Comparative analysis of different surgical methods for patients with moderate to severe uterine prolapse without conserving fertility / 中国医师杂志

Objective:To compare the efficacy of three different surgical methods in the treatment of patients with pelvic organ prolapse (POP)-Q grade Ⅱ-Ⅲ uterine prolapse (UP).Methods:The clinical data of 100 patients with pelvic organ prolapse quantitative (POP-Q) grade Ⅱ-Ⅲ UP treated in the First Affiliated Hospital of Medical College of Shihezi University from November 2015 to April 2019 were analyzed retrospectively. According to the operation method, they were divided into vaginal total hysterectomy group (TVH group, n=46), laparoscopic total hysterectomy + vaginal stump Y-patch sacral fixation group (LSC group, n=34) and transabdominal total hysterectomy + vaginal stump abdominal transverse fascia and round ligament suspension group (AFS group, n=20). The age, body mass index, delivery times, operation time and intraoperative bleeding of the three groups were compared. POP-Q scale, visual analogue scale (VAS) and Pelvic Floor Impact Questionnaire (PFIQ-7) were used to evaluate the objective cure, subjective satisfaction, preoperative and postoperative quality of life, and the recurrence rate of postoperative prolapse was compared. Results:Among the three groups, the TVH group had the shortest operation time and the LSC group had the least intraoperative blood loss ( P<0.05). The postoperative PFIQ-7 score improved the quality of life in the AFS group significantly better than the other two groups ( P<0.05). The postoperative POP-Q indicator points of the three groups were significantly improved than before ( P<0.05). Postoperative prolapse recurred in 8 cases (17.4%) in TVH group, 3 cases (8.8%) in LSC group and 1 case (5.0%) in AFS group, with no significant difference in recurrence rate among the three groups ( P>0.05). Conclusions:These three surgical treatments are all safe and effective for the treatment of moderate to severe uterine prolapse. Various factors should be considered comprehensively to develop individualized surgical plans for patients.

Clinical analysis on pelvic organ prolapse treated by pelvic floor reconstruction surgery with Prolift system and routine transvaginal surgery / 重庆医学

Objective To investigate the clinical effectiveness of pelvic floor reconstruction surgery with Prolift system and rou‐tine transvaginal surgery in treating pelvic organ prolapse (POP) .Methods We analyzed an retrospective study of 64 patients with POP patients from June 2009 to March 2011 .All patients were divided into two groups ,32 cases of the reconstruction group were treated with pelvic floor reconstruction surgery with Prolift system ,as reconstruction group ,the other 32 cases in routine treatment group with routine transvaginal surgery ,which inclouded transvaginal hysterectomy ,repair of anterior and posterior vaginal wall ,as routine treatment group ,the pre operative ,peri operative data and follow up results were compared between the two groups and to evaluate the outcomes of the two groups after surgery .Results The age ,body mass index ,menopause age ,pregnant times and the degree of uterus prolapse were no significant difference between the two groups (P>0 .05) .The operation of all the patients were successful .No patient were infected after surgery ,no vascular injury ,or urinary system injury ,or rectal injury occurred .Reconstruc‐tion group showed more significant in the amounts of blood loss ,average operation time ,anal exsufflation time ,mean of highest postoperative body temperature ,the urinary canal indwelling time and the postoperative hospitalization time compared with routine treatment group(P0 .05) ,but the objective cure rate at 12 months after operation was significantly different between the two groups (P<0 .05) .The objective curative rate in reconstruction group was significantly higher than that in routine treatment group .Conclusion Pelvic floor reconstruction surgery with Prolift system is a safe and effective methods of minimally invasive surgery ,patients had better regain integrity of anatomical structure and functions of pelvic floor in short term for POP when compared with routine transvaginal sur‐gery ,but its long term study is still needed .

Analysis of the complication of transvaginal hysterectomy of patients with non-prolapsed uterus / 中国综合临床

Objective To explore the advantages and disadvantages of transvaginal hysterectomy for patients with non-prolapsed uterus,and explore the cause and preventive measurements of the complications of transvaginal hysterectomy.Methods The complications of transvaginal hysterectomy ( group TVH ) in 110 patients with non-prolapsed uterus and of transabdominal hysterectomy ( group TAH ) in 120 patients were compared with each other.These patients were chosen randomly from June 2006 to April 2010.Results In the TVH group,rectum hurt occurred in one patient,prolapse of fallopian tube in one patient and celiac internal bleeding in one patient.The preoperative diagnosis were not consistent with the postoperative diagnosis in four patients.Two patients encountered with postoperative residual end bleeding and four patients with vaginal residual end polyps.In the TAH group,three patients had postoperative diagnosis inconsistent with their preoperative diagnosis.In addition,there were four abdominal wall incision liquefaction ( including two phase suture in two patients),three postoperative bronchial lung infection and two residual end polyps.No celiac internal bleeding and visceral injury occurred in this group.Conclusion TVH has a higher risk of visceral injury and postoperative bleeding than TAH.These complications should be avoided when treating the patients with TVH technique.

Effect of Different Surgical Approaches to Hysterectomy on the Sexual Function and Psychological Health / 中国医科大学学报

Objective To compare the effects of transabdominal hysterectomy(TAH),transvaginal hysterectomy(TVH),and laparoscopic total hysterectomy(LTH)on sexual function and psychological health.Methods A total of 100 patients undergoing TAH,100 patients undergoing TVH,and 40 patients undergoing LTH were followed up for 1 year.All the patients were aged between 45 and 54 years.The Results of the questionnaire on sexual function and psychological health were analyzed and compared with those from 100 control subjects undergoing hysteromyomectomy.Results In pateints under 50 years of age,no significant difference in the sexual function and psychological health was found between control group and any one of TAH,TVH,and LTH goups.In patients aged 50 yeare and older.ESFI score decreased from control group to TVH group to LTH group to TAH group;CHQ-12 score increased from control group to TVH group to LTH group to TAH group;and there was significant difference in the FSFI and CHQ-12 scores both between TAH and control groups and between TAH and TVH groups(P＜0.05).Conclusion There is no obvious effect of these 3 surgical approches to hysterectomy on the sexual function and psychological health in patients under 50 years of age,and there is no significant difference in the sexual function and psychological health among these 3 surgcial approaches.In patients aged 50 yean;and older,TAH has a negative impact on the psychological health and sexual function.

A comparison of three kinds of hysterectomy / 中国微创外科杂志

Objective To compare the effects of transabdominal hysterectomy(TAH),transvaginal hysterectomy(TVH),and laparoscopic assisted vaginal hysterectomy(LAVH).Methods Clinical data of 48 cases of TAH(TAH Group),38 cases of TVH(TVH Group),and 31 cases of LAVH(LAVH Group) were retrospectively analyzed.Results The operation time was shorter in the TAH Group(73.7?5.9 min) than in the TVH Group(80.9?7.0 min) and the LAVH Group(129.3?9.1 min)(F=612.04,P=0.000).The intraoperative blood loss was greater in the LAVH Group(142.8?17.1 ml) than in the TAH Group(128.1?9.6 ml) and the TVH Group(129.7?10.2 ml)(F=15.18,P=0.000).The postoperative analgesic requirement rate was higher in the TAH Group(75.4%,36 cases) than in the TVH Group(30.2%,11 cases) and the LAVH Group(38.4%,12 cases)(?~2=20.310,P=0.000).The length of postoperative hospitalization was longer in the TAH Group(7.3?1.6 d) than in the TVH Group(4.8?1.0 d) and the LAVH Group(5.1?1.1 d)(F=47.07,P=0.000).The postoperative pyrexia rates were not significantly different among the TAH Group(8.4%,4 cases),the TVH Group(7.4%,3 cases),and the LAVH Group(8.2%,3 cases)((?~2=0.074,) P=0.964).Conclusions As compared with transabdominal hysterectomy,transvaginal hysterectomy and laparoscopic assisted vaginal hysterectomy show advantages of less invasion,less pain,and quicker recovery.