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

[1]	Lecomte-Grosbras P, Witz JF, Brieu M, et al. Quantification of pelvic mobility on dynamic magnetic resonance images: using mechanical insight to help diagnose pelvic pathologies[J]. Strain, 2015, 51(4): 301-310.
[2]	周丽莉，王霞，穆玉明. 经会阴超声评估女性产后前盆腔脏器脱垂的临床研究[J]. 医学临床研究，2015, 32(8): 1584-1586.
[3]	刘晓瑛，周维，刘保华，等. 689例妇科检查者盆底脏器脱垂患病状况分析[J]. 广州医科大学学报，2014, 42(5): 67-69.
[4]	张海清，李斌. 腹腔镜下全子宫切除与腹腔镜辅助阴式子宫切除的比较[J]. 中国微创外科杂志，2013, 13(3): 258-261.
[5]	施如霞，刘素芬，谢晔玲，等. 盆底悬吊术与传统经阴道子宫切除术在治疗盆底功能障碍性疾病中的临床疗效比较研究[J]. 中华妇幼临床医学杂志：电子版，2011, 7(1): 34-38.
[6]	Morris R, Mock S, Dmochowski R. The case for robotics in pelvic prolapse surgery[J]. Curr Bladd Dysfunc Rep, 2014, 9(1): 1-5.
[7]	施敏莅，陈娟. 补片修补盆底重建术与传统阴式修补术治疗重度盆腔器官脱垂的临床分析[J]. 中国医药指南，2013, 11(28): 353-354.
[8]	祖月娥，肖亚玲，李建军，等. 长沙地区农村妇女盆底功能障碍调查及其相关因素分析[J]. 医学临床研究，2012, 29(9): 1745-1749.
[9]	苏园园，韩燕华，曹丽，等. 中山地区产后42天妇女盆腔器官脱垂筛查及防治研究[J]. 中国妇幼保健，2015, 30(24): 4132-4134.
[10]	郑晓红，鲍国. 盆底重建术治疗盆腔器官脱垂临床研究[J]. 中国基层医药，2013, 20(2): 184-186.
[11]	黄骊莉，赵艳，陈晓辉，等. 全盆底重建术与阴式全子宫切除术治疗女性盆底功能障碍性疾病的临床研究[J]. 南通大学学报：医学版，2014, 34(6): 535-536.
[12]	龙燕，王建凤. 40例重度盆底脏器脱垂患者盆底重建术治疗效果观察[J]. 中国妇幼保健，2015, 30(3): 475-476.
[13]	蒋清阔. 盆底重建术治疗重度盆腔脏器脱垂的临床效果观察[J]. 医学信息，2014, 27(4): 443.
[14]	徐春佳，陆安伟，唐建军. 手术治疗盆腔器官脱垂62例疗效观察[J]. 山东医药，2010, 50(50): 96-97.
[15]	哈丽娅. 经阴道手术治疗老年女性前盆腔器官脱垂疗效观察[J]. 中国伤残医学，2013, 21(9): 193.

[1]	Hongyu Wang. Application value of fixed and mobile platform prostheses in total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 871-876.
[2]	Shanwu Li, Yongjie Ye, Bing Wang, Ziyi Wang, Yi Yin, Guanjun Sun, Dagang Zhang. Early efficacy comparison of open wedge high tibial osteotomy and unicompartmental knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 882-888.
[3]	Zhengwen Xu, Zhen Li, Zhenyang Hou, Changzheng Su, Biao Zhu. Platelet rich plasma combined with bone grafting for treatment of early non-traumatic osteonecrosis of femoral head[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 773-779.
[4]	Zeyong Wang, Jian Qin. Effect of white blood cell content on platelet-rich plasma treatment of motor system injuries[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(05): 684-688.
[5]	Zhaolong Yan, Zhenbin Zhang, Guangxing Li, Zhang Zhao, Yeyong Zhang, Luxu Yin, Shufeng Li. Early results and influencing factors of high tibial osteotomy in treatment of knee osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(04): 492-499.
[6]	Cong Wu, Lun Liu, Quanzhong Jia. Short-term efficacy and influencing factors of primary total hip arthroplasty in elderly femoral neck fracture[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(02): 283-287.
[7]	Mengying Guan, Yihui Tu, Huaming Xue, Tang Ma, Tao Wen, Tao Yang, Long Xue, Mei Liu. Comparison of early efficacy between cementless and cemented unicompartmental knee replacements[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(01): 129-135.
[8]	Yao Chen, Boqun Xu, Zhihui Gao. Efficacy and safety of modified intermediate upper approach radical resection in the treatment of thyroid cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 619-622.
[9]	Haitao Zhang, Chanjuan Kang, Jingjie Zhai. Effect of pancreatic duct stent implantation in the treatment of acute biliary pancreatitis[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 654-657.
[10]	Xiong Li, Yongkuan Cao. Clinical study of ISR with different distal incisal margin distances after neoadjuvant therapy for locally advanced rectal[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(04): 443-446.
[11]	Shusen Feng, Dongcheng Zhang, Qi Guo, Haolu Zhang, Kuo Chen. Clinical effect of laparoscopic appendectomy on acute appendicitis and its influence on inflammatory factors[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(04): 447-450.
[12]	Xiaopei Bu, Bing Liu, Jianghua Zhang, Chen Zhao, Jinjiang Zhang, Peizhong Shang. Hysterorectal fistula：a case report[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(04): 469-470.
[13]	Kai Xia, Renyuan Gao, Xiaocai Wu, Yu Ruan, Jing Sun, Mingxia Yu, Lu Yin, Chunqiu Chen. Laparoscopic subtotal resection of the colon combined with modified Duhamel for the treatment of adult Hirschsprung’s disease：report of 25 cases[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(01): 91-94.
[14]	Fengjie Wang, Liguang Wang, Shan Liao, Ying Liu, Rongdang Fu, Huanwei Chen. Safety and efficacy of laparoscopic right hemihepatectomy for hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(05): 517-522.
[15]	Shilong Guo, Xiao Yang, Huanhuan Hu, Liang Yang, Wenfu Zhou, Kuiwu Cong, Yusheng Zhang, Yingfeng Li. Efficacy and safety of ERCP in minimally invasive treatment for biliary and pancreatic diseases[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(02): 216-220.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export