Long-term Clinical Effect After Pelvic Floor Reconstruction Surgery With Transvaginal Mesh In Treating Pelvic Organ Prolapse Patients

ObjectiveTo investigate the clinical outcome?the quality of life and postoperative complications after pelvic floor reconstruction surgery with transvaginal mesh in treating pelvic organ prolapse patients.And factors related to the recurrence of prolapse and mesh exposure were further studied.It aims to provide a theoretical basis for treatment of pelvic organ prolapse and prevention of complications.Materials and methods1 Study objectA total of 132 severe pelvic organ prolapse patients who underwent pelvic floor reconstruction surgery with transvaginal mesh were analyzed at the Third Affiliated Hospital of Zhengzhou University from Jan.2007 to June 2012.The follow-up time is5 years and 117 cases were complete follow-up among them.The average age of the patients was 61.87±11.36 years,average gravidity was 3.84±1.61 time,average parity was 2.78±1.30 time,average menopause was 12.21±9.20 years and average Body Mass Index was(23.85±2.39)kg/m~2.5 cases were previous hysterectomy,36 cases were combined with hypertension and 16 cases were combined with diabetes mellitus.The III degree prolapse patients were 108 cases and IV degree prolapse were 9 cases.31 cases were combined with stress urinary incontinence.2 Observed indicators and postoperative follow-up timeObservation indexes:pelvic organ prolapsed quantitation(POP-Q)evaluates postoperative recovery of sites,the pelvic floor distress inventory short form 20(PFDI-20)and pelvic floor impact questionnaire short form 7(PFIQ-7)score evaluate postoperative quality of life.Evaluate postoperative prolapse recurrence,complications(exposure mesh,pain,defecation discomfort,defecation discomfort,lower abdominal discomfort)and patient global impression of change(PGI-C).Postoperative follow-up:Postoperative follow-up mainly adopts outpatient follow-up and auxiliary adopts telephone follow-up.The time were 1 month,3 months,6months,1 year,2 years,3 years and 5 years.3 Statistical analysisAll the data was processed by SPSS21.0 statistical software.The measurement data were expressed x±s standard and the normal distribution measurement data were compared between the two groups data using paired t test.The non-normal distribution measurement data were expressed in quartiles and the non-normal distribution measurement data were compared by rank sum test.In the univariate analysis,?~2 test?the continuous correction method and the likelihood ratio method were used for categorical variables.Univariate analysis that has significance was conducted further binary logistic regression analysis.P-valve<0.05 was considered have statistical significance.Result1.Comparing preoperative and postoperative POP-Q score,the difference in P value<0.05 was statistically significant,Good anatomical effect was achieved after the operation.2.Postoperative PFDI-20 and PFIQ-7 scores were lower than the preoperation,the difference in P value<0.05 was statistically significant.After 1 year,the quality of life of the patient tends to be stable.The postoperative average PGI-C was 4 points,the postoperative evaluation effect was satisfactory.3.The prolapse recurrence rates of?2 years,?3 years and?5 years after operation were respectively 0%,1.71%and 3.42%.Mesh exposure is the main complication.4.The prolapse recurrence of 3~5 after operation was higher than the prolapse recurrence within 3 years,the difference in P value<0.05 was statistically significant.The mesh exposure within 3 years after operation was significantly higher than 3~5years,the difference in P value<0.05 was statistically significant.5.Postoperative constipation was associated with prolapse recurrence(P<0.05).Diabetes mellitus,BMI,operation time,intraoperative bleeding and mesh type were related to postoperative mesh exposure(P<0.05).High BMI and diabetes mellitus were independent risk factors for mesh exposure.Conclusion1.Pelvic floor reconstruction surgery with transvaginal mesh in treating severe pelvic organ prolapse patients was safety and efficacy,with low recurrence rate,fewer complications,and significantly improved postoperative patient's quality of life.2.Postoperative recurrence of prolapse occurred after 3 years and mesh exposures occurred within 3 years after surgery.3.High BMI and diabetes mellitus were independent risk factors for mesh exposure.