in 2012, the FDA issued notice to consider the transvaginal mesh is divided into class Ⅲ medical devices, to strengthen the supervision and management of its safety. However the Pelvic Surgeons Network thought mesh complications may relate to operation, does not use the mesh of the operation may occur serious complications. The clinical value and the forward clinical effect of transvaginal mesh need further validation in clinical treatment. The study found that mesh explore is one of the most common complications of transvaginal mesh repair systems. We follow-up patients who were treated by using transvaginal mesh repair systems aim to observe the clinical curative effect after pelvic floor reconstruction and analysis related risk factors of exposed mesh, which would provide basis for the POP treatment.ObjectiveTo explore clinical curative effect of POP by using transvaginal mesh repair systems and mesh erosion exposed related factors. This study will deepen our knowledge about the treatment of POP and prevention of complication.Materials and methods1 Study objectFrom January 2007 to January 2015, 200 patients who underwent surgery by using transvaginal mesh repair systems for pelvic floor reconstructive in the Third Affiliated Hospital of Zhengzhou University were reviewed. 155 cases were followed-up successfully. The average age of 155 POP cases were 62.4 ± 10.8(age range: 29 – 84).1.1 Clinical outcomes after pelvic floor reconstructionA total of 57 patients who were followed-up 3~8 years were compared with 98 cases who were followed-up﹤3 years. Include postoperative complications, PFDI –20 and PFIQ- 7.1.2 Mesh exposes analysisA total of 26 patients appeared mesh exposure in through the entire study period were compared with 129 cases without. Dates of the two groups were analyzed include age, Operation time, the prolapses stage, PFDI-20, PFIQ-7, history of hysterectomy, mesh types and Hypertension and(or) diabetes.2 Standard of diagnosisThe dividing standard of pelvic organ prolapse use pelvic organ prolapsed quantitative( POP-Q).3 Follow-up visitWe used outpatient service or home visits methods to follow- up patients. The follow-up visit involved in the last three months of follow-up patients with pelvic,bladder and bowel symptoms and daily life, relationships or personal emotional state.All the data was inputted into computer using the EXCEL spreadsheet.4 Statistical analysisAll the data was processed by SPSS17.0 statistical software. T test was used for the statistical process of measurement data. Chi-square test was used for comparisons among different groups. Measurement data using X ± s standard. α = 0.05 was considered as the test standard. P-valve < 0.05 was considered have statistical significance.Result1. The recurrence rate was 2.58%(4/155) of patients who underwent surgery using transvaginal mesh repair systems.2. The postoperative long-term complication rate is lower than the short term of transvaginal mesh repair systems(X2=4.195,P=0.041).3. The PFDI-20 and PFIQ-7 scores are higher of Patients with complications(t=8.363,P=0.000 and t=8.376,P=0.000).4. The mesh expose incidence of transvaginal mesh repair systems is 16.77%(26/155).5. History of diabetes may lead to mesh exposure after pelvic floor reconstruction values(X2=5.542, P=0.019); On the contrary, uterine preservation is its protection factor(X2=4.848,P=0.034).Conclusion1. Using transvaginal mesh repair systems for POP have long curative effect and lower recurrence rate.2. The incidence of mesh exposure may increase if patients who have history of diabetes.3. Hysterectomy may be the influence factors of mesh exposure after pelvic floor reconstruction... |
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