| Pelvic organ prolapse(POP)is defined as tissues such as bladder,uterus and rectum emerge outside of the vaginal due to the effect of support of the pelvic floor weakened.With the extension of human life,the incidence of pelvic organ prolapse is rising year by year,the lifetime prevalence rate of 30% ~ 50%,and POP-Q III will seriously affect the patient’s quality of life.At present,the treatment of severe pelvic organ prolapse mainly include pessary and surgery,surgery include traditional surgery and pelvic floor reconstruction.The American Society of Obstetrics and Gynecology recommend pessary treatment as the preferred method in its guidelines.However,the application of pessary only appeared in a few grade A class 3 hospital,and the treatment of severe pelvic organ prolapse are dominated by surgical treatment.In recent years,the studies of silicone pessary have emerged in our country,but these studies about the comparison of the treatment strategy is not enough in view of the current popular POP.This study will provide clinical evidence for the selection of treatment for elderly patients by comparing the clinical curative effect of silicone pessary and pelvic floor reconstruction therapy in elderly patients with severe POP.Objective To investigate the differences of improving of life quality,the satisfaction after treatment and complications between silicone pessary and pelvic floor reconstruction for old patients with severe pelvic organ prolapse(POP),and provide clinical evidence of the selection of treatment for old patients.Materials and methods 1 Study object Choose elderly POP patients who accepted treatment in the Third Affiliated Hospital of Zheng Zhou University with symptoms,age over 60 years old,pelvic organ prolapse quantitative(POP-Q)Ⅲ~ Ⅲdegrees.By the consultation of treatment in detail(including silicone pessary and pelvic floor reconstruction therapy method,the advantages and disadvantages,the possible complications and cost,etc.),ruled out for patients with contraindications for two kinds of treatment.2 Research methods 2.1 Silicone pessary Silicone pessary were supplied by the COOPER companies in the United States.Because the objects of this study are based on the POP-Q III-IV,the type for using of the study have both supporting and filling effect with short shank(Gellhorn).2.2 Surgery For the current application widespread and applying to severe POP,vaginal hysterectomy + mesh of pelvic floor reconstruction and simple vaginal mesh pelvic floor reconstruction were selected.Operations were performed by a senior doctor in Pelvic Floor Reconstruction Ward of the hospital.2.3 Data collection Include: age,body mass index(BMI),the vaginal delivery times,hormone replacement therapy,menopausal status,whether accept uterus resection,urinary incontinence,history of chronic cough,chronic constipation,whether diabetes,a history of mental illness,etc.2.4 Grouping After exclusing of contraindication,patients are grouped into silicone pessary group and pelvic floor reconstruction group according to the choices of them.144 cases were included in this study.2.5 Standard of exclusion(1)Someone who was affected by complications only can use pessary and can’t have an anesthesia or surgery;(2)Someone was failed of trying to use the pessary or used the pessary then choose surgery;(3)Someone with other disease of gynecology need operation treatment.2.6 Standard of diagnosis The dividing standard of pelvic organ prolapse choose pelvic organ prolapse quantitative(POP-Q).2.7 Analysis of clinical effect Fill in the Pelvic Floor Distress Inventory 20(PFDI–20)and Pelvic Floor Impact Questionnaire 7(PFIQ–7)before treatment,6 months and 2 years after treatment for patients.Reference to Bai’s satisfaction assessment methods,the satisfaction of patients should be scored after treatment.Compare the quality of life score before and after treatment within group.Compare the quality of life score and satisfaction in 6 months and 2 years after treatment between groups,and analyze the complications.2.8 Follow-up visit and Statistical analysis Mainly follow-up by outpatient and telephone.Complete PFDI-20 and PFIQ-7 in 6 months and 2 years after treatment.Ask for details of the complications of time,type and times.Analysis the score of satisfaction.All data were entried EXCEL spreadsheet.Use SPSS21.0 software for data processing.Measure data was signified by mean±standard deviation(?x±s).Chi-square test was used for the comparison of qualitative data.Before and after treatment within group,curative effect was compared with paired test.Two independent sample of quantitative data use the opposite sample t test for statistical analysis.Inspection level take α = 0.05,P < 0.05 was statistically significant.Result 1.Within group,there was statistically difference of PFDI–20 and PFIQ-7 between 6 month after treatment and before treatment(P < 0.05),and between 2 years after treatment and before treatment(P < 0.05).In silicone pessary group,there was no significant difference in the PFDI-20 and PFIQ-7 scores between the 2 years and 6 months,the P value was 0.43 and 0.75.In pelvic floor reconstruction group,there was significant difference in the PFDI-20 and PFIQ-7 scores between the 2 years and 6 months,the P value was 0.04 and 0.03.2.Between two groups,the score of PFDI–20 and PFIQ-7 in 6 month after treatment was no statistically difference with before treatment(P = 0.35,P = 0.83,P > 0.05).3.In 2 years after treatment,the score of PFDI–20 and PFIQ-7 of pessary group was higher than that of surgery(P=0.00,P=0.02,P< 0.05),pelvic floor reconstruction is better than pessary in curative effect.4.There was no statistically significant difference of satisfaction between two groups in 6 months after treatment(P=0.37).In 2 years after treatment the score of satisfaction is higher in the pelvic floor reconstruction group,there were statistically significant difference(P=0.04).5.The main complications of pessary group include increased discharge 17.02%(8/47),vaginal odor 10.64%(5/47).6.Perioperative complications of pelvic floor reconstruction mainly include the puncture point or lower limbs pull pain 13.92%(11/79)and urinary retention 8.86%(7/79).Postoperative complications include mesh exposed 13.92%(11/79)and new urinary tract symptoms 10.13%(8/79).Conclusion 1.Silicone pessary and pelvic floor reconstructive are both effective treatment for severe POP in elderly women,curative effect is definitely confirmed.2.In short-term,curative effect and satisfaction of pelvic floor reconstruction is pretty with silicone pessary,but it is better than the pessary in long-term.3.For elderly patients,the rate of perioperative complications and mesh leakage of pelvic floor reconstructive is higher in comparison.4.Silicone pessary is a recommended treatment for elderly patients who can’t tolerate surgery or unwilling to accept surgical treatment. |
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