Clinical Analysis Of Three Types Of Surgical Treatment For Pelvic Organ Prolapse

Objective:There are an endless number of surgeries on pelvic floor reconstruction in clinical practice,and the focus of clinicians is how to choose the surgical methods.Total pelvic floor reconstruction with mesh,laparoscopy sacrocolpopexy,and modified vaginal hysterectomy + anteroposterior vaginal wall repair are the more commonly used surgical methods for pelvic organ prolapse,but there are few comparative studies on these three surgical methods.The purpose of this study was to retrospectively analyze and discuss the treatment effect and postoperative recurrence of the three surgical procedures accepted in our hospital,and summarize the advantages and disadvantages of the three surgical procedures,so as to facilitate the guidance of clinical work.Methods:A total of 121 symptomatic patients with moderate,severe or above pelvic organ prolapse diagnosed in the Department of Gynecology of the Second Hospital of Jilin University from November 2011 to December 2019 were selected and divided into three groups according to the operation methods: TVM group(63 cases),LSC group(30 cases),and modified negative group(28 cases).The general data,perioperative parameters,postoperative complications and recurrence of patients in the three groups were compared to further explore the applicable range of the three surgical methods.Fisher’s exact probability method,χ2 test,one-way ANOVA,and rank sum test were used for statistical analysis,and P < 0.05 was considered to be statistically significant.Results:1.In this study,the operative time,postoperative hospitalization time,exhaust time and indwelling catheter time and total hospitalization cost,the difference of the three groups of patients was significant(P < 0.05).Further pair-to-pair comparison showed that the TVM group had the shortest exhaust time and the longest indwelling catheter time.LSC group had the longest mean operation time and the longest exhaust time,but the LSC group had the shortest indwelling catheter time.The modified negative type group had the shortest postoperative hospitalization time and the lowest total hospitalization cost.2.The recurrence rate at 1 year after operation was 7.94% in the TVM group,6.67% in the LSC group and 0% in the modified negative group,respectively.The recurrence rate at 3 year after operation was 11.11% in the TVM group and 10% in the LSC group,respectively.The recurrence rate of TVM group was 14.29% 5 years after operation.Among the long-term postoperative complications,only urinary symptoms were significantly different among the three groups(P < 0.05).3.PFID-20 and PFIQ-7 scores of the three groups were significantly improved after surgery compared with before surgery,with statistical significance(P <0.05);Preoperative PFIQ-7 score of the modified negative type group was the lowest,and the difference was statistically significant(P < 0.0167).PFIQ-7 score was the highest in the LSC group 1 year after surgery,and the difference was significant(P <0.0167).In other words,bladder,rectal and vaginal symptoms had the greatest impact on daily life in the LSC group 1 year after surgery.Three years after surgery,there was a statistically significant difference in PFIQ-7 scores between the TVM group and the LSC group(P < 0.05).Conclusion:1.These three surgical methods are effective methods for the treatment of pelvic organ prolapse.2.Laparoscopy Sacrocolpopexy is suitable for sexually active young women,and total pelvic floor reconstruction using mesh is more suitable for older women who are not sexually active or have low sexual requirements.3.Modified vaginal surgery has the advantages of short operation time and far lower hospitalization cost,which greatly reduces the medical expenses of patients seeking medical treatment,and is worthy of extensive promotion.