Clinical Retrospective Analysis Of Surgical Treatment Of 43 Patients With Pelvic Organ Prolapsed

Objective(s):By analyzing the general situation of 43 patients with pelvic viscera prolapse,the results of related auxiliary examination,clinical symptoms,stages of pelvic viscera prolapse,relevant indexes of pelvic floor surgery and postoperative conditions.Therefore,the disease characteristics of pelvic organ prolapse were analyzed,and the efficacy and safety of different surgical methods were evaluated in order to provide basis for clinical management of pelvic organ prolapse in the future.Method(s):From September 2016 to September 2017,43 patients with pelvic organ prolapse were treated in the first affiliated Hospital of Kunming Medical University.The related evaluation system was used to analyze the effect of operation.POP-Q staging(see schedule 1)was used to quantify the degree of pelvic organ prolapse before operative.Postoperative POP-Q was used to evaluate the operative effect of pelvic organ prolapse.PFDI-20[1](see schedule 2)was used to assess the severity of prolapse related symptoms,the effect on quality of life and the effect of surgical treatment on quality of life.The subjective satisfaction degree of patients after operation was evaluated with subjective Global Impression of change scale[2](see Table 3).Visual analogue pain assessment(VAS,see schedule 4)was used to assess the patient’s pain level.To compare the difference between the two surgical methods and the occurrence of complications.The indexes of operation were as follows:preoperative Hb,postoperative Hb,intraoperative blood loss and operative time.Symptom questionnaire was used to evaluate the effect of surgical treatment of pelvic organ prolapse in 43 patients with pelvic organ prolapse.The counting data and the metrological data analysis were expressed in the format of percentage and mean±standard deviation,respectively.The comparison of the mean among the measurement data groups was conducted by single factor analysis of variance.The count data were tested for normality,which did not accord with normal distribution.Using X2 test,the difference was statistically significant(P<0.05).Results:According to the POP-Q staging of pelvic organ prolapse,there were 22 patients with stage IV prolapse,21 patients with stage III prolapse,The average pregnancy times of 43 patients with pelvic organ prolapse were 3.12 ±1.74,and the average delivery times were 2.23 ±1.62.43 cases with pelvic organ prolapse were treated by operation.The vaginal cavity prolapse was 43/43(100%),the lower abdominal distention was 11/43(25.58%)and the pulling pain was 10/43(23.26%),43 cases of pelvic organ prolapse were treated by operation,and 27(27/43,62.79%) patients in the mesh group.Among them,24 cases underwent pelvic floor reconstruction,3 cases underwent laparoscopic sacral fixation,3 cases underwent anti-urinary incontinence in the mesh group and 16(16/43,37.21%)cases in the non-mesh group.There were significant differences in POP-Q staging and PFDI-20 score in 43 patients with prolapse before and after operation(P<0.05),and there were significant differences in the evaluation of pelvic organ prolapse 3 months after operation(P<0.05).There were significant differences between preoperative and postoperative 3 months and 6 months after operation(P<0.05).All patients had POP-Q staging<stage Ⅱ.43 patients were cured according to the objective POP-Q staging of surgical treatment.Objective satisfaction was 100.By using subjective symptom improvement score and self-made symptom questionnaire summary table to analyze the improvement of PGI-C score and prolapse related symptoms in patients 6 months after operation,43 patients with prolapse related symptoms were significantly improved compared with those before operation.The score was 1.16 ±0.37,which was satisfactory.Subjective satisfaction was 100.By using VAS to evaluate the severity of pain in patients before and after operation,the incidence of pelvic pain in the mesh group was 1/27(3.70%)months after operation,which was mild pain and relieved after 4 months of symptomatic treatment.In the mesh group,the incidence of traction pain was 10/27(37.04%),the incidence of traction pain after 3 month was 1/27(3.70%),and the pain was mild at third month after operation,which was significantly relieved than that before operation.The pelvic pain in the non-netted group was relieved before and after operation,and one case of slight lower extremity traction pain occurred 3 months after operation,which was relieved by symptomatic treatment.All the patients with stress urinary incontinence were cured before and after operation.There was no new urinary incontinence in the new urinary incontinence group(1 case)and non-net film group(1 case).No infection,thrombosis,or bleeding were found in all patients after operation.Preoperative and postoperative hemoglobin,mean operative time,mean intraoperative bleeding volume were statistically analyzed.There was no significant difference between the two groups(P>0.005).In the mesh group,the cure rate was 100,none case recurred during the follow-up period,2 cases of bladder injury occurred during the operation,all cases were cured by symptomatic treatment,and 1 case of late vaginal bleeding occurred after operation,which was cured by interventional therapy and other symptomatic support therapy.At the end of follow-up,there were no net-related complications(such as net exposure,erosion,etc.)in the mesh group.The cure rate of non-net film group was 100,the operation was successful,no complications occurred,no recurrence occurred during the follow-up period,the subjective satisfaction was 100 and the objective satisfaction was 100 at 6 months after operation.Conclusions:1)the occurrence of pelvic organ prolapse is a chronic progressive disease in which many factors are involved,but labor injury is not the absolute factor of pelvic organ prolapse.Low levels of hormones and increased abdominal pressure may be related to the occurrence of pelvic viscera prolapse.2)the most common clinical manifestations of moderate and severe pelvic organ prolapse were vaginal orifice prolapse and discomfort,followed by lower abdominal distention and pulling pain.3)Surgical treatment is an effective method for patients with pelvic organ prolapse,which can effectively improve the symptoms associated with prolapse,improve the quality of life of the patients,and obtain a higher subjective and objective recovery rate.4)the incidence of complications associated with two pelvic floor operations was lower.