Clinical Effect Of "工"-shape Partial Colpocleisis In Elderly Women With Pelvic Organ Prolapse

Objective:This study was performed to evaluate the clinical efficacy of "工"-shape partial colpocleisis（modified Lefort colpoclesis）in old women with pelvic organ prolapse.Methods:This study involved 104 women who of the POP-Q stage Ⅱ～Ⅳ and over 60 years old hospitalized for pelvic organ prolapse from January 2016 to June 2020 at the Department of Gynecology,Qianfoshan Hospital affiliated to Shandong University.there were 57 cases in the "工"-shape partial colpocleisis group（longitudinal septum shaping group）and 47 cases in the transvaginal hysterectomy and vaginal wall repair group（vaginal wall repair group）.The two groups’ clinical data was retrospectively analyzed,compared two groups of general data,perioperative observation indexes and postoperative follow-up data,including prolapse degree,intraoperative blood loss,complications,operation time,indwelling catheter days,hospitalization days,hospitalization expenses,relapse,Pelvic floor distress inventory 20（PFDI-20）score and satisfaction indicators such as observation.The patients went to the outpatient clinic for reexamination one month after the operation,and then went to the outpatient clinic every six months to a year.In longitudinal septum shaping group,we evaluate the objective clinical efficacy of the "工"-shape partial colpocleisis through checking the position and shaping of the longitudinal vaginal septum.In the vaginal wall repair group,the objective clinical efficacy was evaluated by POP-Q grading of patients.At three months,six months and twelve months after surgery,a follow-up staff surveyed the patients through telephone follow-up,filled out the PFDI-20.And the subjective clinical efficacy of patients after surgery was evaluated through the survey of patients’satisfaction.Results:（1）The difference between the two groups’ general data was not statistically significant（P>0.05）.（2）No intraoperative complications occurred in both groups.In the longitudinal septum shaping group,the median intraoperative blood loss was 50（50-100）ml.In the vaginal wall repair group,the median intraoperative blood loss was 100（50-150）ml.The longitudinal septum shaping group had less blood loss than the vaginal wall repair group,the difference was statistically significant（P<0.05）.In the operation time,indwelling catheter days,hospitalization days,and the incidence of perioperative complications after surgery,there was no statistically significant difference between the two groups（P>0.05）.（3）Improvement of postoperative urinary incontinence and postoperative stress urinary incontinence.In the longitudinal septum shaping group,there were 17 cases with urinary incontinence before the operation,7 cases with symptoms of urine leakage disappeared after the operation,10 cases had milder symptoms of urinary leakage than before surgery.8 cases had postoperative stress urinary incontinence,and the incidence of postoperative stress urinary incontinence was 14.0%.In the vaginal wall repair group,there were 10 cases with urinary incontinence before the operation,3 cases with symptoms of urine leakage disappeared after the operation,7 cases had milder symptoms of urinary leakage than before surgery.5 cases had postoperative stress urinary incontinence,and the incidence of postoperative stress urinary incontinence was 14.0%.There was no significant difference between the two groups of postoperative stress urinary incontinence（P>0.05）.（4）During the follow-up period,there was no recurrence of prolapse in the longitudinal septum shaping group,and the objective cure rate was 100%.In the vaginal wall repair group,5 patients relapsed,and the objective cure rate was 89.4%.There was a statistically significant difference between the two groups（P<0.05）.（5）When the patient’s PFDI-20 score is lower,the patient’s pelvic floor function improves more significantly.Before surgery,there was no statistical difference in PFDI-20 score between the two groups（P>0.05）.After the operation,the PFDI-20 score of the longitudinal septum shaping group was significantly lower than that of the vaginal wall repair group（P<0.05）,and the pelvic floor function of the patients in the longitudinal septum shaping group improved more significantly than the vaginal wall repair group.In addition,the patient’s pelvic floor function after the operation were significantly improved compared to before the operation.The score before surgery>the score at 3 months after the operation>the score at 6 months after the operation>the score at 12 months after the operation.4 measurements showed a gradual decrease trend（P<0.001 for comparison between the two）.（6）one year after the operation,the satisfaction rate of the longitudinal septum shaping group was 100%,and the subjective cure rate was 100%.The satisfaction rate of the vaginal wall repair group was 89.4%,and the subjective cure rate was 89.4%.Comparing the subjective cure rates of the two groups,the difference was statistically significant（P<0.05）.Conclusions:The "工"-shape partial colpocleisis has high safety and low recurrence rate.At the same time,after surgery the patients’ pelvic floor function has improved significantly,and the satisfaction is high.Both objective and subjective cure rates are better than vaginal hysterectomy and vaginal wall repair.It is an effective surgical method for elderly female patients with moderate or severe pelvic organ prolapse who do not wish to conserve their vaginal coital function,but the long-term effect still needs to be followed up.