10-year Experience of Combined Surgical Treatment of Severe Pelvic Organ Prolapse in Women

N. Zharkin, V. Seikina, S. Prohvatilov, N. Burova
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Abstract

Study Objective: to compare the effectiveness of two methods of surgical treatment of severe forms of pelvic organ prolapse (POP) in women — the original method with the combined use of own tissues and a mesh implant and the traditional method with ventricular fixation of the uterus with a nylon thread. Study Design: Prospective cohort comparative study in parallel groups. Materials and Methods. The study was conducted in 2012–2021. The sample included 456 patients with a verified diagnosis of “pelvic organ prolapsed” (N81.2, II and III in classification of Pelvic Organ Prolapsed Quantification), complicated by a different combination of anterior, apical and posterior prolapses. The main group included 116 women operated on according to the original technique with the combined use of their own tissues (vaginal stage) and lateral ventrofixation of the uterus/cervix with a mesh implant was performed retroperitoneal to aponeurosis in the iliac regions. The second group (comparison) included 340 patients who also underwent a two-stage operation (according to the traditional method), but the abdominal stage consisted in ventrofixation of the uterus/cervix to aponeurosis of the anterior abdominal wall in the suprapubic region with a nylon thread. The frequency of relapses during the entire follow-up period and the quality of life were assessed according to the questionnaire “Pelvic Organ Prolapse — Quality of Life” (PT-QL) during the two years after surgery. Study Results. The frequency of relapses after surgery with uterine ventrofixation to aponeurosis in the suprapubic region with a nylon ligature (11/64; 17.2%) was statistically more significant than with the use of a mesh implant according to the original technique (3/116; 2.6%) (p < 0.001). The quality of life after treatment was higher in the main group in the first days after surgery due to a statistically significant smaller number of patients with dysuric symptoms (7/116; 63%) in contrast to the comparison group, where more than half of the operated patients noted urinary retention 76,5% (260/340) (p < 0.001). In the long-term follow-up periods, there were no statistically significant differences in the patients of the compared groups according to the results of the PT-QL survey (p > 0.05). Conclusion. The developed method of surgical treatment of POP with the combined use of own tissues and a mesh implant provided a reduction in the frequency of relapses of the disease and a higher quality of life in the early postoperative period. Keywords: pelvic organ prolapsed, mesh implant, lateral ventrofixation.
联合手术治疗女性严重盆腔器官脱垂10年体会
研究目的:比较两种手术治疗女性重度盆腔器官脱垂(POP)的效果——采用自体组织联合网状植入的原始方法与采用尼龙线固定子宫心室的传统方法。研究设计:平行组的前瞻性队列比较研究。材料与方法。该研究于2012年至2021年进行。样本包括456例确诊为“盆腔器官脱垂”的患者(盆腔器官脱垂量化分类N81.2, II和III),并伴有前脱垂、根尖脱垂和后脱垂的不同组合。主组116例妇女,按原术式,结合自身组织(阴道期),在髂区腹膜后至腱膜处行子宫/子宫颈侧腹固定术。第二组(比较)340例患者也接受了两阶段手术(按照传统方法),但腹部阶段包括用尼龙线将子宫/子宫颈固定到耻骨上区域前腹壁的腱膜。根据术后两年盆腔器官脱垂-生活质量问卷(PT-QL)评估整个随访期间复发频率及生活质量。研究的结果。尼龙结扎子宫腹膜固定术后耻骨上腱膜复发率(11/64;17.2%)比按照原始技术使用网状种植体(3/116;2.6%) (p < 0.001)。治疗后的生活质量在主组术后第一天较高,因为有尿痛症状的患者数量较少(7/116;63%),而对照组中,超过一半的手术患者出现尿潴留(76.5%)(260/340)(p < 0.001)。长期随访期间,两组患者PT-QL调查结果比较,差异无统计学意义(p > 0.05)。结论。结合使用自身组织和网状植入物的手术治疗POP的发展方法减少了疾病复发的频率,并在术后早期提高了生活质量。关键词:盆腔器官脱垂,网状植入物,侧腹固定术。
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