Clinical Study Of Laparoscopic Uterine Preservation In The Treatment Of Pelvic Organ Prolapse

BackgroundFemale pelvic floor dysfunction(PFD)is a group of diseases in which the pelvic floor support tissue is weak due to various causes.This weakness results in the pelvic organs displacement,and leads to abnormalities in the position and function of other pelvic organs,mainly manifested as pelvic organ prolapse(POP)and stress urinary incontinence(SUI).With the aging of the population and the improvement of people's living standards,the incidence of POP has also increased year by year,which has caused great troubles for patients'daily life and work,and also caused a certain burden on society.Treatment is unnecessary in women with mild pelvic organ prolapse who are asymptomatic,and symptomatic patients may choose conservative treatment or surgery.Most of the previous surgical methods were mainly transvaginal hysterectomy and anterior or posterior vaginal wall repair.With the deepening of pelvic floor anatomy studies,the current surgical treatments pay more attention to the reduction of anatomical structure and the recovery of organ function.Gynecologists gradually realize that the uterus is only a passive structure in the development of prolapse.Therefore,the procedures for preserving the uterus are proposed,such as sacrohysteropexy,uterine or cervical abdominal wall suspension,uterine preservation in pelvic floor reconstruction.Previous retrospective studies have shown that uterine-preserving pelvic organ prolapse surgery may provide an option that is less invasive with shorter operative times,less blood loss,and faster recovery than hysterectomy.However,the currently data on the long-term clinical efficacy and risk of reoperation in the preservation of the uterus is limited,and no uniform standards are confirmed for:indications and relative contraindications at home and abroad.In a word,there are still many disputes about the application of this kind of surgery.ObjectiveTo explore the safety and effectiveness of laparoscopic uterine preservation vs hysterectomy in the treatment of pelvic organ prolapse.MethodsA total of 57 patients with moderate or severe pelvic organ prolapse treated by surgery at Qilu Hospital of Shandong University from 2015 to 2017.According to the different surgical procedures,they were divided into two groups:29 patients in the uterine preservation group,of which 13 patients underwent laparoscopic cervical abdominal wall suspension in the preservation I subgroup,and 16 patients underwent laparoscopic sacrohysteropexy in the preservation 2 subgroup;28 patients in the hysterectomy group,of which 11 patients underwent laparoscopic/transvaginal hysterectomy plus vaginal stump abdominal wall suspension in the hysterectomy 1 subgroup,and.17 patients underwent laparoscopic/transvaginal hysterectomy plus sacrocolpopexy in the hysterectomy 2 subgroup.We evaluated the safety of different procedures by comparing the operation time,blood loss,intraoperative and postoperative complications.Also,we evaluated the effectiveness by comparing the location of POP-Q indication points,PGI-C,PFDI-20,PFIQ-7,and postoperative recurrence at 6 months postoperatively.Statistical analysis was performed using SPSS 24.0.Results1.Comparison of clinical characteristics between the laparoscopic uterine preservation and hysterectomy groups:The information of 57 patients with moderate or severe pelvic organ prolapse is complete.There were statistically significant differences(P<0.05)in the age(45.21±7.28 years vs 60.93±8.84 years),preoperative menopause rate(31.03%[11/29]vs 78.57%[22/28]),and hypertension(6.90%[2/29]vs 39.29%[11/28])between the two groups.There was no significant difference(P>0.05)between the two groups in the number of births,the history of delivery,the body mass index,the age of menopause,and the preoperative POP-Q.For the subgroup analysis,there were significance differences(P<0.05)between the preservation and hysterectomy I subgroup in terms of age(46.85±9.64 years vs 68.55±5.41 years),preoperative menopause rate(56.25%[9/16]vs 100%[11/11]),and hypertension(6.25%[1/16]vs 63.64%[7/11]).Also,there were significance differences(P<0.05)between the preservation and hysterectomy 2 subgroup in terms of age(43.88±4.50 years vs 56.00±6.92 years),preoperative menopause rate(15.38%[2/13]vs 64.71%[11/17]).2.Comparison of perioperative data between the laparoscopic uterine preservation and hysterectomy groups:All the 57 patients with moderate or severe pelvic organ prolapse underwent surgery successfully.The operation time of preservation group and hysterectomy group were(91.72±40.60)min and(130.00±40.14)min,the intraoperative blood loss of preservation group and hysterectomy group were(79.48±77.02)ml and(150.36±89.71)ml.,the differences were statistically significant(P<0.05).However,there was no statistically significant difference(P>0.05)between the hospitalization days,catheter stay days,accompanying surgery,and perioperative complications.For the subgroup analysis,the operation time of preservation 1 subgroup and hysterectomy 1 subgroup were(72.31±21.37)min and(113.64±32.41)min,the intraoperative blood loss of preservation 1 subgroup and hysterectomy 1 subgroup were(46.92±33.26)ml and(105.45±63.62)ml.The operation time of preservation 2 subgroup and hysterectomy 2 subgroup were(107.50±46.04)min and(140.59±41.94)min,the intraoperative blood loss of preservation 2 subgroup and hysterectomy 2 subgroup were(105.94±92.33)ml and(179.41±93.64)m],the differences were all statistically significant(P<0.05).No complications occurred during operation,and 1 case of intermuscular venous thrombosis occurred postoperatively in the hysterectomy group.3.Comparison of surgical outcomes between the laparoscopic uterine preservation and hysterectomy groups:All the 57 patients with moderate or severe pelvic organ prolapse were followed up for an average of(22.6517.56)months.The POP-Q scores were?I degrees after operation.The indication points were significantly improved compared with preoperative(P<0.05).There were statistically significant differences(P<0.05)in vaginal length(8.79±0.68cm vs 7.31±0.79cm)and sexual life satisfaction(91.67%[22/24]vs 64.29%[9/14])between the two groups and no significance difference(P>0.05)in the indicator point,score of questionnaire,incidence of complications,and the rate of recurrence.For the subgroup analysis,the TVL of preservation 1 subgroup and hysterectomy 1 subgroup were(8.69±0.63)cm and(7.27±1.19)cm,the TVL of preservation 2 subgroup and hysterectomy 2 subgroup were(8.88±0.62)cm and(7.35±0.93)cm,the differences were all statistically significant((P<0.05).There were 2 cases of abdominal pain and 1 case of postoperative recurrence in the preservation group,1 case of vaginal stump bleeding,1 case of mesh exposure and infection,and no recurrence in the hysterectomy group.Conclusions1.Laparoscopic cervical abdominal wall suspension and sacrohysteropexy are both safe and effective surgical methods for the treatment of pelvic organ prolapse;2.Uterine preservation can shorten the operation time,decrease the intraoperative blood loss,reduce the risk of surgery,obtain longer TVL,and improve postoperative sexual satisfaction,but its long-term therapeutic effect,complications and prevention need further follow-up observation;3.Uterine preservation should be based on the patients wishes,surgical complications and risks,the risk of postoperative malignant tumors and other factors to develop an individualized treatment plan.