Modified Pelvic Floor Reconstruction Using Autologous Tissue And Its Application In Combined Surgery To Treat Severe Pelvic Organ Prolapse Comorbid With Pelvic And Abdominal Tumor

Part I: Mid-term efficacy analysis of the laparoscopic modified pelvic floor reconstruction using autologous tissue in treatment of the pelvic organ prolapse Objective: To investigate the mid-term effectiveness of the laparoscopic modified pelvic floor reconstruction using autologous tissue in women suffering from pelvic organ prolapse(POP).Method:From February 2016 to August 2017,a total of 91 patients with POP were treated by laparoscopic modified pelvic floor reconstruction using autologous tissue in Zhejiang Provincial People's hospital.Follow?up visits were performed once every 3 months after surgery in the first year and then annually.The clinical data of 78 patients who completed systematic follow-up were analyzed retrospectively.Anatomic results of POP was established by pelvic organ prolapse quantitation system(POP-Q)staging.Surgical success required the fulfillment of a criteria: prolapse leading edge of 0 cm or less and no prolapse reoperations or pessary use during the study period.Analyze the changes of POP-Q indicator points after surgery,and observe surgical related data and complications at the same time.Funtional results were obtained by patient global impression of improvement(PGI?C)scale in POP,pelvic floor distress inventory?short form 20(PFDI?20)and pelvic floor impact questionnaire short form(PFIQ?7).Result: all surgeries of the included 78 patients were successfully finished laparoscopically.The average follow-up time was(3.3±0.5)years and the median one was 3.7 years.During the follow-up,The total anatomic success rate was 93.6%(73 / 78)and the anatomical recurrence rate was 6.4%(5 / 78).Two patients with recurrence were hospitalized for surgery again,and the reoperation rate was 2.6%.The subjective satisfaction rate was 91% after the surgery.The difference in PFIQ-7 and PFDI-20 scores were statistically significant before and after surgery(P<0.05).Conclusion:The Modified pelvic floor reconstruction using autologous tissue for POP offers good mid-term anatomical results and subjective satisfaction.It is minimal traumatic and worthy of being popularized for clinical application.Part II: Transabdominal modified pelvic floor reconstruction using autologous tissue combined reduction of abdominal tumor to treat severe pelvic organ prolapse comorbid with pelvic or abdominal tumor—two cases report Objective: To investigate reasonable and effective method for the treatment of severe pelvic prolapse combined with pelvic and abdominal tumors.Methods: Two patients with severe pelvic organ prolapse comorbid with pelvic or abdominal advanced malignancy who were treated by reduction of abdominal tumor combined transabdominal modified pelvic floor reconstruction using autologous tissue at the same time in Zhejiang Provincial People's hospital.One case of uterine vaginal prolapse combined with recurrent gastrointestinal stromal tumor(POP-Q stage III,Aa + 2,Ba + 3,C 0,Ap-2,Bp-1,D-3,GH 6,Pb 1.5,TVL 8)was treated with modified pelvic floor reconstruction using autologous tissue with uterine preservation;one case of uterine vaginal prolapse combined with ovarian myxoma(POP-Q stage IV,Aa + 3,Ba + 6,C + 8,D + 3 Ap 0,Bp + 3,GH 5,Pb 2.5,TVL 8)was treated with modified pelvic floor reconstruction using autologous tissue without uterine.Results: The surgical procedures of both patients were successfully finished and there were no intraoperative complications.The time of pelvic floor repair during the operation was 20 minutes and 25 minutes,respectively,and the catheterization was removed at third day after surgery.The residual urine volume of two cases were 25 ml and 20 ml,respectively.There were no postoperative complications,and they were discharged at 10 and 8 days respectively.Follow-up was performed every 3 months in the first year after surgery,and every 6 months after 1 year.The tumor and prolapse of pelvic organs have not been recurred after two years of follow-up,and there are no symptoms such as difficulty in urination and pelvic pain.(POP combined with ovarian myxoma,postoperative POP-Q :Aa-3,Ba-3,C-6,Ap-3,Bp-3,GH 1.5,Pb 4,TVL 6;POP combined with recurrent gastrointestinal stromal tumors,postoperative POP-Q :Aa-3,Ba-3,C-7,Ap-3,Bp-3,D-8,GH 2cm,Pb 3cm,TVL 8cm).Conclusion: Transabdominal modified pelvic floor reconstruction using autologous tissue may be a reliable method for pelvic floor repair in patients with severe POP comorbid with pelvic and abdominal tumor.there was effective method for patients with pelvic and abdominal tumors or other diseases that require transabdominal surgery.