两种阴道黏膜切口缝合方法治疗前盆腔脱垂的效果及阴道微生态变化分析OACSTPCD

Objective To compare the clinical efficacy,mesh exposure and vaginal microecological changes of two suture methods of vaginal mucosa incision in implanting mesh for treatment of moderate and severe anterior pelvic prolapse.Methods Sixty one patients with recurrent anterior pelvic prolapse of POP-Q Ⅲ-Ⅳ degree admitted in the Department of Gynecology of Shanghai Putuo Hospital from June 2021 to June 2023 were randomly divided into two groups.All patients underwent simple anterior pelvic floor reconstruction,31 cases received conventional vaginal mucosal suture(Group A)and 30 cases received modified vaginal mucosal suture(Group B).The intraoperative blood loss,operation time,and postoperative hospital stay were observed;the subjective evaluation indexes(Pelvic Organ Prolapse and Urinary Incontinence Questionnaire PISQ-12 rating scale,Pelvic Floor Function Impact Questionnaire Short Form PFIQ-7)and objective evaluation indexes(POP-Q)were compared between two groups.The changes in the vaginal microecology,and the exposure of the mesh after surgery were also compared between two goups.Results There were no significant differences in operation time and intraoperative blood loss between the two groups(P＞0.05).The length of postoperative hospital stay was shorter in group B compared with group A.Points Aa,Ba,C,Ap,and Bp rose more significantly postoperatively ingroup B(P＜0.05).The PISQ-12 scale score was significantly higher in group B at 6 months postoperatively(P＜0.05);there were significant differences in the subcategories of"bladder or urethra"and"vagina or pelvis"on the PFIQ-7 scale between group A and group B at 1 and 6 months postoperatively(P＜0.05).The difference in the bowel subcategory was not statistically significant(P＞0.05).At 1 month after surgery,the dominant vaginal bacteria in group B were Lactobacillus,pH value and other indicators were closer to the vaginal microecological status of menopausal women,and the difference between two groups was statistically significant(P＜0.05).There was one case of mesh exposure in group A and none in group B at 6 months after surgery.Conclusion After TiLOOP Total 4 mesh was implanted through the anterior vaginal wall,two different suture methods of vaginal mucosa are effective in the treatment of moderate and severe anterior pelvic prolapse.Patients with modified vaginal mucosal suture have more satisfaction,and the vaginal microecology can be earlier and better corrected.