A Comparative Clinical Study Of Two Surgical Procedures For The Treatment Of Elderly Patients Suffered From Severe Pelvic Organ Prolapse

Objective: To explore the clinical effect of transvaginal mesh pelvic floor reconstruction and vaginal closure in the treatment of senile severe pelvic organ prolapse(POP).Methods: A retrospective analysis of 331 elderly patients with severe POP over 65 years old who were surgically treated in our hospital from January 2010 to June 2018.They were divided into transvaginal mesh pelvic floor reconstruction surgery according to different surgical methods.248 patients(group A)and 83 patients(group B)who underwent vaginal closure were compared.The intraoperative and postoperative conditions of the two groups were compared.Results: Compared with general data,the age and menopausal time were different,group B were significantly longer than that of group A,and the differences were significant(P<0.05).The body mass index and body weight were not statistically different in the two groups(P>0.05).All patients had successful surgery and the postoperative cure rate reached 100% in both group A and group B patients.Comparison of surgical conditions showed that for patients undergoing transvaginal mesh pelvic floor reconstruction and vaginal closure,the operation time was(88.68±28.16)min and(75.71±27.19)min,and the total hospitalization costs were(29059.29±6634.43)yuan and(14052.18±4431.31)yuan.There were significant differences between group A and group B(P<0.05),group A was larger than group B;the difference of surgical bleeding,the indwelling time and the length of hospital stay were not significant(P>0.05);combined with other surgical rates during the operation,such as hysterectomy rate,cervical extension partial resection rate,There was no significant difference in TVT-O rate(P>0.05).Comparing the incidence of combined SUI,the difference was not statistically significant(P>0.05).During the perioperativeobservation,there was no significant difference in the perioperative complications between the two groups(P>0.05);long-term complications: the differences of prolapse recurrence rates were not statistically significant(P>0.05).The rate of mesh complication is 3.4%.The postoperative PFDI-20 and PFIQ-7 scores of the two groups were significantly improved compared with those before surgery,and the differences were statistically significant(P<0.01).However,the postoperative PFDI-20 and PFIQ-7questionnaire scores of the two groups were compared.The difference was not statistically significant(P>0.05).Conclusion: Partial vaginal closure and transvaginal mesh pelvic floor reconstruction have reliable clinical effects in the treatment of patients with severe POP.Vaginal closure is not superior to pelvic floor reconstruction with transvaginal mesh.Not all pelvic floor reconstruction operations with transvaginal mesh implantation will have serious complications,so such operations cannot be stopped blindly.