| Objective: Female pelvic outraged prolapse is a kind of common disease that serious influence the patient's quality of life.The surgical is one of the main treatment method to degree of more particular POP. So far, operations are diversiform inconclusively that advantages or not. This paper discusses laparoscopic sacrocolpopexy and laparoscopic sacrohysteropexy the clinical curative effect of treatment to POP,that difference is the problem reserve uterus are not, so that evaluate its effectiveness and safety for patients.Methods: Analysis between January 2014 and June 2015 in the Fourth Hebei Medical University Hospital of department of gynaecology after confirmed by dividing POP ? degrees or more, and that have completed birth of 14 cases patients,8 cases of them have completed laparoscopic sacrocolpopexy are LSC group, 6 cases of them have completed laparoscopic sacrohysteropexy are HSP group. To follow-up visit among postoperative 1 month, 3 months, 6 months, 12 months and a year,and the results compared with the preoperative data.Application of POP – Q degree assess the anatomy of the postoperative recovery objectively.Application of PGI- I subjective satisfaction of surgery in patients with satisfaction evaluation, that including seven options,1 represents “improvement”,7 represents “worst than preoperative”. Application of short form 20 of pelvic floor distress inventory(PFDI- 20) and short form 7 of pelvic floor impact questionnake(PFIQ- 7), evaluate of curative effect with functional recovery, symptoms, and health related quality of life(HRQL). By observing the operation time, intraoperative bleeding, so that assessment of the safety comprehensively.Results:1 General condition14 cases of patients with an average age of 55.42 + /- 11.72 years(37 ~72 years), of which LSC group with an average age of 64.13 years(n=8,51 ~ 72 years), HSP group with an average age of 43.83 years(n=6,37 ~ 47 years). 14 cases of patients with on average number of pregancy is 3.57 + /- 1.66 times(2 ~ 8 times), the average production time is 2.07 + /- 1 times(1 ~ 4 times), BMI is 26.13 + /- 2.78 kg/m2/. The average intraoperative blood loss is 16.43 + /- 3.23 ml(10 ml ~ 22 ml).The surgerys are completed smoothly, no intraoperative bleeding, and so on.The HSP group of average operation time is 185.00 + /- 11.10 mins(n=6,169 ~ 169 mins). The LSC group of average operation time is 129.13 + /- 8.49 mins(n=8,114 ~ 114 mins).There are no more than 38.5 ? of postoperative temperature, the average time of postoperative placing urinary catheter is 4 + /-2 d(3 d ~ 6 d), residual urine tests are negative. The average hospitalization time is 12 + /- 5 d(6 ~ 24 d).2 Preoperation or postoperation POP- Q degree.2.1 14 patients are followed up for 1 ~ 25 months, median follow-up time is 12.5 months.The each indicator point location dramatically improve in postoperative 1 month, 3 months, 6 months of the POP- Q degre, its respectively compared with the preoperative statistically significant(P < 0.05), and can maintain vaginal length(7.17 + /- 0.46 cm). The each indicator point location no statistical significance(P > 0.05) among the postoperative 1 month, 3 months, 6 months. Anatomical in postoperative POP- Q ? degree and above for recurrence is objective standard, each patient's postoperative vaginal top and wall well before and after the reset, objective cure rate 100%. PGI- I satisfaction scores are 1 ptions that represent “improvement”in postoperative 1 month, 3 months, 6 months.3 The life quality score follow-up compare of preoperation and postoperation.3.1 PFDI- 20 are include POP questionnaire of POPDI- 6, defecation dysfunction questionnaire of CRADI- 8, urinary dysfunction questionnaire of UDI- 6.Each preoperative score of POPDI- 6, CRADI- 8, UDI – 6 is 2.26 + /- 0.70,1.02+ /- 0.06,1.07 + /- 0.83,that significantly decreased in postoperative 1 month, 3 months, 6 months and in the statistics significantly(P < 0.05), postoperative 1 month, 3 months, 6 months three scores weresignificantly decreased, the scores were compared with the preoperative difference had statistical significance(P < 0.05). POPDI-6 in the postoperative 3 months and 6 months are no satistically significant difference(P > 0.05), in the postoperative 1 months and 3 months are compare with postoperative 6 months are satistically significant(P < 0.05).The between of UDI- 6 and CRADI- 8 grades differences are no statistical significance(P > 0.05), in the postoperative 1 month compare with 3 months or 6 months of the differences are statistically significant(P < 0.05).3.2 The questionnaire scores of PFDI- 20 and PFIQ- 7 in the preoperative are 124.56 + /- 17.02,107.62 + /- 14.77, postoperative 1 month are 47.63 + /-15.29,24.46+ /- 10.55, postoperative 3 months are 36.35 + /-14.44,13.59 + /- 7.22, postoperatively 6 months are 14.40 + /- 1.08,5.10 + /- 3.95. Compared among the scores of preoperative and postoperative 1 month, 3 months, 6 months are statistically significant(P < 0.05). HSP group of PISQ- 12 questionnaire is 13.83 + /- 2.04 preoperatively, in the postoperative 3 months,6 months scores are 32.17 + /- 1.72, 1.72 + /- 1.79. postoperative 3 months, 6 months the scores were compared with the preoperative difference are statistically significant(P < 0.05), the scores of between postoperative 3 months and 6 months are compared differences no statistical significance(P > 0.05). Because of LSC and HSP group average age is no statistically difference(P < 0.05), the PISQ- 12 questionnaire score of two groups have no comparability.3.3 ?1 Postoperative ~ 1 month period HSP group: 1 patient in the postoperative 1 day has lumbago, gradually ease within one weeks.1 patient in the postoperative 1 day has appeared vaginal foreign body sensation, gradually ease within a month. 3 patients with urinary tract symptoms of 14 patients in the preoperative such as frequency, urgency, 4 cases with constipation symptoms, bowel dysfunction, all of them are effective relievedly in the 2 weeks after surgery.?2 Postoperative 1 ~ 3 months period 7 cases of the 14 patients with constipation symptoms, including 3 cases emerging. 6 cases of the 14 patients with symptoms of urinary urgency, including 2 cases emerging.5 cases of not have keep the uterus uncomfortable with dropping abdominal straining feeling. The Constipation symptoms are relieved by adjusting diet, oraling cathartic. The Urinary symptoms and uncomfortables are relieved by psychological counseling, observing treatment in the 3 ~ 6 months period.?3Postoperative 3 ~ 6months All patients with subjective symptoms were significantly improved. During follow-up, there are no symptoms with exposure of the mesh,stress urinary incontinence(SUI) and so on.Conclusions:1 This study features: Intraoperative LSC group modified by placed the mash over the vagina and closed peritoneal twice.Adopting barb wire central and fixed corners suture. Before using the bipolar electric coagulate S1 longitudinal ligament fixation area, in order to reduce and prevent bleeding.2 The short period of postoperative may be due to urinary, urgency, constipation and other symptoms present recovery "platform".Since the postoperative 3 months,the basic symptoms are fully relieved, medium-term recovery effectively.3 Postoperative POP- Q each points are 0 degrees and follow-up questionnaire scores are effectively.The patients on curative effect, the symptoms and health-related quality of life are improved well.4 Laparoscopic sacrocolpopexy/ sacrohysteropexy by restoring pelvic floor objective anatomical structure to reset function, so that improve the quality or sex of the patient's life. |
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