| Background and ObjectivePelvic floor dysfunction mainly includes pelvic organ prolapse and stress urinary incontinence,in which the prevalence rate of POP is about 10% in young women and about 50% in postmenopausal women,which seriously affects the quality of life of women.According to relevant reports,the lifetime risk of POP women undergoing surgery is 11-19%,and this ratio is expected to rise in the next 20-30 years.The pathogenic factors of POP are still complicated,age,body mass index,menopausal status,diabetes and maternal times are all risk factors.There are many treatments,including conservative treatment and surgical treatment,for young patients with uterus preservation or severe internal and surgical diseases,conservative treatment is the first choice,such as,electromagnetic stimulation,biofeedback therapy,pelvic floor function exercise and pessary placement.However,for patients with moderate and severe prolapse,surgical treatment should be the best choice,such as,Vaginal closure,Sacrocol popexy,Sacrospinous ligament suspension,Pectopexy and High sacral ligament suspension.For the operator and the patient,complications,perioperative conditions,curative effect,recurrence rate and reoperation rate of each operation method are the key issues to be considered,so as to comprehensively evaluate and select an optimal operation scheme and maximize the quality of life and sexual life of patients.In this study,130 patients with moderate or severe uterine prolapse were selected for surgical treatment in the gynecological ward of Zhengzhou Central Hospital,among them,68 cases underwent laparoscopic high uterosacral ligament uterine suspension and 62 cases underwent laparoscopic pectopexy.By comparing the POP-Q scores and PFDI-20,PFIQ-7,PISQ-12 questionnaires before and after operation between the two groups,the short-term anatomy and clinical efficacy,quality of life and quality of sexual life were evaluated,the recurrence rate and reoperation rate were analyzed,and discuss the advantages and disadvantages,to provide the best surgical plan for POP patients.Materials and methods1.Materials130 patients with moderate to severe uterine prolapse with or without vaginal anterior and posterior wall prolapse and stress urinary incontinence were selected in the gynecological ward of Zhengzhou Central Hospital from June 2019 to June2020.They were divided into group A: 48 cases of laparoscopic high uterosacral ligament uterine suspension(LHUS),group B:48 cases of laparoscopic pectopexy.General data such as age,body mass index,pregnancy and childbirth times,combined internal and surgical diseases were collected in detail,and perioperative situation,suah as Intraoperative complications,blood loss,total operation time,catheter withdrawal time,postoperative hospitalization days and residual urine volume.The anatomy efficacy was evaluated by comparing the POP-Q scores before and after operation;PFDI-20,PFIQ-7 and PISQ-12 questionnaires were used to judge the short-term clinical efficacy of the two groups,and improve the quality of life and sexual life;the general condition improvement questionnaire(PGI-C)was used to understand subjective satisfaction,understand postoperative complications and recurrence rate.2.Statistical methodsThe measurement data of normal distribution and non-normal distribution are expressed by mean±standard deviation and quartile spacing separately,two groups of normal distribution and non-normal distribution measurement datas are compared by independent sample T test and Rank test;the counting data is described by percentage,and comparison between groups is performed by χ test,were used to perform statistical analysis using SPSS 25.0 software.(The test level is α=0.05,and the difference is statistically significant with P < 0.05)Results1.There was no significant difference in intraoperative blood loss,catheter withdrawal time,postoperative hospital stay and residual urine volume between the two groups(P>0.05),while the total operation time in group A(125.97±25.06min)was shorter than that in group B(172.58±49.38min),the difference was statistically significant(P<0.05),which was related to more additional operations in group B than in group A.There was no significant difference between the two groups in various additional surgical operations(P>0.05).2.Both groups were successfully operated,and no injuries of rectum,great vessels and bladder occurred;During hospitalization,one case in group A had respiratory tract infection,which was cured after anti-inflammatory treatment,one case in group B had venous thrombosis of lower limbs,which was considered to be related to the history of hypertension and postoperative hypercoagulable state,and was cured after active anticoagulation;No complications and recurrence occurred in both groups one month after operation;Three months after operation,two cases of post-operative stress urinary incontinence occurred in group A and group B,one case of pelvic pain occurred in group A and one case of pelvic floor spasm syndrome occurred in group B,the symptoms improved significantly after operation after pelvic floor rehabilitation treatment.Two cases of vaginal stump mesh exposure occurred in group B,and the exposed mesh was cut off in a sterile state,one patient had sexual pain six months after operation,which was considered to be related to vaginal stump mesh.However,In general,there was no significant difference in intraoperative and postoperative complications between the two groups(P>0.05),and there was no case of enterocele,intestinal hernia and recurrence prolapse during short-term follow-up.3.There were significant differences between the two groups in Aa,Ba,C,Ap and Bp in POP-Q indicator points before and one month after operation(P<0.05),while there was no significant difference in TVL between the two groups before and after operation(P>0.05).There was no significant difference between the two groups in Aa,Ba,C,Ap,Bp and TVL in POP-Q indicator points before and after one month,after three months and after six months.4.There were significant differences in PFDI-20 and PFIQ-7 between the two groups before and after 3 months,before and after 6 months(P<0.05);The results of PFDI-20 and PFIQ-7 in group A were significantly different after 3 months and after6 months(P<0.05),while there was no significant difference in PFDI-20 and PFIQ-7between 3 months and 6 months after operation in group B,and the scores of PFDI-20 and PFIQ-7 in group B were higher than those in group A,indicating that the clinical efficacy of improving quality of life in group A was higher than that in group B.5.The difference between the results of PISQ-12 questionnaire before and 6months after operation between the two groups was statistically significant,however,the PISQ-12 questionnaire score in group A is higher than that in group B,which indicates that the clinical effect of improving sexual life quality in group A is better than that in group B.6.According to the patient’s general condition improvement questionnaire(PGI-C),the subjective satisfaction of patients in two groups was 93.9% and 90.3%respectively,but there was no significant difference between the two groups(P=0.665P>0.05).Conclusion1.laparoscopic high uterosacral ligament uterine suspension and laparoscopic pectopexy have the advantages of less intraoperative complications,less intraoperative bleeding,short hospital stay and low recurrence rate,and there is no significant difference between them.2.Short-term anatomy and clinical effect of two surgical methods are obvious,both can improve the quality of life and sexual life of patients,according to the questionnaire score,the short-term efficacy of laparoscopic high uterosacral ligament uterine suspension is better than that of pectopexy,due to the limited follow-up time of this study,the long-term efficacy needs further study and analysis.3.The two surgical methods have high effectiveness and safety,and can be widely used in clinic,however,laparoscopic pectopexy has postoperative complications affect the quality of life,such as mesh exposure,erosion and contracture,and even sexual pain.Therefore,for patients with weak sacral ligament or congenital dysplasia,we should use mesh to suspend the top of vagina properly. |
