Recent Clinical Curative Effect Observation And Survey The Satisfaction Of Patients After Total Pelvic Floor Reconstruction Operation

Objective: Analysis of recent clinical curative effect after total pelvic floorreconstruction and investgate the quality of life of patients after operation.Methods: According to the POP-Q staging diagnosis of pelvic organ prolapsedⅢ-Ⅳ57cases treated in Dalian Maternity And Child Health Hospital for total pelvicfloor reconstruction with mesh during2010January to2013January. To choose thereasonable operation method according to patient age, disease, complication and patientpreference. A total of13patients underwent hysterectomy operation, including2caseswith adnexal masses underwent laparoscopic hysterectomy and bilateral salpingooophorectomy,11cases underwent transvaginal hysterectomy.3cases had hysterectomypatients do excision of cervical stump. There were6patients with stressurinary incontinence,5cases underwent tension-free vaginal tapeobturator technique（TVT-O）. The clinical anatomy were evaluated by pelvic organ prolapse quantitive(POP-Q).By comparing the preoperative, postoperative pelvic floor distressinventory-20(PFDI-20) and pelvic floor impact questionaire-7(PFIQ-7) to assess thequality of life after operation. By comparing the preoperative and postoperative pelvicorgan prolapse/urinary incontinence sexual function-12(PISQ-12), impact assessmentof quality of life in patients with operation. The PFDI-20is divided into three subscales:pelvic organ prolapsed distress inventory-6(POPDI-6),colo-rectal-anal distressinventory-8(CARDI-8), urinary distress inventory-6(UDI-6). PFIQ-7is also divided into3subscales: pelvic organ prolapse impact questionaire-7(POPIQ-7),colo-rectal-analimpact questionaire-7(CARIQ-7),urinary impact questionaire-7(UIQ-7). They are fromthree aspects of pelvic, colorectal and anal, bladder symptomsto evaluate the effect ofoperation. This paper also discusses the intraoperative and postoperative complications.Results:（1）Therapeutic effects of anatomic:According to the indication of POP-Qafter operation, vaginal wall Aa, Ba, Ap, Bp, and top C were significantly corrected （P＜0.05).The perineal body length increased significantly（P＜0.05).Genital hiatus lengthshortened significantly（P＜0.05).But no significant change in the total length of thevagina（P＞0.05).A total of4patients had recurrence, including1cases ofrecurrenceafter1years as a vault prolapse stage Ⅳ again in our hospital underwent laparoscopicsacral colpopexy,3cases relapse into phaseⅢ, who underwent conservative treatment.（2）Functional outcome and sexual life:Compared with PFDI-20, PFIQ-7before andafteroperation, the difference was statistically significant (P <0.05),operation cansignificantly improve the life quality of the patients. The three subscales of the PFDI-20POPDI-6, CARDI-8, UDI-6and PFIQ-7three score subscales of the POPIQ-7,CARIQ-7, UIQ-7note: before and after surgery in patients with pelvic, colorectal andanal, bladder symptoms were significantly alleviated (P <0.05); compared withPISQ-12before and after operation,there was no significant difference (P>0.05),operation has no effect on sexual life.（3）Complications during operation and afteroperation:There were3cases of bladder injury in this study,2cases occurred duringoperation,1cases occurred in the postoperative. These3cases were given fullindwelling catheterization recovered. After operation1patients appeared mesh infection,2patients had patch exposure,1patients had pelvic pain symptoms.6patients werefound to have new lower urinary tract symptoms,4cases of urinary frequency, urinaryendless in1cases,1cases of stress urinary incontinence.Conclusion: This study is a prospective study of total pelvic floor reconstruction,recent anatomic success rate was93%.The vaginal walls of A, B and vaginal apical Cwere significant elevation, suggesting that the total pelvic floor reconstruction for thesupport of three chambers, are very effective, reliable. Clinical effect of total pelvic floor reconstruction with mesh recent is certain.Quality of life of the patients improvedsignificantly after operation. Pelvic, colorectal and anal, bladder symptoms weresignificantly alleviated, and operation of the quality of sexual life has no obviousinfluence. But complications during operation period safety, mesh extrusion, newlydiscovered urinary tract symptoms can not be ignored.