| Objective To compare the clinical efficacy of laparoscopic sacrohysteropexy / sacrocolpopexy and laparoscopic artificial round ligament suspension in the treatment of uterine prolapse,and to provide a reference for surgical treatment of uterine prolapse.Methods 1 A total of 38 patients with pelvic organ prolapse who underwent laparoscopic sacrohysteropexy / sacrocolpopexy or laparoscopic artificial round ligamental reconstruction under the laparoscopic approach at Zhongda Hospital affiliated to Southeast University from June 2014 to December 2016 were selected.Surgical methods were divided into sacral fixation group(laparoscopic sacrohysteropexy / sacrocolpopexy)and artificial round ligament group(laparoscopic artificial round ligament suspension).There were 13 patients in the sacral fixation group and 25 in the artificial round ligament group.Retrospective analysis of the clinical data of these patients.The epidemiological investigation include: General information of patients,like age,BMI,number of vaginal deliveries,Menopause age,history of pelvic surgery,etc.;surgical data,such as operation time,intraoperative blood loss,Postoperative hospital stay,postoperative complications,etc.;Postoperative follow-up data: Follow-up patients’ recurrence with Pelvic Organ Prolapse Quantification system,quality of life with Pelvic Floor Distress Inventory short form,and sexual quality of life with The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire at 6 months and 1 year after surgery.2 SPSS 24.0 software was used for data analysis.The count data with normal distribution were tested with independent sample t-test;count data without normal distribution and ordered classification data use the rank sum test;chi-square test,Fisher’s exact test was performed with disorderly data(dichotomous data);count data Intra-group were compared using analysis of variance.α=0.05 was used as the test level,P<0.05 was considered statistically significant.Results 1 There was no statistically significant difference in general data(age,education level,BMI,number of vaginal deliveries,age of menopause,etc.)between the two groups.2 The operation time of sacral fixation group was 217.50(183.75,303.75)min,the intraoperative blood loss was 100(75,200)ml,postoperative hospital stay was 6.0(6.0,7.0)days,and the operation cost was(20,623.62±3425.71)yuan;In the round ligament group,the operation time was 100(90,123.75)min,the intraoperative blood loss was 50(50,100),the postoperative hospital stay was 5.0(5.0,6.5)days,and the operation cost was(15311.06±4035.15)yuan.The difference between the two groups was Statistically significant(P<0.05).There were no Intraoperative complications in both groups.Postoperative complications were 0(0.0%)in the sacral fixation group and 2(8.0%)in the artificial round ligament group,with no statistically significant difference(P>0.05).3 The scores of PDFI-20 and PISQ-12 questionnaires and POP-Q scores of the sacral fixation group and the artificial round ligament group were significantly improved after surgery,and the differences were statistically significant(P<0.05).There was no statistically significant difference with one year postoperatively(P>0.05).4 There was no significant difference in the scores of PDFI-20 and PISQ-12 questionnaires before and after surgery between the two groups.5 In the sacral fixation group,the preoperative Aa point was(2.35±1.52)cm,the Ba point was(4.15±2.44)cm,the C point was(4.15±1.91)cm,the artificial round ligament group had a preoperative Aa point(1.36±1.32)cm,and the Ba point was(2.04±1.77)cm,point C was(2.08±2.38)cm,the difference was statistically significant(P<0.05).However,there was no significant difference in the degree of prolapse between the two groups and the degree of prolapse of the anterior and posterior walls of the vagina(P>0.05).There was a statistically significant difference between the two groups in C-points postoperative 6 months and 1 year(P<0.05),and there was a statistically significant difference in the degree of apical prolapse after six months(P<0.05).6 In the sacral fixation group,one patient had new Incontinence in the first half of the year,and one patient experienced Sexual pain.The patient’s overall subjective satisfaction was high.Only 1 patient had apparently discomfort postoperative compared with preoperatively,and the subjective cure rate was 92.3%.In the artificial round ligament group,there were 3 cases appear obvious incision pain postoperative,1 case appears new Incontinence postoperative,the subjective cure rate is 88%.7 In the sacral fixation group,13 patients had no recurrence after follow-up for 1 year,and the recurrence rate was 0%;25 patients in the artificial round ligament group had 8 patients relapsed after follow-up 1 year,of whom 6 relapsed within 6 months after operation.The recurrence rate was 32%.There was significant difference between the two groups(P<0.05).Conclusions 1 Compared with the artificial round ligament group,the sacral fixation group had a longer operation time,more intraoperative blood loss,longer postoperative hospital stay,high surgical cost.The incidence of intraoperative and postoperative complications were both lower.No complications such as mesh erosion and exposure occurred in both groups.2 The postoperative quality of life and sexual quality of life of the patients are significantly improved compared with before surgery,and the degree of postoperative prolapse is better than that before surgery in both groups.3 There was no significant difference in the objective cure rate between the two groups.4 The sacral fixation group is better than the artificial round ligament group in the subjective cure rate,and the recurrence rate is lower. |
