Therapeutic Effect Of Different Surgical Treatments On Pelvic Floor Dysfunction

Objective: Follow-up and analysis of the clinical efficacy and quality of life of pelvic floor dysfunction(PFD)surgery,it aims to find out the shortcomings in the past diagnosis and treatment,and provide reference for the standardization and effectiveness of PFD diagnosis and treatment in the future.Methods: Retrospective analysis of the medical records of 310 patients who were treated in our hospital from January 2013 to December 2017 due to pelvic floor dysfunction and surgical treatment were divided into the anterior pelvic surgery group and the middle pelvic surgery group.The anterior pelvic surgery group includes three surgical procedures: anterior vaginal wall repair,modified Kelly,and middle urethral suspension.The middle pelvic surgery group includes four types of surgery: colpocleisis,total hysterectomy and anterior and posterior vaginal wall repair,total vaginal hysterectomy and laparoscopic sacral colpopexy,total hysterectomy and autologous ligament suspension.Review and record the patient's operation time,intraoperative blood loss,urinary catheter retention time,hospitalization days and postoperative complications,and conduct a questionnaire survey on the quality of life of PFD patients(Pelvic Floor Dysfunction Symptoms Questionnaire PFDI-20).Results:1.The anterior pelvic three surgical methods were statistically significant in terms of operation time,urinary catheter retention time,length of hospital stay,and PFDI-20 score(F values were 16.979,0.978,42.295,21.673,7.144,P < 0.05).In the operation time,the operation time of the middle urethral suspension group was the shortest;in the retention time of the urinary catheter,the urethral suspension group had the shortest retention time,the modified Kelly group was the second,and the vaginal anterior wall repair group was the longest;In the hospital days,the number of hospital stays in the middle urethral suspension group was the shortest,the modified Kelly group was the second,and the vaginal anterior wall repair group was the longest.On the PFDI-20 score,the middle urethral suspension group was the lowest and the quality of life was higher.2.The four pelvic surgery methods were statistically significant in terms of operation time,intraoperative bleeding,urinary catheter retention time,and PFDI-20 score(F values were 19.824,3.702,2.536,1.508,P < 0.05).In the operation time,the colpocleisis group had the shortest time.,the total vaginal hysterectomy and laparoscopic sacral colpopexy group had the longest operation time;in the intraoperative bleeding,the colpocleisis group had the least amount of intraoperative blood loss;In the retention time,the total vaginal hysterectomy and laparoscopic sacral colpopexy group had the shortest retention time,and the colpocleisis group had the longest retention time;on the PFDI-20 score,the total vaginal hysterectomy and laparoscopic sacral colpopexy group had the lowest score,followed by the total hysterectomy and autologous ligament suspension group.Conclusions:1.Regarding the treatment of stress urinary incontinence,the effect of the middle urethral suspension is better than that of anterior wall repair and modified Kelly,but the former is more expensive,and it can be selected when economic conditions are good.2.Colpocleisis has the advantages of short operation time and less intraoperative bleeding,and is more suitable for patients who are frail and unable to tolerate major surgery and asexual life.3.Compared with total hysterectomy and anterior and posterior vaginal wall repair,total hysterectomy and autologous ligament suspension,total vaginal hysterectomy and laparoscopic sacral colpopexy had the shortest time to retain the urinary catheter,the lowest PFDI-20 score,and the higher quality of postoperative life.But the operation time is longer and the operation is more difficult,showing no obvious advantages.4.At present,there are still some problems in our hospital,such as inconsistent diagnostic criteria for PFD,fewer new methods of pelvic floor reconstruction and poor long-term follow-up,which need to be improved urgently.