ABSTRACT
Objective:To study the long-term clinical effect of transvaginal mesh (TVM) and pelvic floor reconstruction with native tissue repair (NTR) in the treatment of advanced pelvic organ prolapse (POP).Methods:Totally 207 patients with advanced POP who were treated in Hunan Provincial Maternal and Child Health Care Hospital from Jan. 2016 to Sep. 2019 were enrolled. The patient′s pelvic organ prolapse quantification were all at degree Ⅲ or above, and they all complained for different degree of symptoms. They were divided into two groups according to the different surgical methods, TVM group and NTR group. In TVM group, the mesh was implanted through the vagina for pelvic floor reconstruction, while in NTR group, the traditional transvaginal hysterectomy combined with uterosacral ligament suspension and anterior and posterior wall repair, as well as perineal body repair were performed. The median follow-up time was 60 months, during the follow up time, 164 cases (79.2%, 164/207) had completed follow-up, including 76 cases in TVM group and 88 cases in NTR group. The perioperative data and complication rates of the two groups were compared, and the subjective and objective outcomes of the two groups at 1, 3 and 5 years were observed, respectively. The objective efficacy was evaluated by three composite criteria, namely: (1) the distance from the farthest end of the prolapse of the anterior and posterior wall of the vagina to the hymen is ≤0 cm, and the descending distance of the top is ≤1/2 of the total length of the vagina; (2) determine the disappearance of relevant POP symptoms according to “Do you often see or feel vaginal mass prolapse？”; (3) no further operation or pessary treatment was performed due to prolapse. If the above three criteria were met at the same time, the operation is successful; otherwise, it was recurrence. The subjective efficacy was evaluated by the pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire-short form 7 (PFIQ-7).Results:The median follow-up time of the two groups was 60 months (range: 41-82 months). Five years after the operation, the subjective and objective cure rates of TVM group were 89.5% (68/76) and 94.7% (72/76), respectively. The subjective and objective cure rates in NTR group were 80.7% (71/88) and 85.2% (75/88), respectively. There were significant differences in the subjective and objective cure rates between the two groups ( χ2=9.869, P=0.002; χ2=3.969, P=0.046). The recurrence rate of TVM group was 5.3% (4/76), and that of NTR group was 14.8% (13/88). There was a significant difference between the two groups ( P=0.046). The postoperative PFDI-20 and PFIQ-7 scores of the two groups were significantly lower than those before surgery, and there were significant differences of the two groups before and after surgery (all P<0.05). Postoperative mesh exposure in TVM group was 1.3% (1/76). Conclusions:The long-term outcomes between the two groups show that the subjective and objective outcomes of pelvic floor reconstruction in TVM group are significantly higher than those in NTR group, and the recurrence rate is significantly lower than that in NTR group. TVM has certain advantages in the treatment of advanced POP.
ABSTRACT
Objective To investigate the effect of laparoscopic hysterectomy and open hysterectomy on ovarian hemodynamics.Methods Selected 132 patients who underwent hysterectomy,among them,76 cases (laparoscopic group)underwent laparoscopic hysterectomy,56 cases(open group)underwent open hysterectomy.The preoperative and postoperative ovarian artery hemodynamic parameters,T cell subsets and serum hormone index of the two groups were observed.Results In the observation group and the control group postoperative 48h,the pulsatility index(PI), resistance index (RI),systolic blood flow velocity maximum (Vmax)and diastolic stage blood velocity minimum (Vmin)decreased(all P <0.05),which of postoperative 2 weeks increased(all P <0.05).The RI,Vmax and PI in the observation group postoperative 48h and 2 weeks were (1.17 ±0.16)and (1.30 ±0.14),(0.66 ±0.11)and (0.70 ±0.06),(11.80 ±3.10)m/s and (12.17 ±3.26)m/s,(3.01 ±0.19)m/s and (2.98 ±0.20)m/s,which were all higher than those in the control group(t =-10.637 and -7.609,-5.880 and -2.583,-5.084 and -3.271,-13.660 and -4.826,all P <0.05).The CD +4 and CD +3 T cells levels of the observation group and control group postoperation were increased(all P <0.05),and the CD +8 T cells levels were decreased(all P <0.05).The CD +4 and CD +3 T cells levels of the observation group postoperative 48h and 2 weeks were (43.50 ±3.50)% and (47.20 ±3.16)%, (73.50 ±6.17)% and (80.06 ±9.20)%,which were higher than those in the control group(t =-6.859 and -5.599,-5.515 and -4.853,all P <0.05),while the CD +8 T cells were (37.52 ±5.10)% and (34.10 ±3.20)%,which were lower than those in the control group(t =3.007 and 3.214,all P <0.05 ).The estradiol(E2 )levels of the observation group and control group were significantly decreased(all P <0.05),follicle stimulating hormone(FSH) levels were significantly increased(all P <0.05).The E2 levels of the observation group postoperative 1 month and 3 months were significantly lower than those of the control group(all P <0.05),FSH levels were significantly higher than those of the control group (P <0.05).Conclusion The effect of laparoscopic hysterectomy on ovarian hemodynamics, ovarian function and immune function is small,and it is worth to be popularized in clinical application.