Clinical Effect Observation Of Transvaginal Paravaginal Repair Combined With Central Repair In The Treatment Of Anterior Vaginal Prolapse

Background: Female pelvic floor dysfunction refers to gynecological diseases caused by abnormal pelvic floor supporting structure,including stress urinary incontinence,sexual dysfunction and pelvic organ prolapse.Among them,SUI and POP are common,especially in elderly women.Due to the lack of awareness of the disease,people are unable to receive early treatment,which develops to moderate and severe pelvic organ prolapse,which seriously affects their daily life and finally seeks surgical treatment.At present,the commonly used cl inical methods of surgery include autologous tissue repair and artificial synthetic mesh implantation.Traditional surgical treatment of POP has a high recurrence rate,while transvaginal mesh is prone to mesh-specific complications.With the increasingly detailed description of the anatomical structure of the pelvic floor and the continuous improvement of surgical techniques,the mode of operation has developed to "de-netting" and "minimally invasive".Objective: To investigate the efficacy and safety of transvaginal paravaginal repair combined with central repair in the treatment of anterior vaginal prolapse.Materials and methods: This study was an retrospective study of 32 consecutive women in Maternity Hospital Affiliated to Dalian Medical University from November 2016 to December 2018 with transvaginal paravaginal repair combined with central repair.According to the International association of urinary control(ICS)of POP-Q degree measurement,these patients were in POP-Q III-IV stage.All patients were graded by POP-Q after operation.The postoperative anatomical cure,failure and recurrence were evaluated objectively.Pelvic floor distress inventory-short form 20(PFDI-20),pelvic floor impact questionnaire-short form 7(PFIQ-7)and female sexual function index(FSFI)were used to subjectively evaluate the pelvic floor symptoms,urinary system symptoms,intestinal symptoms,sexual life and other symptoms before and after operation.The functional status of pelvic organs and the effect of operation were accurately evaluated according to the changes of scores before and after operation.SPSS23.0 software was used for statistical data analysis.All test results were considered statistically significant if P < 0.05.Result: 1.Thirty-two patients were included in the study,with a success rate of 100%(32/32).The average time of operation was 83 minutes,and the average amount of bleeding was 73 ml.2.Three months after operation,the follow-up rate was 94.12%(32/34).The cure rate of objective anatomy was 100%(32/32),and there was no recurrence of prolapse.Six months after operation,the follow-up rate was 94.12%(32/34),and the objective anatomical cure rate was 100%(32/32).Twelve months after operation,the follow-up rate was 94.12%(32/34),and the objective anatomical cure rate was 100%(32/32).The anatomic position of Aa and Ba indicator points recovered respectively from 1.5(-1?3)cm and 2(1?7)cm to-3(-3?-2.5)cm and-3(-3?-2.5)cm one year after operation(P <0.05).The total length of vaginal wall is shorter than that before operation.3.During the follow-up of 3,6 and 12 months after operation,the subjective evaluation PFDI-20 and PFIQ-7 scores were lower than those before operation,indicating that the urinary sys tem symptoms,intestinal symptoms,pelvic symptoms and quality of life of the patients were improved.Four patients underwent TVT-O during operation,and stress urinary incontinence was significantly improved after TVT-O.4.31.3%(10/32)of the patients ha d sex,and the overall FSFI score increased from 21.5(19 ? 25.2)before operation to 30.8(25.9 ? 32.8)after operation.The quality of sexual life was improved compared with that before operation,and there was no new intercourse pain..5.One patient had ret ropubic hemorrhage during the operation,and the amount of bleeding was about 150 ml.Two patients were newly diagnosed with urinary incontinence,and the incidence was 6.3%(2/32).One patient developed urinary retention after operation,and the incidence was 3.1%(1/32).Conclusion: Transvaginal paravaginal repair combined with central repair has a low short-term recurrence rate.It can improve the quality of life,improve sexual satisfaction.