Clinical Study Of Using Four Methods For The Treatment Of Pelvic Organ Prolapse

Object To investigate the clinical significance of total vaginal hysterectomy (TVH)+repair vagina, mesh repair of vagina (total vaginal mesh TVM) and Prolift pelvic floorreconstruction on the treatment of POP. To analyze whether there were differences inpostoperative complications and cure rates between using mesh or not and removing theuterus or not.Method This study selected180patients with POP who had received surgicaltreatment in Ningxia Medical University General Hospital gynecological from January2008to November2011.All the patients’ POP-Q stage were II-IV. They were divided into twogroups: TVH group and Prolift group. Depending on whether using mesh or not，the TVHgroup were divided into TVH1group (74cases) and TVH2group (59cases). Depending onwhether retaining the uterus or not, the Prolift group were divided into the UC group (24cases)and the CH group(23cases). Analyze the clinical materials, situations during the operation,recovery after the operation, curative effect and complications of these180patients, get therecurrence rate and quality of life, and carry on statistics to get significance.Result (1) General clinical data: Between TVH group and Prolift group, betweenTVH1group and TVH2, between the UC group and the CH group, there were no significancedifference in the aspects such as age, years since menopause, pregnant times, delivery times,BMI, and the degree of POP;(2) Perioperative data: There was no significant difference ofoperation time, bleeding, the highest temperature and the average time in hospital between theTVH group and the Prolift group (P>0.05), and there was significant difference of indwellingcatheter time (P <0.05). There was significant difference of operation time, bleeding and the average time in hospital between TVH1group and TVH2(P <0.05), and there was nosignificant difference of the highest temperature and indwelling catheter time (P>0.05). Therewas significant difference of operation time, the average time in hospital and indwellingcatheter time between the UC group and the CH group(P <0.05), and there was no significantdifference of bleeding and the highest temperature(P>0.05).(3) objective efficacy: There wasno significant difference of the cure rate after6months between the Prolift group and theTVH group, between the TVH1group and the TVH2group, between the UC group and theCH group (P>0.05). There was significant difference of the cure rate after1year between theProlift group and the TVH group, between the TVH1group and the TVH2group (P <0.05),and there was no significant difference between the UC group and the CH group (P>0.05).(4)subjective efficacy: There was significant difference between postoperative score andpreoperative score (P <0.01). Between the UC group and the CH group, there was significantdifference of the P-QOL score after6months and after1year, health and living (P <0.05), therest of P-QOL(P <0.01).(5) Postoperative complications: After3months the vaginal stumprejective incidence is19.85%in the TVH group. After6months, the mesh erosion of vaginalrate was7.02%of the TVH2group,12.5%of the UC group,17.39%of the CH group.Conclusions (1) TVH+repair vaginal or TVM and Prolift pelvic floor reconstructionare effective, safe and feasible means of treatment of POP. The cure rate of Pelvic floorreconstruction is higher than the traditional surgery. The patients will get better life. Thelong-term efficacy needs further observation.(2) Between TVH+repair vaginal and TVH+TVM, the latter one has better effect and higher cure rate. The long-term efficacies have to befurther followed up.(3) Between retain the uterus and does not retain the uterus in Proliftpelvic floor reconstruction, the first one has better efficacy. Retain the uterus can retain thecomplete structure of the pelvic floor, improve function and improve quality of life.