The Structure Change Of Pelvic Floor Perineal Ultrasound Evaluation After Transabdominal Total Hysterectomy

Objectives To observe the early changes of women pelvic floor structure with posttransabdominal hysterectomy 3 months by transperineal pelvic ultrasound dynamically;Comparative analysis the impact of radical hysterectomy and non radical hysterectomy to pelvic floor structure and function;Analyze the main risk factors of each type of pelvic floor dysfunction in post-transabdominal hysterectomy 3 months.Methods We selected 189 cases of gynecology prepared to receive transabdominal hysterectomy in Affiliated Hospital of North China University of Science and Technology during October in 2015 to January in 2017.None of them received clinical diagnosis of pelvic floor dysfunction.All cases received the transperineal pelvic ultrasound examination in the pre-operation a week,and were followed up for 3 months.Finally,150 cases were enrolled in this study.The patients were divided into 2 groups,namely non radical hysterectomy group(group?)and radical hysterectomy group(group?),the number of cases was 78 cases and 72 cases respectively.The ultrasonic parameters of the resting state,the contracting state and the maximum valsalva maneuver were measured dynamically,the position of bladder neck,vaginal fornix and the anorectal juction in X axis,Y axis(x B,y B;x F,y F;x A,y A),and the lowest point in X axis,the angle of the bladder neck(BA),the posterior urethrovesical angle(UJV),urethral inclination angle(UIA),the displacement of bladder neck,vaginal fornix and the anorectal juction(s B,s F,s A),minimum sagittal diameter of levator hiatal(M).The following parameters were calculated : the rotation angle of the bladder neck(?v BA),the rotation angle of the urethral(?v UIA),the bladder neck descent(BND),the change of the minimum sagittal diameter of levator hiatal(?v M,?c M).Excel 2013 to establish a database,using SPSS(21.0)statistical analysis software for statistical analysis.All normality measurement data used by mean±standard deviation((?)±s);measurement data of skewed distribution with a median(four point interval)(Md(QR).The changes of pelvic floor function after 3 months were evaluated and the effects of transabdominal radical hysterectomy and non radical hysterectomy on pelvic floor function were compared with the repeated measures ANOVA,the Independent-Samples T test and the Paired-Samples T test.The main risk factors of each type of pelvic floor dysfunction in post-transabdominal hysterectomy 3 months were analyzed: the single factor analysis,measurement data compared with the IndependentSamples T test or Nonparametric Test,two groups rate and composition ratio comared with the Chi-Square test,and the multiple factors analysis with Logistic regression analysis.There was statistical significance as P<0.05.Results 1 The changes of pelvic floor function in post-transabdominal hysterectomy 3months:(1)Compared with preoperative,the ultrasonic parameters ?v BA,v UJV,?v UIA,BND,vs B,vs F and ?v M was increased(P<0.05),and group? increased more obviously(P<0.05).The results show that the activity of bladder neck and vaginal fornix were increased compared with preoperative,The peripheral muscle,ligaments and fascia tissue of abdominal pressure resistant function,support function were abated,and the transabdominal radical hysterectomy was more seriously.(2)Compared with preoperative,the ultrasonic parameters vs A was increased(P<0.05),but there was no difference between groups(P>0.05).The results show that the activity of anorectal junction was increased compared with preoperative,The peripheral muscle,ligaments and fascia tissue of abdominal pressure resistant function,support function were abated,but affected by the operation scope was not obviously.(3)Compared with preoperative,the ultrasonic parameters Dx B and Dx A changed to negative of X axis(P<0.05),and group? changed more obviously(P<0.05).The results show that bladder neck and anorectal junction were shifted foot side,and the transabdominal radical hysterectomy was more seriously.(4)Compared with preoperative,the ultrasonic parameters Dx F changed to negative of X axis(P<0.05).but there was no difference between groups(P>0.05).The results show that bladder neck and anorectal junction were shifted foot side,but affected by the operation scope was not obviously.(5)Compared with preoperative,the ultrasonic parameters cs B,cs F,?c M was reduced(P<0.05),and group? abated more obviously(P<0.05).The results show that systolic function of the levator ani muscle was abated,and the transabdominal radical hysterectomy was more seriously.(6)There was no significant change of ?v ARA and ?c ARA between before and after operation 3 months(P>0.05),either between two groups.The results show that the pubic rectum muscle contraction function not affected by the operation.2 Risk factors of each type of pelvic floor dysfunction in post-operation 3months:(1)Risk factors of SUI were repeatedly vaginal delivery(OR=8.913,95%CI1.076~73.809,P=0.043),repeatedly pregnant(OR=8.406,95%CI 1.002~1.048,P=0.047),high age(OR=1.288,95%CI 1.038~1.597,P=0.021),high BMI(OR=1.211,95%CI1.009~1.454,P=0.039),and long duration of operation(OR=1.025,95%CI 1.002~1.048,P=0.030).(2)Risk factors of cystocele were repeatedly vaginal delivery(OR=36.115,95%CI 2.731~477.660,P=0.006),repeatedly pregnant(OR=28.670,95%CI 2.213~371.516,P=0.010),high BMI(OR=1.626,95%CI 1.149~2.301,P=0.006),high age(OR=1.211,95%CI 1.051~1.394,P=0.008).(3)Risk factors of rectocele were menopause(OR=5.373,95%CI 1.110~25.997,P=0.037),repeatedly pregnant(OR=3.619,95%CI 1.435~9.125,P=0.006),repeatedly vaginal delivery(OR=3.052,95%CI 1.267~7.347,P=0.013),high BMI(OR=1.294,95%CI 1.107~1.512,P=0.001),and high age(OR=1.244,95%CI1.002~1.515,P=0.030).Conclusions 1 Compared with preoperative,the pelvic floor structure was changed,and the function was reduced in post-transabdominal hysterectomy 3 months.2 The extent of the destruction of the pelvic floor by transabdominal radical hysterectomy was higher than that of the non radical hysterectomy.3 In post-transabdominal hysterectomy 3 months,risk factors of each type of pelvic floor dysfunction:(1)The risk factors of SUI were repeatedly vaginal delivery,repeatedly pregnant,high age,high BMI and long duration of operation;(2)The risk factors of cystocele were repeatedly vaginal delivery,repeatedly pregnant,high BMI,high age;(3)The risk factors of rectocele were menopause,repeatedly pregnant,repeatedly vaginal delivery,high BMI,and high age.