| Background and purposePelvic floor dysfunction(PFD),is also called pelvic floor defect or pelvic floor support structure relaxation,mainly including urinary incontinence,pelvic organ prolapse(POP),chronic pelvic pain and so on.It is because of various causes that the pelvic floor support tissue is weak,which leads to pelvic organ displacement,resulting in a series of other pelvic organ location and function abnormalities.Pelvic organ prolapse and urinary incontinence are common,and both are often combined.About 30%-50%of women may experience uterine prolapse or protruding of the anterior and posterior walls of the vagina during their lifetime,affecting the patient's urinary,defecation and quality of sexual life.Although these diseases are not fatal,they affect the quality of life of patients.At present,in the treatment of moderate to severe pelvic organ prolapse,the main treatment is surgery.Although there are many surgical treatment methods for pelvic organ prolapse at present,there is no clear gold standard.Traditional surgical methods,for example,transvaginal hysterectomy plus anterior and posterior vaginal wall repair,have not fundamentally solved the problem and the postoperative recurrence rate is relatively high.The pelvic floor repair by transvaginal mesh(TVM)has also been widely used in clinical practice,but,due to its serious side effects,increasing the risk of postoperative mesh exposure and erosion of mesh.In 2012,the Prolift pelvic floor repair system of Johnson Corporation of the United States announced delisting from the global market.Due to the strict limitation of indications,the clinical application of TVM has been significantly reduced.Vaginal sacral fixation is currently recognized as one of the standard methods for the treatment of apical prolapse,which can achive better subjective satisfaction and objective satisfaction.With the improvement of laparoscopic technology,there are many advantages of vaginal sacral fixation in the treatment of apical prolapse,example less surgical trauma,faster recovery and so on.Laparoscopic vaginal sacral fixation is considered to be the classic gold standard for the treatment of middle pelvic defects.In recent years,with the improvement of people's quality of life,especially in some young women,high uterosacral ligament suspension has been widely used in clinical practice,which has abandoned the traditional rely on other auxiliary biomaterials such as mesh and so on.The sacral ligament was continuously sutured to the cervical attachment with the non-absorbable thread,and then retrogradely sutured to the beginning,tighten suture,and shortened the sacral ligament to restore the prolapse organ to its original position.Both methods of surgery are mainly for pelvic apical prolapse,but there are few controlled studies of two surgical methods.Since 2012,our hospital began to carry out surgical treatment of patients with moderate or severe prolapse,and to follow up the postoperative recovery of all the patients,regular follow-up and questionnaire survey.The purpose of study was to retrospectively analyze and compare the clinical data of patients undergoing vaginal sacral fixation and high uterine sacral ligament suspension in our hospital and to evaluate the clinical efficacy of the two surgical methods,to provide a powerful clinical basis for the individualized treatment of POP patients,at the same time,it promotes the effectiveness and reliability of surgery in theoretical level.Object and methodSelection in March 2014 to January 2018 in the second hospital of shandong university department of gynaecology diagnosis of uterine and vaginal vault prolapse or different degree of vaginal wall protruding,POP-Q stage ?-?,and accepted Laparoscopic vaginal sacral fixation and laparoscopic high uterosacral ligament suspension of symptomatic patients,including vaginal sacral fixation group 66 examples,uterosacral ligament suspension 36 cases.Recording the preoperative and postoperative indicators and following-up the postoperative.The clinical data and postoperative follow-up data of the patients with operation were analyzed by SPSS 22.0 software.The measurement data were expressed by MeanąSD,and paired t-test was used for the changes of indicators before and after surgery and the questionnaire scores.The counting data were tested by chi-square test,P<0.05 was considered statistically significantObservation outcome:(1)Objective cure rate:The objective cure was judged by the lowest point of POP-Q.The criteria for determination:0 degree,I degree for objective cure;Recurrence occurs when the vaginal wall,cervix or vaginal vault reaches grade II or above(2)the subjective cure rate:the subjective cure was that the patient had no symptoms of vaginal mass prolapse at the time of review.The subjective symptoms were used to improve PGI-C score to evaluate the patient's subjective satisfaction,including 7 options,one for "significant improvement" and 7 for "much worse than preoperative.".The subjective satisfaction was defined as" "Significant improvement(1 point)" or "improvement(2 points);(3)follow-up of the wooden heel,the scores of the pelvic floor dysfunction questionnaire(PFDI-20),the Pelvic floor impat questionnaire(PFIQ-7)and the sex life quality questionnaire(PISQ-12)and were compare with the preoperative scores;(4)comparing the mean operative time,retention time,intraoperative blood loss,postoperative exhaust time,mean hospitalization time,total hospitalization cost and operative complications(bladder injury,urine retention),etc.(5)understand the recurrence rate of prolapse,postoperative complications and the occurrence of reoperation through postoperative follow-up.Result(1)Objective cure rate:the anatomic cure,the two groups of patients were compared through the pelvic organ prolapse quantitative stage method(POP-Q).The results indicated that the difference of POP-Q score between the two groups was statistically significant(P<0.01).The anatomic reduction of the two groups was satisfactory.(2)subjective satisfaction:by the follow-up inquiry,there was no significant difference in patients' satisfaction with the operation between the two groups(P>0.05).(3)There was a significant difference in PFDI-20,PFIQ-7 and PISQ-12 scores between the two groups before and after operation(P<0 01).The intestinal function,urinary function and sexual life quality of the two groups were improved compared with those before operation(P<0 01).(4)There were satisfactory perioperative outcomes in this study,The mean operative time,retention time,mean hospitalization time and intraoperative blood loss were not statistically significant in the sacrocolpopexy and high uterosacral ligament suspension.However,sacrocolpopexy combined with more surgery.The postoperative exhaust time in the ssacrocolpopexy group was longer than that in the high uterosacral ligament suspension(P<0.05),and the difference was statistically significant.(5)There was no significant difference in the recurrence rate between the two groups(P>0.05).Conclusion1.Laparoscopic sacrocolpopexy and laparoscopic high uterosacral ligament suspension for the treatment of pelvic organ prolapse is remarkable,with small trauma,quick recovery,the persistent effect.The quality of life of the patients after operation is obviously improved.2.The mean operative time,retention time,mean hospitalization time and intraoperative blood loss were not significant difference.However,sacrocolpopexy combined with more surgery.The postoperative exhaust time in the sacrocolpopexy group was longer than that in the high uterosacral ligament suspension.3.The postoperative quality of life and sexual life of the patients in the two groups were significantly improved during the whole postoperative follow-up. |
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