Effect analysis of transvaginal iliococcygeal fixation combined with traditional surgery in treatment of pelvic organ prolapse

doi:10.3877/cma.j.issn.1673-5250.2016.06.016

Objective

To analyze the value of transvaginal iliococcygeal fixation combined with transvaginal hysterectomy, anterior and posterior colporrhaphy in treatment of pelvic organ prolapse (POP).

Methods

From January 2014 to December 2015, 98 patients with POP in Longchuan County People′s Hospital and the Sixth People′s Hospital of Foshan Nanhai District were chosen as study subjects. According to the surgical method, all patients were divided into study group (n=48, received transvaginal iliococcygeal fixation + transvaginal hysterectomy + anterior and posterior colporrhaphy treatment) and control group (n=50, received transvaginal hysterectomy+ anterior and posterior colporrhaphy treatment). The clinical baseline data, surgery duration, transoperative bleeding volume, the recovery time of gastrointestinal function, hospitalization, treatment cost, cure rate, adverse reaction rate, infection rate, unhealing rate of wound and recurrence rate were compared between two groups by statistical methods.

Results

①There were no significant differences between two groups in age, body mass index, parity, menopause time, pelvic organ prolapse quantitation (POP-Q) and complications constituent ratio (P>0.05). ②There were no significant differences between two groups in transoperative bleeding volume and surgery duration (P>0.05). While the recovery time of gastrointestinal function of study group was (8.5±2.7) h, which was shorter than (10.6±3.2) h of control group, and the difference was statistically significant (t=3.504, P=0.035). ③The hospitalization of study group was (8.4±1.2) d, which was shorter than (10.5±1.7) d of control group, and the difference was statistically significant (t=7.038, P<0.001). The treatment cost of study group was (6 084.7±844.9) yuan, which was lower than (6 515.6±1 018.4) yuan of control group, and the difference was statistically significant (t=2.275, P=0.047). ④In study group, the cure rate was 97.9% (47/48), the adverse reaction rate during hospitalization was 4.2% (2/48), and in control group, they were 90.0% (45/50) and 8.0% (4/50), respectively, but both the differences were not statistically significant (P>0.05). There were no significant differences between two groups in the infection rate, unhealing rate of wound and the recurrence rate at the time of return visit (P>0.05).

Conclusions

The effect and safety of transvaginal iliococcygeal fixation combined with transvaginal hysterectomy, anterior and posterior colporrhaphy in treatment of POP are reliable, and its cost is relatively lower.

Key words: Pelvic organ prolapse, Treatment outcome, Transvaginal iliococcygeal fixation, Primary hospitals

表1 2组盆腔脏器脱垂患者一般临床资料比较

组别	例数	年龄(岁，±s)	人体质量指数(kg/m²，±s)	产次(次，±s)	POP-Q分度[例数(%)]
组别	例数	年龄(岁，±s)	人体质量指数(kg/m²，±s)	产次(次，±s)	Ⅲ度	Ⅳ度
观察组	48	54.7±8.4	24.9±1.1	2.4±0.9	24(50.0)	24(50.0)
对照组	50	56.4±8.5	25.2±1.3	2.3±1.0	26(52.0)	24(48.0)
检验值	?	t＝1.572	t＝1.104	t＝1.325	χ²＝0.029
P值	?	0.298	0.589	0.327	0.994
组别	例数	合并症[例数(%)]				绝经时间(年，±s)
组别	例数	糖尿病	高血压	压力性尿失禁	冠心病	绝经时间(年，±s)
观察组	48	2(4.2)	10(20.8)	4(8.3)	1(2.1)	9.6±6.5
对照组	50	3(6.0)	9(18.0)	5(10.0)	1(2.0)	10.1±7.0
检验值	?	χ²＝0.002^a	χ²＝0.126	χ²＝0.004^a	χ²＝0.470^a	t＝1.194
P值	?	0.964	0.795	0.950	0.828	0.553

表1 2组盆腔脏器脱垂患者一般临床资料比较

组别	例数	年龄(岁，±s)	人体质量指数(kg/m²，±s)	产次(次，±s)	POP-Q分度[例数(%)]
组别	例数	年龄(岁，±s)	人体质量指数(kg/m²，±s)	产次(次，±s)	Ⅲ度	Ⅳ度
观察组	48	54.7±8.4	24.9±1.1	2.4±0.9	24(50.0)	24(50.0)
对照组	50	56.4±8.5	25.2±1.3	2.3±1.0	26(52.0)	24(48.0)
检验值	?	t＝1.572	t＝1.104	t＝1.325	χ²＝0.029
P值	?	0.298	0.589	0.327	0.994
组别	例数	合并症[例数(%)]				绝经时间(年，±s)
组别	例数	糖尿病	高血压	压力性尿失禁	冠心病	绝经时间(年，±s)
观察组	48	2(4.2)	10(20.8)	4(8.3)	1(2.1)	9.6±6.5
对照组	50	3(6.0)	9(18.0)	5(10.0)	1(2.0)	10.1±7.0
检验值	?	χ²＝0.002^a	χ²＝0.126	χ²＝0.004^a	χ²＝0.470^a	t＝1.194
P值	?	0.964	0.795	0.950	0.828	0.553

表2 2组盆腔脏器脱垂患者手术情况比较(±s)

组别	例数	手术时间(min)	术中出血量(mL)	术后胃肠功能恢复时间(h)
观察组	48	105.4±25.2	104.2±14.2	8.5±2.7
对照组	50	98.4±19.4	97.9±13.5	10.6±3.2
t值	?	1.279	1.752	3.504
P值	?	0.533	0.247	0.035

表2 2组盆腔脏器脱垂患者手术情况比较(±s)

组别	例数	手术时间(min)	术中出血量(mL)	术后胃肠功能恢复时间(h)
观察组	48	105.4±25.2	104.2±14.2	8.5±2.7
对照组	50	98.4±19.4	97.9±13.5	10.6±3.2
t值	?	1.279	1.752	3.504
P值	?	0.533	0.247	0.035

表3 2组盆腔脏器脱垂患者住院时间及治疗费用比较(±s)

组别	例数	住院时间(d)	治疗费用(元)
观察组	48	8.4±1.2	6 084.7±844.9
对照组	50	10.5±1.7	6 515.6±1 018.4
t值	?	7.038	2.275
P值	?	<0.001	0.047

表3 2组盆腔脏器脱垂患者住院时间及治疗费用比较(±s)

组别	例数	住院时间(d)	治疗费用(元)
观察组	48	8.4±1.2	6 084.7±844.9
对照组	50	10.5±1.7	6 515.6±1 018.4
t值	?	7.038	2.275
P值	?	<0.001	0.047

表4 2组盆腔脏器脱垂患者住院期间不良反应情况及复诊时感染、手术创面愈合不良、复发情况比较[例数(%)]

组别	例数	住院期间					复诊时
组别	例数	出血	盆腔疼痛	腹胀	排尿异常	合计	感染	手术创面愈合不良	复发
观察组	48	1(2.1)	1(2.1)	0(0)	0(0)	2(4.2)	1(2.1)	0(0)	1(2.1)
对照组	50	1(2.0)	2(4.0)	1(2.0)	1(2.0)	5(10.0)	2(4.0)	1(2.0)	5(10.0)
χ²值	?	－^a	－^a	－^a	－^a	1.083^b	0.001^b	－^c	1.470^b
P值	?	－^a	－^a	－^a	－^a	0.574	0.975	0.510	0.225

表4 2组盆腔脏器脱垂患者住院期间不良反应情况及复诊时感染、手术创面愈合不良、复发情况比较[例数(%)]

组别	例数	住院期间					复诊时
组别	例数	出血	盆腔疼痛	腹胀	排尿异常	合计	感染	手术创面愈合不良	复发
观察组	48	1(2.1)	1(2.1)	0(0)	0(0)	2(4.2)	1(2.1)	0(0)	1(2.1)
对照组	50	1(2.0)	2(4.0)	1(2.0)	1(2.0)	5(10.0)	2(4.0)	1(2.0)	5(10.0)
χ²值	?	－^a	－^a	－^a	－^a	1.083^b	0.001^b	－^c	1.470^b
P值	?	－^a	－^a	－^a	－^a	0.574	0.975	0.510	0.225

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