The Clinical Analysis Of New Pelvic Reconstructive Approach And The Traditional Surgical Treatment Of Pelvic Organ Prolaps

Pelvic floor functional disorder (PFD) is caused by various reasons of pelvicfloor organization’s weakness or structure defect of anatomical changes，which arecaused by pelvic organs and pelvic floor functional defects, mainly showing pelvicorgan prolapse (POP), stress urinary incontinence (SUI) and chronic pelvic pain or aseries of structural and functional abnormalities in PFD. In2002, the United Stateswomen’s health study found that about40%in50~79-year-old woman has adifferent degree of pelvic organ prolaps. The prevalence rate is as high as more than25%in our country, and most of patients are seriously influenced in the life qualityand body and mind heath. Medium and serious POP is given priority with surgicaltreatment, different patients need the individualized treatment. Previous surgicalprocedure include vaginal hysterectomy and bilateral ligation of primary sacralligament involution and vaginal wall repair traditional surgery, and its main drawbackis the postoperative high recurrence rate, but the effect of surgery can’t meet therequirements of different people on the postoperative quality of life. So scholars athome and abroad investigated all kinds of operation methods. In2004, Berrocalfirstly reported the application of Gynecare Prolift System defects in multiple parts ofthe pelvic floor repair. Recently pelvic floor reconstruction using mesh began tobeing applied to the clinic. In order to compare the new mesh pelvic floor reconstruction and the efficiency of traditional surgery, my research centered aroundthe clinical analysis of65patients in our hospital. Study group of35patientsunderwent the new POP pelvic floor reconstruction which is Prolift pelvic floorreconstruction, and30patients in the control group underwent traditional surgery thatis vaginal hysterectomy and vaginal wall repair. I compared the clinical efficacy oftwo surgical methods to provide more theoretical basis for future clinical studies.ObjectiveCompare the new clinical curative effect between the pelvic floorrevascularization and the traditional surgery.Materials and Methods1．The object of study: select August2011-September2012third affiliatedhospital of zhengzhou university treated65cases of pelvic floor functional disorderpatients, aged42to80, according to the International association of urinary control(ICS) of POP-Q degree measurement as a diagnostic criteria, are Ⅲ~Ⅳ degrees ofuterus and (or) patients before and after vaginal wall prolapse, unincorporated tumordisease of department of gynaecology and severe local disease.35patients with Proliftwhole pelvic reconstructive approach as a team, including9cases of combined stressurinary incontinence and10cases of high blood pressure, diabetes,4cases;30traditional routine surgery patients as control group, in which the combination ofstress urinary incontinence3cases,9cases of hypertension and diabetes in5cases.Two groups of patients were multipara and vaginal delivery.2．Methods: all patients with preoperative line POP-Q scores assessed theextent of pelvic organ prolapse, pelvic ultrasound pelvic understand the situation,understand urodynamic voiding, whether given before surgery can tolerate surgery,laboratory examinations and assessments.Preoperative7d give estriol ointment applypreoperative oral1day delay evacuant, age less than60cleaning enema.The teamline Prolift whole pelvic floor revascularization, those with SUI and middle lineurethra without tension suspension (TVT-O);The control line of traditional vaginal hysterectomy and vaginal anterior repair, merge SUI is added through the vaginaurethra bladder neck fascia cotton-padded mattress suture technique, according to thepostoperative follow-up situation, comparing the clinical curative effect of two kindsof operation method.3．Statistical methods: Using SPSS17.0software for statistical data analysis,measurement data with mean±standard deviation(x±s) said, count data expressedas a percentage. Mean differences between groups were compared using theindependent sample t test, with α=0.05as the inspection level.Results1．Case analysis results perioperative team average operation time, blood loss,residual urine volume, postoperative hospitalization days were (68.48±15.65) min、(127.60±30.21) ml、(37.25±23.40)ml、(6.11±1.62)d； the control group was(93.83±15.12) min、(150.40±35.81)ml、(52.33±36.30) ml、（7.23±1.43）d, thedifference was statistically significant (P <0.05).2．Two groups of patients with postoperative POP-Q dividing each indicatorpoint analysis results two groups of patients with postoperative follow-up time4~12months, according to POP-Q rating method, postoperative team average vaginaltotal length (TVL):(9.75±1.52) cm, average point C measurements:5.37±1.35) cm;Control group average vaginal total length (TVL):(6.40±1.61) cm, average pointmeasurements C:(-6.401±1.61) cm, the difference was statistically significant (P <0.05); The rest of the POP-Q indexing instructions point of comparison, there wasno statistically significant difference (P>0.05).3．The cure rate and postoperative complications: two groups of patients withpostoperative follow-up of4~12months, follow-up rate was100%. Team: vaginalall indicate points of35cases were in the normal position, objective cure rate100%;1case (2.8%) patients with symptoms of stress urinary incontinence postoperatively,the preoperative urine dynamics test accord with stress urinary incontinence dynamicsperformance, refused to surgery, caused by its show that occult stress urinaryincontinence postoperatively; In2cases (5.7%,2/35) after vaginal wall mesh exposure, manicured exposed mesh, cooperate with topical estrogen after healing.Control group:30cases of patients with recurrence of3cases (10%,3/30),1casebefore vaginal wall prolapse II degree,1case II degree, after vaginal wall。ConclusionBy using the new type of pelvic mesh revascularization, shorter operation time,small trauma, rapid recovery, low recurrence rate, effectively achieving functionrecovery through anatomical restoration and superior to the traditional mesh vaginalhysterectomy and vaginal anterior repairing.