The Ultrasound Morphologic Research On Pelvis And Mesh Of Pelvic Restruction Operation And The Analysis Of Surgical Complications

【Objective】Assess the affecting of TVM on pelvic floor anatomy and the effectiveness of theapplication of pelvic ultrasound, then provide the new ideas and basis of pelvicultrasound technology for TVM in the preoperative assessment, intraoperativeguidance and postoperative follow-up, proposing the prevention and the treatmentstrategy.【Menthods】1. The primary part: The Ultrasound Comparative Research on Pelvic MorphologicChanges before and after Transvaginal Placement of Surgical Mesh.30patients with POP cured successfully by TVM participated in this study,whounderwent transperineal3D ultrasound twice before TVM procedure and3monthslater. We measured the distance between the neck of bladder and the inferior edge ofthe pubic system, retrovesical angle in the sagittal plane and the thickness of thepubovisceral muscle,dimensions of the levator hiatus in the cross section andcompared the parameters before and after TVM procedure.2. The second part: This study was designed to observe the situation of mesh used inTVM.62patients with POP underwent TVM participated in this study. We scanned thepelvic floor at rest, on Valsalva and contration.We measured the length,the locationand the level, the distance between the middle of the mesh and the inferior edge of thepubic system in the sagittal plane, the width of cross section, and the proportion ofanus levator fissure. We identified the differences of the mesh on Valsalva andcontraction.3. The third part: The analysis of the complications in pelvic reconstructive surgery from vaginally placed mesh.We retrospectively identified49patients referred to our institution from June2007through June2012who had complications after TVM.【Results】1. The primary part: The Ultrasound Comparative Research on Pelvic MorphologicChanges before and after Transvaginal Placement of Surgical Mesh.Postoperative implanted mesh of TVM has a linear strong echo undertransperineal three-dimensional ultrasound. Before and after TVM procedure,comparisons of the neck of bladder and the fracture and the thickness of levator werenot significant difference at rest, on Valsalva and contraction, p＞0.05,but the area ofthe levator hiatus was smaller than that after TVM surgery at rest, on Valsalva andcontraction, and the retrovesical angle was smaller than before at rest, on Valsalva, p＜0.05.2. The second part: This study was designed to observe the situation of mesh used inTVM.Under the perineal ultrasound, the mesh echo of TVM is hyperechoic line whichmove to the sacral side when Valsalva, to the head when ventral anal contraction,according to the distance from mesh to pubic symphysis and ultrasound morphologicchange. In different states, the length of the mesh in sagittal and coronal slices arechanging, becomes longer when having Valsalva maneuver, shorter when havingcontraction maneuver, related parameters having significant difference by pairedsample t test after analysis (p <0.05). However the average depth of the implanted inmeasurement: the front wall is0.72-0.84cm, the rear wall is0.73-0.86cm, which islocated in20%to76%position of the front wall and the16%to75%of the parts ofthe rear wall, filling about82%-84%of the levator ani muscle fractured inthree-dimensional plane.3. The third part: The analysis of the complications in pelvic reconstructive surgeryfrom vaginally placed mesh.According to the pelvic organ prolapse quantitation（POP-Q）, Patients had beensignificantly improved in the anterior, uterine/vault and posterior vaginal wall (P 〈0.001). The Complication formation rate is16.44%（49/298）：including mesherosion in20patients(6.71%), dysuria in12patients（4.03%）, pain after surgery in5patients（1.68%）, prolapse recurrence in4patients（1.34%）, hematoma after surgeryin3patients （1.01%）, bladder perforation in2paitients （0.67%）, operation failurein2patients（0.67%）, rectal perforation in1paitient（0.34%）. The dysuria involvevoiding difficulty in5paitients, post-void residual volume in4paitients and urinaryincontinence in3patients.【Conclusions】1. TVM is effective to POP, whose machanism is to fill in and shrink the levatorhiatus, correcting the urethra and bladder normal anatomical position. The"hammock-like" effect of mesh to support the prolapsed tissue, but can not improvebladder neck location and levator ani muscle thickness and fracture. Evaluate theeffectiveness of the TVM operation should combine clinical questionnaire, clinicalexamination and auxiliary inspection method.2. The parameters of mesh in transperineal ultrasound are relate to the patients’condition, while the efficacy and safety of TVM surgery have closelyconnection with the length, the placement and the tension when abdominal pressureincreases. The transperineal three dimension ultrasound technic is helpful toobservation of the mesh, postoperative follow up and analysis of complications,providing the new ideas and the basis for the follow-up of TVM surgery.3. TVM can produce many kinds of complications，most can be prevented andtreated, and the complication occurrence is closely related to the surgical procedure,patients’ vaginal conditions, perioperative nursing and the follow-up operation.