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Objective: preoperative, intraoperative and postoperative retention groups, and does not preserve the uterus uterus group observation and follow-up, two groups of patients during surgery, postoperative recovery, and changes in the quality of life in all aspects compared to evaluate retention the uterus in the pelvic floor reconstructive surgery effect, so as to select the best for the patient clinical surgical provide a theoretical basis. Methods: a research object: Select the First Hospital of Shijiazhuang City, from December 2006 to December 2008 in force 29 cases to add a mesh-based whole pelvic suspension surgery, pelvic organ prolapse by POP-Q stage Ⅲ ~ Ⅳ period, except for vaginal vault prolapse, 27 cases met inclusion criteria. Two test groups and diagnostic criteria: method of grouping by inclusion. Pelvic examination, transvaginal B-pathological endometrial curettage, cervical cytology showing benign lesions, but it should be Entrant hysterectomy hysterectomy group (concomitant hysterectomy group, CH group); these checks into the uterus with normal group ( uterus conservation group, UC group). Data comparison between the two groups no significant difference in the situation. CH group of 15 patients underwent vaginal hysterectomy, and vaginal whole pelvic sling, including 10 cases of patients with stress urinary incontinence (urine leakage after coughing and acupressure test confirmed) simultaneously modified TVT-O surgery; UC group 12 cases, to retain the uterus, the whole pelvic floor suspension surgery, nine patients because of stress urinary incontinence (diagnosis ibid.) underwent modified TVT-O surgery. Diagnostic criteria: POP-Q Indexing: Ⅲ grade: prolapse furthest point over the hymen plane under 1cm but not more than the total vaginal length 2cm [ie quantitative value gt; 1cm ~ lt; (TVL-2) cm]. Ⅳ level: lower genital tract completely prolapse eversion, prolapse of the far point of at least TVL-2cm [ie, the quantitative value? (TVL-2) cm]. In most cases, IV grade prolapse edges shall be cervical or vaginal stump. Stress urinary incontinence: cough - leak test (cough stress test): also known as pressure test (stress test), ie bladder filling test, get detrusor activity, bladder capacity to understand, measure residual urine, through the pressure test Learn urethra closed and functions; finger pressure test (Marshall-bonney test): also known as bladder neck raising test (Mashall-Marchett test), about both sides of the urethra anterior vaginal wall with two fingers but do not put pressure on the urethra, instruct No urine of patients forced to cough overflow as positive. 3 Preoperative preparation: Preoperative pelvic examination, B-and cervical cytology exclude organic disease uterine attachment. Such as uterine fibroids, endometrial lesions, cervical lesions (benign), etc. hysterectomy, no such lesions retain the uterus. 2 d journeyed preoperative bowel preparation before surgery 1 d of oral laxatives and enemas to clean. Four surgical options: Full pelvic suspension surgery include: vaginal fascia transvaginal bladder reconstruction, the main ligament, the bladder neck ligaments, sacral ligament suspension and rectovaginal septum reconstruction; treatment of stress urinary incontinence surgery using the modified TVT-O. 5 Special equipment used in surgery: mesh using Johnson \u0026 Johnson's Gyne mesh (10 × 15cm). Special equipment: Prof. Tong Xiaowen developed by the Shanghai Medical Instruments Co., Ltd. Manufacturing Qingtai puncture cone. 6 follow-up: patients after two months for the first time review, after review every six months 1. Including patients with subjective feeling, routine pelvic examination, etc., record the patient's POP-Q staging situation. In its review of patients without symptoms of vaginal prolapse lumps subjective cure, pelvic examination, breath plus abdominal, POP-Q nadir judge objectively cured. Criteria: no prolapse or anatomical relationships recovered satisfactorily, POP-Q lt; Ⅱ period of objective cure, ≥ Ⅱ period of recurrence. 7 Statistical treatment: SPSS13. 0 statistical software to test, P lt; 0. 05 for the difference was statistically significant. Results: The two groups were not statistically significant clinical data. CH group, the average age of 55.80 ± 7.75 years, UC group was 54.42 ± 5.71 years, P gt; 0.05. CH group and the UC group preoperative Aa, Ba, C, D, Ap, Bp points POP-Q values ??not statistically significant. UC operative time was 86.25 ± 7.30min, significantly shorter than the CH group 118.60 ± 17.55min (P lt; 0.01), UC blood loss was 230.33 ± 39.03ml, significantly less than the CH group 369.93 ± 32.63ml, the difference was statistically significant (P lt; 0.01). The average length of stay, use of antibiotics time there was significant difference between the two groups (P lt; 0.05). Post-operative POP-Q in each group compared with preoperative values, the differences were statistically significant (P lt; 0.05), surgical treatment of pelvic organ prolapse recent significant effect. After review of these points mean difference was not statistically significant (P gt; 0.05), two procedures to improve pelvic organ prolapse similar effect. Followed up for 2 to 24 months, with an average 9.96 months, follow-up rate of 100%. CH group, postoperative subjective cure rate was 100% objective cure rate of 100%. UC group subjective cure rate was 100%, the objective cure rate of 100%. Both groups were no recurrence. No infection occurs. Only one case of mesh erosion exposure occurred. Conclusion: reconstructive pelvic surgery uterus pelvic floor structures for maintaining stability in a certain sense, the recent results were similar with the removal of the uterus, shorter operative time, help to reduce middle-aged women perioperative risk. But needs further follow-up to observe long-term effects and long-term complications.
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