The Clinical Study Of Female Anterior Pelvic Organ Reconstruction Surgery With Biological Mesh

Background:Pelvic organ prolapse (POP) is defined as the descent of the genital tract due to weakness of the pelvic floor supportive tissues by degenerate,damage and so on. It is one of pelvic floor dysfunction disease (PFDs),and has no exact pathogenesis up to now. The clinic symptoms associated mainly include uterine prolapse,anterior vaginal wall prolapse and posterior vaginal wall prolapse. With the progression of the aging society, the incidence of POP is increasing. POP has seriously influenced the health and quality of life for middle-aged and elderly women. Therefore,the treatment is aim to rebuild structure and recover the function of the pelvic floor, having a satisfactory sexual function,and retaining the effect. Surgery has become the primary method in POP therapy. In order to achieve satisfactory therapeutic effect,a wide range of mesh has been used in the therapy of impaired pelvic fascia tissue. Biological mesh has high biocompatibility and rarely erosion,which has become the newstar in mesh.Objective:To explore the efficacy and safety of biological mesh in the treatment of female anterior pelvic organ reconstruction surgery.Methods:This study was an observational case series of113consecutive women in Beijing hospital from January2010to June2013,with symptomatic anterior vaginal wall prolapse. Preoperative and postoperative pelvic evaluations were performed with the POP-Q system.98cases underwent vaginal hysterectomy simultaneously.38cases underwent anterior vaginal wall repair with biological mesh.35cases underwent anterior vaginal wall repair with chemically synthesized mesh and40cases underwent vaginal approach to paravaginal repair. Patients were followed up for1to36months. Criteria for objective cure were defined as the anterior vaginal walls at grade0and firmly apposing the lateral pelvic sidewalls.The data were analyzed by SPSS17.0,measurement data were expressed as x±s,Kruskal-Wallis test among the three samples,Chi-square test the rate among the three groups,if P<0.05means statistically significance.Results:Of the113patients,3had grade Ⅱ,34had grade Ⅲand76had grade Ⅳ anterior vaginal wall prolapse. In all patients the anterior vaginal repair was performed successfully. No complication happened during and post operation. The operation time (x2=2.969,P>0.05),the bleeding in operation (x2=0.594, P<0.05),fluid replacement in operation (x2=4.930,P>0.05),the days of gauze in vaginal (x2=5.966,P>0.05),the time of catheter retained post operation (X2=5.870,P>0.05),the days of hospitalization post operation(x2=1.749, P<0.05),three groups had no statistically significance.Making the last follow-up as the final results,biological mesh group and chemically synthesized mesh group were all cured and no relapse so far. The paravaginal repair group were all effective,and5cases relapse(12.5%),including4cases of grade Ⅱ,the clinical symptom was anterior fornix prolapse, patients had no symptoms or discomfort,and1patients with grade Ⅲ. The rate of relapse was statistically different among the three groups (x2=9.547,P＜0.05). The relapse rate between biological mesh group and paravaginal repair group (x2=5.075,P＜0.05), and relapse rate between chemically synthesized mesh group and paravaginal repair group (x2=4.688,P<0.05) were statistically different. The chemically synthesized mesh group had more complications than the biological mesh group(x2=4.595, P<0.05),including3cases of having chronic pain and sexual pain,1case of mesh erosion. Conclusions:The effect of anterior vaginal repair with biological mesh is satisfied. It is an effective and safe procedure in our study.