To Evaluate The Curative Effect Of Prolift Pelvic Reconstructive Surgery All Sidedly And The Clinical Application Of MRI In Appraising The Quality Of Pelvic Reconstructive Surgery

Objective:1 To evaluate the curative effect and complications of Prolift pelvic reconstructive surgery by questionaire and follow-up study.2.To evaluate the pelvic muscle strength and myoelectricity after the Prolift pelvic reconstructive surgery.3.To investigate the objective effect of the Prolift pelvic reconstructive surgery and detect the alteration and length of the Prolift mesh after implantation by magnetic resonance image(MRI). To find out the iconography index for mesh shrinkage which may provide evidence for the complication and recurrence after the surgery.Methods:Twenty-six patients who suffered from pelvic organ prolapse (POP) from June,2009 to March,2011 were selected. Twenty patients suffered the Prolift pelvic reconstruction, the other six suffered hysterectomy and anterior/posterior colporrhappy through vagina. Fifteen patients without POP or stress urinary incontinence(SUI) were selected as the control group.1. To evaluate the curative effect and complications of the Prolift pelvic reconstructive surgery by pelvic floor impact questionaire-short form 7 (PFIQ-7), pelvic floor distress inventory-short form 20 (PFDI-20), prolapse and incontinence sexual function questionaire (PISQ) and follow-up study.2.To appraise pelvic floor muscle strength by biofeedback electrical stimulation device to gain electromyogram,myoelectricity and defatigation degree of pelvic floor muscle,and adopting vaginal palpation at the same time, in order to evaluate the alteration of the pelvic floor comprehensive muscle strength after the Prolift pelvic reconstructive surgery.3.Measure the imaging indexes of levator hiatus size (LHS), iliococcygeus thickness (ICT), puborectalis thickness (PRT), iliococcygeus angle (ICA), levator plate angle (LPA),anus-rectum angle (ARA),the distance of bladder to PCL (B-PCL), the distance of uterus to PCL(U-PCL), the distance of Douglas pit to PCL (D-PCL), the distance of anus-rectum conection to PCL (A-PCL), the distance of rectum to AACEL(R-AACEL), levator hiatus(H-line), muscular pelvic floor relaxation(M-line) and the mesh length (Mesh-L) by MRI pre and post-operatively. Recovery of the Prolift pelvic reconstruction and the alteration of the mesh were analyzed to assess the curative effect and find out the image index for shrinkage.Result:1.Post-operational follow-ups were three to twenty- one months. The incidence rate of Pain in the puncture points and bruise post-operatively was 20%. It recovered naturely in a few days.The incidence rate of urinary retention was 15%. The patiens recovered after the doctor's therapy. The incidence rate of mesh erosion or exposure was 10%,but taking a turn for the better after trim. The incidence rate of shrinkage was 25%,but they didn'nt suffer any comfortlessness.The incidence rate of sexual intercourse discomfort was 20%, and the incidence rate of posterior vaginal wall prolapse was 15%.2.The quality of life obviously improved after the Prolift pelvic reconstruction (P <0.05),but there was no diference between six months and one more year after the operation(P>0.05). It had no impact on the quality of sexual activity(P>0.05).3. Pelvic floor muscle strength, electromyogram and defatigation degree of type-I and type-Ⅱpelvic floor muscle fibre were correlated with the pelvic floor muscle strength which acquired through vaginal palpation. The pelvic floor muscle strength, electromyogram of type-Ⅰand type-Ⅱpelvic floor muscle fibre of the control group were higher than the pre-operatively,and the defatigation degree was less than the pre-operatively (P<0.05).There was no diference in all indexes of pelvic floor muscle strength between the pre-operatively and six months after the operation(P>0.05).4.After the Prolift operation, pelvic organs were in normal position. At the Valsalva state,LHS, ICA, LPA, ARA, H-line and M-line were smaller than pre-operatively(P <0.05),but ICT and PRT did'nt change(P>0.05). All imagine indexes had difference between two to four weeks and five to seven months post-operatively (P>0.05). At the five to seven months post-operatively,LHS, ICA, LPA, ARA,H-line and M-line of the Prolift group were smaller than the traditional repair group at the Valsalva state (P<0.05).5.The Prolift mesh appear low singal on T2WI of MRI. The length of mesh which planted on the vaginal wall five to seven months post-operatively was obviously shorter than two to four weeks post-operatively. The average shrinkage rate of mesh was about 31.58%±3.81%.Conclusion:1.The Prolift pelvic reconstruction is relatively safe and has less complications, the curative effect in short time is positive.lt can improve the quality of daily life obviously,but has no impact on the quality of sexual activity This maybe realated to limit samples We can assess the alteration of life quality post-operatively by applying the questionaire exactly.2.vaginal palpation associating with biofeedback electrical stimulation device can appraise the comprehensive pelvic floor muscle strength and pelvic floor muscle function. Pelvic floor muscle strength which is acquired by hands or biofeedback electrical stimulation device,electromyogram,defatigation degree of type-I and type-II pelvic floor muscle fibre can become favorable indexes to evaluate the function of pelvic floor muscle. Vaginal palpation may be a nicer index in clinical especially in the poor hospital.3.The Prolift pelvic organ reconstruction repair the defective fascia and ligament, it can recover the normal position of pelvic organs. Singal radial line of mesh in MRI may be the image index for shrinkage.