Десятилетний опыт комбинированного хирургического лечения тяжелых пролапсов тазовых органов у женщин

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.