Therapeutic Effect Of Laparoscopic Sacral Fixation On Pelvic Organ Prolapse

BackgroundPelvic function disorder(PFD).Which includes pelvic organ prolapse(Pelvic organ Prolapse,POP),stress urinary,fecal incontinence,sexual dysfunction and other diseases.Some data have shown that POP has decline the quality of daily life in elderly women.This disease should get more attention in clinicians.The incidence of POP has not yet been elucidated,such as patients have a history of pregnancy,childbirth;chronic cough,ascites,constipation and other conditions frequently maybe increased intra-abdominal pressure;The age of the growing,the original Muscle,fascia,ligament tissue becomes weak,and further reduce the pelvic floor support force,not enough to fight down the pelvic organ and thus the emergence of a series of symptoms of POP.Non-surgical treatment can not solve the anatomical abnormalities,can not stop the further progress of the disease,;Surgical treatment is still the main method of treatment.In recent years,with the renewal of treatment concept,laparoscopic instruments,the popularity of technology,the gradual development of bio-mesh,based on ALYTE Pelvic reconstruction of the patch gradually in clinical development.Laparoscopic sacrocolpopexy(LSC)and laparoscopic vaginal sacral colpopexy(LVSC)have been carried out since 2013 in our hospital.The clinical data and follow-up data of laparoscopic sacral fixation between 2014.01-2016.01 are reviewed and analyzed.The perioperative,intraoperative and postoperative follow-up of LSC / LVSC for the treatment of POP were reviewed.The safety and efficacy of LSC / LVSC were evaluated,which could provide a theoretical reference for future treatment.MethodsDuring the period of 2014.01-2016.01,the first affiliated Yijishan Hospital of Wannan Medical College and the Second People's Hospital of Wuhu City were diagnosed as "Uterine prolapse II degree" and above stage,with or without vaginal anteroposterior bulge,29 cases of LSC and 21 cases of LVSC were selected in this study,total 50 cases of middle-aged and elderly women were selected as subjects.Spss18.0 was used for statistical analysis.Statistical data were expressed as mean ± SD.P< 0.05 was considered statistically significant * P <0.05 ** P < 0.001 In this study,the following statistics were studied1.To evaluate the preoperative condition and the feasibility of LSC / LVSC operation,the general condition of patients,the index of POP disease,the complication,the PFDI-20 / PFIQ-7 score..2.The safety of LSC / LVSC was evaluated by comparing the general condition of perioperative operation and the perioperative complication,and compared with other data.3.The postoperative quality of life of the patients was compared with other literatures to evaluate the effectiveness of LSC / LVSC.The postoperative quality of life was evaluated by the general situation,complications,POP-Q score and PFDI-20 / PFIQ-7 score.4.To compare the statistical data of LSC / LVSC surgery to study whether this procedure to retain the uterus on the prognosis of POP disease have a negative / favorable impact.Result50 patients were divided into degrees of which 10 cases of grade ?,? 34 cases,? 6 cases.Including mild to moderate stress urinary incontinence in 12 cases,32 cases of varying degrees of vaginal anterior and posterior wall bulge.The operative time was(149.77 ± 17.34)min,the intraoperative blood loss was(64.89 ± 11.88)ml and the median postoperative hospital stay was 4(3-7)days.Perioperative complications: postoperative infection in 1 case,3 cases of lower urinary tract symptoms,improved after treatment,no serious complications.There were significant differences in the scores of POP-Q,PFDI-20 / PFIQ-7 and postoperative follow-up.The quality of life was significantly improved before operation.There was no significant statistical difference between the two groups in the preoperative,intraoperative and postoperative follow-up of LSC / LVSC.There was no significant difference between the two groups in the satisfactory quality of life.Conclusion1.Laparoscopic uterine sacral fixation / laparoscopic vaginal sacral fixation can be used as the local treatment of uterine prolapse with / without anterior vaginal wall bulge,mild to moderate pressure urinary incontinence of the effective operation.2.Laparoscopic uterine sacral fixation / laparoscopic vaginal sacral fixation of surgical techniques is mature,less invasive,rapid postoperative recovery,perioperative complications,the treatment of POP disease is an excellent minimally invasive surgical approach.3.Laparoscopic uterine sacral fixation / laparoscopic vaginal sacral fixation restored pelvic anatomical structure,followed up for 1 year to obtain satisfactory subjective and objective effect,the patient's quality of life improved significantly.4.Laparoscopic uterine sacral fixation may preserve the uterus of the patient,the perioperative complications,follow-up treatment,recurrence than laparoscopic vaginal sacral fixation was no difference,it is worth further in the clinical Promotion.