| Pelvic organ prolapse is caused by many factors,such as pelvic support structure degradation,defect,damage,and then lead to pelvic organ displacement and other pelvic organ position and function abnormalities,t is one of the most common pelvic floor dysfunction diseases,and it is also a common disease in middle-aged and elderly women.With the arrival of the aging society and the extension of people's life time,the incidence of POP has increased obviously,which has seriously affected the physical and mental health of female patients.POP treatment includes surgery and non-surgical treatment,surgical treatment is the main treatment of moderate and severe POP patients.the traditional operation in the past mainly includes hysterectomy,vaginal anterior and posterior wall repair,perineal repair and so on,the main disadvantage is high recurrence rate after operation.In recent years,with the development of new concepts and theories of pelvic floor,and the development of surgical techniques and new materials,surgical treatment of POP has also been rapid development,pelvic floor reconstruction and repair surgery began to be widely used in clinical practice,and achieved satisfactory results.Laparoscopic sacral colpopexy and sacrospinous ligament fixation is the treatment of pelvic organ prolapse in two kinds of operation.In this study,the clinical data of 52 patients with severe pelvic organ prolapse were retrospectively analyzed and compared,27 cases underwent laparoscopic sacral colpopexy surgery,called LSC surgery group(LSC group),25 cases of sacrospinous ligament fixation,called SSLF surgery group(SSLF group),to compare the clinical efficacy and long-term complications of the two surgical methods,and to provide the clinical basis for the selection of the best surgical procedure for POP patients.objectiveComparison of clinical efficacy and complications of laparoscopic sacral colpopexy and sacrospinous ligament fixation,to provide clinical basis for POP patients to choose the best type of operation in order to improve the efficacy and safety of operation to provide a theoretical reference.1.Research object: from January 2013 to January 2015 by the Department of gynaecology,the Third Affiliated Hospital of Zhengzhou University and Zhengzhou City Hospital of traditional Chinese medicine in 52 cases the need for surgical treatment of POP patients as the research object,all patients according to POP-Q grading method to develop the International Continence Society,were diagnosed as grade III or IV uterine / vaginal vault prolapse with different the degree of anterior and posterior vaginal wall prolapse.Two groups of patients were vaginal delivery,27 cases of patients with laparoscopic sacrol colpopexy,called LSC surgery group(LSC group),including 4 cases of diabetes,7 patients with hypertension,with a history of hysterectomy in 9 cases,25 cases of patients with sacral ligament fixation,referred to as SSLF surgery group(SSLF group),of which 3 cases of diabetes mellitus,simple hypertension in 5 cases,hypertension and coronary heart disease in 3 cases,had a history of hysterectomy in patients with a history of 7 cases.2.Methods: all patients with a POP-Q score as diagnostic criteria,exclusion of stress urinary incontinence and gynecological tumor diseases,with sufficient preoperative assessment and preoperative preparation,signed informed consent procedure.Group LSC underwent laparoscopic sacral colpopexy,group SSLF underwent sacrospinous ligament fixation,postoperative follow-up,clinical curative effect and long-term complications were compared between the two kinds of operation method.3.Statistical methods: all the experimental data obtained in this study were used by the SPSS21.0 software for statistical processing,by the mean and standard deviation(sx ±)measurement data,t test was used for comparison between groups,two groups of patients life quality score data using LSD-t test,the same group before and after the surgery related quality of life score data using repeated measurement data in the 2 test,P < 0.05 said the difference was statistically significant.Result1.Two groups of patients with perioperative indicators: The amount of bleeding in LSC group:(45.14 + 13.05)ml,the operation time:(142.38 + 34.06)min,time of indwelling catheter after operation:(2.24 + 1.08)d,postoperative exhaust time: Materials and Methods(1.93 + 0.28)d,days of hospitalization:(5.9 + 2.3)d;the amount of bleeding in SSLF group:(68.34 + 9.52)ml,the operation time:(69.45 + 14.62)min,time of indwelling catheter after operation:(3.68 + 1.42)d,postoperative exhaust time:(1.91 + 0.32)d,days of hospitalization:(5.8 + 2.4)d.LSC group of patients in the intraoperative blood loss,postoperative indwelling catheter time were significantly less than the SSLF group,the operation time was significantly longer than the SSLF group,the difference was statistically significant(P < 0.05);there was no significant difference between the two groups in postoperative exhaust time and average length of stay(P > 0.05).2.The POP-Q indicator dividing point after operation in the two groups: at 12 months after operation,according to the POP-Q score,LSC group of patients with postoperative vaginal total length(TVL),C measured values were:(9.77 + 1.54)cm,(-5.35 + 1.34)cm;SSLF group of patients after TVL,C measurements were:(-5.35 + 1.34)and cm(-6.58 + 1.59)cm;TVL,C point measurements after operation in the two groups compared,the difference was statistically significant(P < 0.05).The other Aa,Ba,Ap,Bp indicated that the two groups had no significant difference(P > 0.05),which showed that the LSC group was better than the SSLF group in the effect of anatomical repair.3.Comparison of quality of life between two groups before and after operation There is statistical significance in two groups of patients after 6 months,12 months and 24 months of PFDI-20 and PFIQ-7 compared with the preoperative scores difference(P< 0.05),but the LSC group and SSLF group had no significant difference(P > 0.05),the quality of life of two groups of patients with postoperative improvement of pelvic floor good functional recovery.4.Two groups of patients with postoperative long-term complications: the follow-up of the two groups of patients for a period of up to 24 months,the follow-up rate was 100%.Prolapse recurrence occurred in 1 cases of 27 patients in LSC group(3.7%),sexual pain after operation in 1 cases(3.7%),vaginal mesh exposure in 1 cases(3.7%),the total complication rate was 11.1%(3/27);SSLF group of 25 patients with prolapse recurrence in 3 cases(12%),sexual pain after operation in 1 cases(4%),1 cases of dysuria(4%),the total complication rate was 20%(5/25).Compared with the two groups,the complication rate of LSC group was significantly lower than that of SSLF group,the difference between the two groups was statistically significant(P < 0.05)conclusion1.Laparoscopic sacrol colpopexy and sacrospinous ligament fixationfor the treatment of severe pelvic organ prolapse have good clinical efficacy.2.Laparoscopic sacrolcolpopexy small trauma,quick recovery,obvious curative effect,low recurrence rate,has clinical application value and good prospect.3.The operation of sacral ligament fixation is simple,the operation time is short,and the cost is low,more suitable for older patients with severe medical complications. |
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