The Preliminary Study In Evaluation Of Pelvic Floor Function In Post-hysterectomy Patients By Transperineal Ultrasonography

Objective: This study is aims to explore the pelvic floor structure by the two-dimensional ultrasound in normal young nulliparous group and normal fertile women; assessing of pelvic floor function in patients after total hysterectomy;comparison of total hysterectomy patients with preoperative and postoperative pelvic structure in different time of static and dynamic change, and measure the related indicators. ?n order to get the clinical usefulness of the two-dimensional ultrasound in the evaluation of pelvic floor function in patients with total hysterectomy.Methods: ?n this study, 122 women were divided into four groups. Group ? includes 40 normal nullipatas, group ? includes 30 women who had been given birth, group ? includes 30 patients who had received total hysterectomy after more than 3 months,group ? includes 22 patients who were prepared to receive total hysterectomy. All patients were examined by two-dimensional ultrasound at resting state and maximal Valsalva action to obtain the midsagittal view of the pelvic floor under different conditions.(1)To observe the anatomic structure, position and movement of pubic symphysis(PS), bladder neck(BN) and urinary tract(U), vagina(V), the rectum and anal canal connected part(RA)with group?;(2)Group?, ?, ? of bladder necksymphyseal distance(BSD), posterior urethrovesical angle(PUA), urethral rotation angle(UR), bladder neck and pubic symphysis axis angle(?);(3) Ultrasound diagnosis of pelvic organ prolapse of group ?;(4) Respectively for group ? and ? group, group ? and ? and ? group before and after operation in different time section parameters were compared.Result:1 ?n pelvic floor median sagittal section, two-dimensional ultrasound images from ventral to dorsal side in order show pubic symphysis, bladder neck and urethra, vagina and rectum.2 Four groups of patients in resting and maximal Valsalva action of bladder neck, cervical and connecting part of the rectum and anal canal are located below the reference line and motor coordination in the valsalva action.Asking patient relax after pelvic organ recovery to in situ. ?n the Valsalva movement, the pelvic organs move to the back and the side of the tail. ?n group ?, there were many cases of pelvic organs located below the reference line in the Valsalva movement.3 Compare with group ? and group ?, BND, the difference of resting state of the bladder neck, pubic symphysis axis angle(R-?), bladder neck rotation angle(??), and posterior urethrovesical angle(PUA) were not significant difference(P>0.05). There are significant statistical difference in Valsalva status of V-?, V-PUA, and the urethral rotation angle(UR).(P<0.05).4 Compare with group ? and group ?,V-PUA, R-PUA were not statistically significant(P>0.05). BND, ??, UR, there is a statistically significant difference(P<0.05). And group ? of BND, UR and ?? more than group ?.5 Compare with before surgery and 1 months, 3 months after surgery in group ?, BSD, R- ?, R-PUA were not statistically significant(P>0.05), V-?, V-PUA and UR in three different time were statistically significant(P<0.05).Conclusion:1 Two-dimensional transperineal ultrasonography can be used for dynamic observation of female pelvic organ anatomical structure, position and movement.2 Two-dimensional transperineal ultrasonography can evaluate the pelvic floor function, the useful parameters are: BND, R-PUA, V-PUA, R-?, V-?, ??, UR.3 The risk of stress urinary incontinence and the possibility of pelvic floor dysfunction in patients after total hysterectomy are increased.