골반장기 탈출증 환자에서 mesh를 이용한 골반재건술의 성적비교

Abstract

Object : This study was carried out in order to compare the outcomes in different surgeries with mesh of pelvic organ prolapse patients whose leading points were C Materials & methods : Study subjects were the 39 patients who were admitted to Severance hospital, Dept. of Obstetrics and Gynecology between March 1, 1999 and May of 2002, and who were compliant to follow up for more than 1 year. Considering the stage higher than Ⅱas recurrence, the recurrence rates at 6 and 12 months were 1.3% and 6.7% in abdominal high uterosacral colpopexy group, and 2,9% and 7.7% in abdominal sacral colpopexy group, respectively. No significant difference was found in total vaginal length, perineal body and genital hiatus between pre-and postoperative measurements up to 1 year. The patients were categorized into 3 groups:group A who underwent pelvic reconstruction with hysterectomy;group B who underwent hysterectomy prior to pelvic reconstruction;group C who underwent pelvic reconstruction with uterus preserved. At first visit, POP-Q stage was determined, and post-operative stage change was studied. Age, BMI, admission days, operation time, post-operative complications were observed and the results were analyzed and compared. Fisher's exact test and Kruskal-Wallis test was used for comparison and analysis. Result : Among the 39 patients, group A, B and C were each 19, 10, 10 cases. All stage Ⅳ patients who were operated (21 cases) were converted to stage 0 in 1 month folowing the operation, and no further change was observed except in one patient who were converted stage Ⅱ in 3 months. All stageⅢ and Ⅱ (18 cases) patients were converted to stage 0 in 1 month following the operation. Each group's average admission days did not have statistical significance. HOD was reduced in group C. In addition, each patient group's average operation time in 'AEgroup A and B' and 'AEgroup A and C' showed statistically significant difference. (220(180-250) vs 175(130-210) vs 180(170-210)(min), P=0.0001) There was no significant difference in post operative complication between each groups but 3 of group A developed erosion while no patient in group B and C did. Conclusion : Pelvic reconstruction using mesh is a very efficient method of treatment for pelvic organ prolapse. Improvement in stage and symptom did not appear to have significant difference in each group. However, in the case of uteropexy, compared with conventionally the pelvic reconstruction operation with hysterectomy, short operation time and HOD, and reduction in erosion due to usage of mesh are thought to be the advantages of the surgery.