Application Of Anatomic Repair In Pelvic Floor Disorder

Background and objectivePelvic floor dysfunction in women is a degenerative disease caused by the decreased supporting function of pelvic floor muscles,fascia and uterine ligaments,mainly manifested as pelvic organ prolapse(POP),stress urinary incontinence(SUI),sexual dysfunction and chronic pelvic pain and a series of pelvic floor injuries or defects.With the aggravation of aging society in China,the incidence of female pelvic organ prolapse is getting higher and higher,and this phenomenon has gradually attracted social attention.For patients with moderate to severe POP,surgical treatment is still the first-line treatment.Currently,there are many surgical methods in clinical practice,and there is no unified standard surgical method.Therefore,this study retrospectively analyzed the surgical situation of 20 patients with POP in our hospital,discussed the surgical treatment plan of POP,explored its clinical efficacy and safety,and provided reference and basis for the clinical surgical treatment of POP.Object and methodRetrospective analysis was performed on 20 patients with pelvic organ prolapse who were admitted to the department of gynaecology of Jinan Central Hospital,Shandong University from 2018 to 2020.Among them,patients with anterior pelvic defects were given anterior vaginal wall repair+laparoscopic retropubic Cooper ligament suspension;patients with middle pelvic defects were given transvaginal hysterectomy+laparoscopic suspension of high sacral ligament+shortened suspension of round ligament;patients with posterior pelvic defects were given posterior vaginal wall+perineal body repair.All operations were performed by the same chief physician.Perioperative observation indexes included:operative time,intraoperative blood loss,preoperative and postoperative hemoglobin changes,postoperative exhaust time,postoperative indwenting catheter time,postoperative hospital stay,and perioperative complications.Postoperative follow-up mainly included outpatient follow-up and telephone follow-up.Follow-up included:surgical complications(such as chronic pelvic pain,dysuria,recurrence of prolapse,etc.),postoperative POP-Q scale indicator points,PFDI-20(Pelvic Floor Disorders Symptoms Questionnaire)and PFD1-7(Pelvic Floor Disease Quality of Life Questionnaire).Statistical Methods:Statistical software SPSS26.0 was used to analyze the general data,perioperative data and postoperative follow-up data of all patients.Mean±standard deviation(X±s)was used to represent the analysis results of measurement data.Paired-t-test was used for preoperative and postoperative comparison of relevant indicators,and P<0.05 indicated statistically significant differences.Results(1)The average age of 20 patients with pelvic organ prolapse was 61.45±7.80 years,the average pregnancy time was 2.45±1.10 times,the average labor time was 1.06±0.75 times,the average menopause time was 10.63±8.41 years,and the average prolapse time was 2.13±1.73 years.Among the 20 patients,6 cases(15%)were complicated with hypertension,7 cases(17.5%)were complicated with hypertension,6 cases(15%)were complicated with stress urinary incontinence,11 cases(27.5%)were complicated with old cleft perineum,3 cases(7.5%)were complicated with uterine fibroids,3 cases were complicated with coronary heart disease,and 1 case was complicated with history of cerebral artery embolism.(2)The average operative time of the 20 patients was 157.61±76.54 minutes,the average intraoperative blood loss was 110.84±88.97ml)the average preoperative Hb was 129.7±8.53g/L,the average postoperative Hb was 116.4=17.82g/L,the average postoperative exhaust time was 1.55±0.6 days,the average postoperative indwelling catheterization time was 5.95±1.28 days,and the average postoperative hospitalization time was 6.55±1.39 days.(3)The preoperative mean values of AA,BA,AP,BP and C points of all patients were 0.23±1.85,1.04±2.80,-2.07±1.12,-1.79±1.66 and-1.04±3.35,respectively.The mean values of AA,BA,AP,BP and C points one month after operation were-2.74±0.41,-2.79±0.42,-2.91±0.18,-2.89±1.60 and-3.57±0.78,respectively.There was significant difference between preoperative and postoperative,P<0.05,the difference was statistically significant.PFDI-20 and PFIQ-7 were significantly lower than those before operation(P<0.05),and the difference was statistically significant.Postoperatively,1 patient developed lumbar acid discomfort,1 patient developed pelvic traction pain,and the other patients had no complications or recurrence of prolapse.Conclusions(1)Anterior vaginal wall repair+laparoscopic retropubic Cooper ligament suspension,transvaginal hysterectomy+laparoscopic high sacral ligament suspension+short round ligament suspension,and posterior vaginal wall+perineal body repair can effectively anatomically repair anterior pelvic defects,middle pelvic defects and posterior pelvic defects.(2)Anatomic repair can effectively treat pelvic organ prolapse,restore the pelvic floor anatomical structure and function of patients,and has the advantages of less trauma,quick postoperative recovery and fewer complications.