Application Of Transperineal Ultrasound In The Detection Of Patients With Outlet Obstruction Constipation

Objective:To research the sonographic performance of pelvic floor structure and function in patients with outlet obstruction constipation (OOC).To have a preliminary study of transperineal ultrasound’s value in imaging of the pelvic floor structure.Methods:26 patients in First People’s Hospital of Yunnan Province from March 2014 to October 2014 were recruited, whom with a complaint of constipation and longo’s outlet obstruction constipation score table scoring≥9.30 cases normal people with no symptoms and longo outlet obstruction constipation score table scoreing≤1 as a control group. High frequency and convex array probe were employed to examined through the perineum to observe the anal canal, rectum, anorectal angle(ARA), the internal anal sphincter (IAS), external anal sphincter (EAS), and puborectalis (PR) and other pelvic floor structures. The EAS, IAS and PR’s thickness were measured. The patients were asked to make a defecation efforts to observe the levator ani and ARA action.Results:All 30 cases of control group and most of the OOC group in defecating phase had a larger ARA angle than the resting phase, and the ARA angles smaller when in lifting phase.3 cases in OOC group had a reverse movement of anorectal angle. Data of OOC group and the control group compared:ARA in resting phase between the two groups showed no significant difference (P≥0.05); OOC group ARA angle is smaller, the difference was statistically significant (P<0.001). OOC group’s ARA change value significantly smaller than normal control group, the difference was statistically significant (P<00.001); There was no significant difference (P> 0.05) between the OOC group and the control group’s PR, EAS, IAS thickness and the left and right sides of PR in the same group. Ultrasound detected 2 cases of EAS and (or) IAS tear in the control group, accounting for 6.6% in control group. Ultrasound detected 5 cases of EAS and (or) IAS tear in the OOC group, accounting for 19.2% in OOC group. Ultrasound detected 7 cases of rectocele(RC) in OOC group, digital rectal examination diagnosed 9 cases of RC. These two methods have a very good agreement (Kappa = 0.821, P<0.001).Conclusion:1. Transperineal ultrasound can be used to observe the movement of puborectalis to evaluate its function.2. Ultrasonography, with its convenience and low cost, can be used as a imaging method in the diagnosis of pelvic floor dysfunction disease.