Clinical Study Of Sacrospinous Ligament Fixation For Pelvic Organ Prolapse

Background and Purpose:Pelvic organ prolapse(POP)is an important medical problem with huge socio-economic costs.It is estimated that more than 50 percent of perimenopausal women are affected.The main therapeutic goal is to restore normal anatomy and thus normalize pelvic organ function.Therefore,surgical strategies must be based on the location and severity of the pelvic floor defect.Given the variability of causes,wider surgical coverage and treatment options are needed to allow for individualized treatment.In recent years,the surgical treatment of pelvic organ prolapse has changed significantly.Due to the problems of mesh erosion and exposure,more and more clinical medicine chooses the vaginal route through the natural orifice,among which the sacrospinous ligament suspension is one of the classic pelvic floor reconstruction methods,and its clinical efficacy has been widely concerned.However,there are few clinical studies on the long-term follow-up during and after the sacrospinous ligament suspension.Therefore,the purpose of this study was to identify the clinical efficacy and quality of life for the patients who diagnosed moderate to severe pelvic organ prolapse and had the surgery of sacrospinous ligament suspension.In order to have a deeper understanding of the clinical efficacy of this operation in the treatment of pelvic organ prolapse through the collection of clinical data and long-term follow-up after surgery.Materials and Method:The second affiliated hospital of Anhui medical university were retrospectively analyzed in January 2013 to December 2019 for the patients who were clinically diagnosed of POP-Q(Pelvic organ prolapse qualification)Ⅱ-Ⅳ stage,124 cases of patients with pelvic organ prolapse.All patients underwent sacrospinous ligament fixation,and when necessary,total hysterectomy,anterior and posterior vaginal wall repair and perineal repair were performed.At the same time,perioperative information,postoperative complications,postoperative subjective recovery and postoperative quality of life questionnaire were observed and compared.According to different postoperative follow-up time,patients were divided into the < 12 month group,the12-24 month group,the 24-60 month group and the ≥60 month group.Subjective postoperative recovery of patients in different groups was counted.Result:POP-Q score(Aa,Ba,Ap,Bp,C)were in normal position 3 months after operation,and the values of gh,pb,and TVL were significantly different from those before operation(P< 0.001).The results of the pelvic floor dysfunction questionnaire for 19 patients 12 months after surgery showed that the total PFDI-20 score was significantly different from that before surgery(P < 0.001),the preoperative and postoperative scores of UDI-6 and POPDI-6 were significantly different(P < 0.001),and CRADI-8 was not significantly different from that before surgery(P > 0.05).114 postoperative patients with pelvic organ prolapse subjective symptoms improved questionnaire survey,according to different postoperative follow-up time respectively,the results showed: <12 months group obviously improved 21 people,improved 2 people,the total cure rate92%(23/25),12 to 24 months group obviously improved 29 people,improved 9 people,the total cure rate 95%(38/40),24 to 60 months group obviously improved 23 people,improved 13 people,the total cure rate 92.3%(36/40),60 or more month group obviously improved 11 people,improved 4 people,the total cure rate 100%(15/15);There were 18 patients complained the postoperative recurrence or annoying complications.Hemoglobin difference was statistically significant during the preoperative and postoperative(P < 0.001),while preoperative and postoperative residual urine values were not statistically significant(P > 0.05).Conclusion :Sacrospinous ligament fixation(SSLF)has a significant effect on the treatment of moderate and severe pelvic organs,and can effectively restore its anatomical structure.SSLF has advantages such as short operation time,less intraoperative blood loss,fewer postoperative complications,higher safety and significantly improving the patient’s quality of life,which are similar to other literature reports.