| ObjectiveBy comparing the perioperative conditions,postoperative recurrence,and postoperative complications of laparoscopic iliac ligament suspension surgery and uterine/vaginal sacral fixation for the treatment of moderate to severe pelvic organ prolapse,to understand the two different clinical effect of surgical treatment of pelvic organ prolapse and the advantages and disadvantages of two kinds of operative methods,provide a reference for the surgical treatment of pelvic organ prolapse women value.MethodsRetrospective analysis was made on the clinical effect of laparoscopic iliopecal ligament suspension(32 cases)or laparoscopic uterine/vaginal sacropexy(44 cases)in the treatment of pelvic organ prolapse in jiangxi provincial hospital of maternal and child health in 2019.Clinical evaluation was made by studying the operative time,intraoperative bleeding and intraoperative conditions of the two operations.The recovery of anatomical function and recurrence of the two operations were analyzed by measuring the condition of each indicator point of pop-q before operation,3months after operation and 6 months after operation.To understand the postoperative complications of the two operations through outpatient review or telephone follow-up;The clinical effects of the two methods of POP were evaluated by questionnaire before,3 months after and 6 months after surgery.The pisq-12 questionnaire was not conducted because most patients did not have sex within half a year after surgery.In this study,pfd-20,pfiq-7 and other questionnaires were used to investigate the daily life of patients after surgery.Data on age,number of pregnancies,number of years of menopause,number of years of prolapse,and body mass index of the two groups were collected.Results1.General condition of patients before surgeryA total of 76 pelvic organ prolapse patients with POP-Q II degree and abovewere collected from Jiangxi Maternal and Child Health Hospital.laparoscopic iliopecal ligament suspension(32 cases): mean age(52.65±10.97)years,including24 menopausal patients,mean age of menopause(58.0±5.83)years,mean age of menopause(8.25±5.25)years,course of disease(6.66 ±6.88)years,age at first birth(23.04 ± 2.84)years,average pregnancy times(3.88 ± 1.27)times,average births(2.42±0.86)times,average body mass index(23.36±2.27)kg/m2,POP-Q There were 2 cases(6.25%)of degree IV,17 cases(53.12%)of degree III,and 13cases(40.63%)of degree II.laparoscopic uterine/vaginal sacropexy(44 cases): mean age(53.38±11.25)years,including 29 menopausal patients,mean age of menopause(59.79±6.20)years,mean age of menopause(8.86±7.15)years,course of disease(4.69 ± 7.24)years,the age of the first delivery(22.59 ± 2.55)years,the average number of pregnancy times(3.73±1.69),the average number of parity(2.68±1.16)times,the average body mass index(22.84 ± 2.63)kg/m2,POP-Q index IV There were 4 cases(9.09%),24 cases(54.55%)of degree III,and 16 cases(36.36%)of degree II.The baseline data of the two groups of patients were statistically processed,and all the indexes were p>0.05,no statistical significance,and there was comparability between the two groups.2.Operation time and intraoperative bleedingThe operative time was(97.23 ± 12.67)minutes and the intraoperative blood loss was(60.77±19.17)ml in the iliopubic ligament suspension group.The operative time of the sacral fixation group was(105.24±16.12)minutes,and the intraoperative blood loss was(74.86±26.21)ml.All the patients underwent the operation smoothly,and there were no injuries to bladder,ureter,rectum and other organs,as well as important blood vessels and nerves.The operative time and intraoperative blood loss of the two groups were statistically analyzed,and the difference was statistically significant(p<0.05).3.Recovery of surgical anatomical functionTwo groups of patients in the preoperative measurement POP-Q indicates points to determine the severity of patients with prolapse,3 months,6 months after surgery in outpatient care when each indicator to measure the POP-Q point to evaluate patients postoperative function recovery anatomy,but because there are 8cases of iliopubic ligament group and 10 patients with sacral fixation group in the operation process of the bank of China total hysterectomy,using the D point value can’t be measured,so in the outpatient care of postoperative point D is not discussed.Preoperative iliopubic ligament suspension group and sacral fixation group preoperative(Aa)(1.38±1.11)cm vs(1.38±1.1)cm,Ba(1.88±2.18)cm vs(1.88±2.18)cm,C(1.38 ± 3.28)cm vs(1.80 ± 3.10)cm,D(0.99 ± 2.72)cm vs(-0.65 ±2.52)cm,Ap(1.44 ± 1.22)cm vs(1.64 ± 0.99)cm,Bp(1.81 ± 1.87)cm vs(1.84 ±1.76)cm,TVL(7.41±0.60)cm vs(7.22±0.60)cm].Three months after surgery,the indicators of the two groups were(Aa(-3.00±0.12)cm vs(-3.01±0.33)cm,Ba(-3.11±0.37)cm vs(-3.05±0.25)cm,C(-7.13± 0.64)cm vs(-7.28±0.61)cm,Ap(-3.08±0.33)cm vs(-3.04±0.26)cm,Bp(-3.12±0.35)cm vs(-3.02±0.27)cm,and TVL(7.51± 0.64)cm,At 6 months after surgery,the indicators of the two groups were(Aa(-2.97 ± 0.12)cm vs(-2.97 ± 0.22)cm,Ba(-2.97 ± 0.14)cm vs(-2.99 ± 0.25)cm,C(-7.06±0.68)cm vs(-7.58 ±0.58)cm,Ap(-2.97±0.12)cm vs(-3.00±0.23)cm,and Bp(-3.08 ± 0.38)cmVs(-3.02 ± 0.17)cm,TVL(7.48 ± 0.60)cm vs(7.27 ±0.38)cm.Statistical treatment was carried out on pop-q indicators between the two groups before surgery,3 months after surgery and 6 months after surgery,and the results showed no statistical significance(p>0.05).In addition to TVL,all the indicators were statistically significant after surgery(p<0.05).4.Postoperative cure and recurrencePelvic organ prolapse was significantly improved in the two groups at 3 months and 6 months after surgery compared with that before surgery.Taking the lowest point of pelvic organ protuberances within 1 cm from the inside of the hymen.that is,degree II prolapse or the recurrence of vaginal prolapse was considered as recurrence.There was no recurrence in the iliopubic ligament suspension group and sacral fixation group 3 months after surgery,and the objective cure rate was 100%.There was no statistical significance in the recovery and recurrence in the two groups3 months after surgery(>0.05).No recurrence occurred in all patients in the iliopectineal ligament suspension group 6 months after surgery,and the objective cure rate was 100%.In the sacrum fixation group,the objective cure rate was 97.72%(43/44)6 months after the operation,and the recurrence rate was 2.27%(1/44)in 1case.No statistical significance was found in the two groups in 6 months after the operation(p>0.05).5.Postoperative complicationsDuring the reexamination and follow-up at 3 months and 6 months after the operation,2 patients in the iliopectineal ligament suspension group showed increased leucorrhea and 1 patient showed mild pelvic discomfort.In the sacral fixation group,there were 3 cases with increased leucorrhea,1 case with emerging defecation disorder(2.27%),and 1 case with mild lumbar acid and lumbar distension.The postoperative complications of the two groups were not statistically significant(p>0.05).6.Subjective healingMost of the patients in theiliopubic ligament suspension group and the sacral fixation group did not have sex within half a year after the operation,so the FSFI follow-up questionnaire was not used for the time being.Only the pfd-20 and pfiq-7questionnaires were used to evaluate the subjective healing conditions of the two groups.The pfd-20 and pfiq-7 questionnaires between the two groups before,3months after,and 6 months after surgery showed no statistical significance,while the pfd-20 and pfiq-7 scores before,3 months after,and 6 months after surgery showed statistical significance(p<0.05).Conclusion1.Compared with laparoscopic sacral fixation,laparoscopic iliopectineal ligament suspension is a new minimally invasive,safe and effective way to solve the symptoms of pelvic organ prolapse due to its short operation time,relatively simple operation,less intraoperative blood loss and relatively safe operation.2.Both laparoscopic iliac ligament suspension and laparoscopic sacral fixation can effectively restore the anatomical structure.,maintain normal physiological axial of women and effective resume the function of female pelvic cavity,,with laparoscopic sacral fixation,can obtain a better short-term clinical results,for the treatment of pelvic organ prolapse provides a new effective surgical option.3.Compared with the postoperative recurrence and postoperative complications of the two groups,iliopectineal ligament suspension has a relativelylow postoperative recurrence rate and postoperative and incidence rate,which has a good clinical application value and prospect and is worth promoting vigorously. |
