| Objective:Pelvic organ prolapse (POP) refers to genital tract prolapse which is due to defectiveness of the genital supportive tissue, and then a kind of disease caused by dysfunction. As the extend of Life expectancy in the world, the incidence rate of POP presents an upward trend, which is already a common and frequently-occurring diseases of the middle-aged and old women, and seriously influenced their quality of life. Therefore, the prevention and control of pelvic organ prolapse of disease is the urgent affairs. The treatment of POP is divided into nonoperative treatment and surgical treatment. Surgical treatment is still the most effective treatment by far. The traditional vaginal hysterectomy,repair of anterior and posterior vaginal wall,vaginal folding surgery, although have certain curative effect, Its essence no change, all only for the prolapse problem without solving the reasons,thus its recurrence rates are higher, repeated surgery and recurrence caused patients great burden both on economic and psychological. In recent years, foreign scholars successively put forward integral theory that would relatively complete explan about the reasons of female pelvic viscera prolapse, three chamber's theory and three horizontal theory. Based on the theory above, various inventions of repairing and substituted material and the improvement of surgical instrument, the principles to " Side-side connected ",structure reconstruction recovery function,retain organ of pelvic revascularization got great application and promotion. Prolift whole pelvic repair system and the improvement of pelvic revascularization according to its principle have been the most widely used in pelvic revascularization, it is able to reinforce the weak organization, and also provide upholder for tissue regeneration, make pelvic form an anatomical and functions overall. This paper is able to investigate retrospectively curative effect of pelvic revascularization on pelvic viscera prolapse and the effluence of related complications is analyzed retrospectively.Methods:To collect 48 women with POP who have undergone operation in china union Japan hospital of Jilin university from January 2008 to July 2010 with an average age of 62.60(30-81).According to the different methods of surgery patients were divided into research group and the control group. There are 20 cases in the research group, which implemented the pelvic revascularization. According to whether retain the uterus, the research group was divided into research group 1 (retain the uterus 8 cases) and research group 2 (hysterectomy 12 cases). The control group is 28 cases, the implementation was the traditional vaginal hysterectomy and repairing of anterior and posterior vaginal wall. The preoperative general clinical data of the three groups of patients has no statistically significant. The physicians are peer ratings physicians, and the operational proficiency consistent. All patients have stood the operation well, and the postoperative patients were cured and discharged from the hospital. Through the preferences of three groups of between the operative time, intra-operative blood loss, intraoperative and postoperative complications, postoperative hospitalization days, the days of retain urine tube postoperative and postoperative highest temperature, Postoperative complications were followed up for one year, the cure rate aspects were compared, to evaluate the efficacy and the cure rate of the modified pelvic reconstructive surgery for severe pelvic organ prolapse.results:(1) intraoperative statistics results:operating time:The operating time of group 1 is 65-120min, average surgical time is 83.12±12.52 min, The operating time of group 2 is 70-180 min, average surgical time is 126.25±31.91 min, The operating time of the control group is 50-185min, average surgical time is 110.63±33.73 min. The average operating time of group 1 is less than group 2 and the control group, There is statistically significant difference (P<0.05).While there is no significant difference between group 2. and the control group (P>0.05).Bleeding during the operation:For study group l,the amount of bleeding was 70-600ml, and the average was 157.14±79.73 ml,for study group 2 the amount of bleeding was 50-500ml, and the average was 233.75±152.24,and for the control group,the amount bleeding was 50-500ml,and the average was 166.07±91.05 ml. Although the average amount of bleeding in group 1 is less than the group 2 and the control group,there was no significant difference between study group and the control group (P< 0.05). Complications after the operation:As to the rate of complications after the operation, the amount of bleeding during the operation of one patient in group 1 is more than others, the rate of complications in group 1 was 5%(1/20), In the control group,2 cases with A transient hematuria were occurred, the rate of complications in group 2 was7.14% (2/28).Although the rate of complications in group 1 is less than the control group there is no significant difference between the two groups.(P>0.05).(2) The comparison and analysis of the postoperative statistics:Mean in-hospital time post-operation:For study group 1 it was 7-14 days,and the average was 9.25±2.25 days,for study group 2 was 7-15 days, and the average was 9.25±2.26 days,and for the control group it was 5-13 days.and the average is 7.93±1.76 days. The in-hospital time post-operation of study group 1 was longer than the control groups, while there is no significant difference between study group and control group.(P>0.05).Retain urine tube days:group 1 postoperative retain urine tube 3-5 days, the average was 4.00±0.93days; Group 2 postoperative retain urine tube 3-6 days, the average 4.50±1.00days; The control group began retain urine tube 5-7 days, the average was 6.58±1.56 days.while there is no significant difference between study group and control group.(P>0.05).Postoperative highest temperature:The postoperative highest temperature in group 1 was 38.5℃, the average was 37.65±0.42℃; 2 the highest temperature in group 2 was 38.2℃,the average was 37.62±0.33℃; The highest temperature in the control group was 38.5℃, the average was 37.57±0.39℃. while there is no significant difference between the study group and the control group.(P>0.05). Complications after the operation:As to the rate of complications after the operation, one accured Vaginal wall hematoma in group l,rate of complications was 12.50 (1/8), In the study group,2 cases with Urinary retention were occurred, the rate of complications in group 1 was 8.33%(1/12). In the control group,1 case with Vaginal bleeding and 2 cases with Urinary retention were occurred, the rate of complications in group 2 was 14.28%(4/28). There is no significant difference among the three groups. (P>0.05).(3) follow-up long-term complications of one year:1 case showed up Suture rejection in group 1,and 2 cases accured in group 2,one of them showed up mesh erosion of.the patients who use the praline Mesh.The rate of Suture rejection in the study group was 15% (3/20); there was no Postoperative lower urinary tract symptoms accured in the study group 1,there was one case has Postoperative lower urinary tract symptoms accured in group 2, the rate of complications in the study group was 5%(1/20); There were 4 patients recovery the restorative life in group 1, there was no significantly symptoms Between the husband and his wife, There were 6 patients recovery the restorative life in group 2, and one case showed up pain during intercourse in goup 2,the rate of complications in the study group was 1/10(10%)o 5 cases showed up Suture rejection in the control group,the accurence rate was 19.2%%(5/26); there was 4 cases has Postoperative lower urinary tract symptoms accured in the control group, the rate of complications in the control group was 15.4%(4/26); There were 13 patients recoveried the restorative life in the control group of 25cases, there was 4 cases accured pain during intercourse,the accurence rate was 30.77%(4/13)。This follow-up results to comparative analysis between the study group and the control group among some respects such as Suture rejection and urinary tract symptoms, quality of sexual activities. The results show that the incidence of complications in the group is less than the control group, but there were no statistically significant (P>0.05).(4) curerate after 3 months back to court for follow-ups, there was no case of recurrence in group 1,the curerate is 100%. The control group after 3 months back to court for follow-ups 26 cases, there were 3 cases of recurrent group, cure rate objective 88.5% (23/26), The recurrence rate of the study group is lower than that of the control group,but there is no statistically significant difference (P>0.05). after 6 months back to court for follow-ups, there was one case of recurrence in group 1, and there was no case of recurrence in group 2,the cure rate of study group is 95%(19/20).The control group after 6 months back to court for follow-ups 26 cases, there were 6 cases of recurrent group, the cure rate objective 76.9%(20/26), The cure rate of the study group is higher than that of the control group,but there is no statistically significant difference (P>0.05).after 1 years back to court for follow-ups, there was one case of recurrence in group 1, and there was no case of recurrence in group 2,the cure rate of study group is 95%(19/20).The control group after 1 year back to court for follow-ups 26 cases, there were 9 cases of recurrent group, the cure rate is 65.4%(17/26), The cure rate of the study group is higher than that of the control group, there is statistically significant difference between the study group and the control group. (X2=4.217, P=0.040). Conclusion:(1) TVH,repair of vaginal anterior and posterior wall and Prolift suspensory are both effective ways in the treatment of POP.(2) As a new surgical technique, Total Prolift suspensory and improved pelvic revascularization can better repair the defects and realize the structural reconstruction and tissue replacement. The recurrence rate of Prolift surgery is lower. The short-term and mid-term effects are stable and the long-term effect needs further observation.(3) The average amount of bleeding in the group which retain the uterus was significantly short, less bleeding and postoperative rehabilitation faster, that is helpful for reducing the middle-aged and old women perioperative related risks.(4) The Pelvic reconstructive surgery which retaining the uterus is meaningful to maintain pelvic stable structure, the recent effect and complications are similar. As the hysterectomy group... |
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