| Objective: This study is designed to investigate the changes of pelvic floor anatomy before and after hysterectomy in patients undergoing hysterectmy using transperineal real-time two-dimensional ultrasound and measure the relative indexes to evaluate the function of patients after hysterectomy.And the study aims to observe the pelvic floor of women not fertility or fertility by two-dimensional ultrasound.Methods: In this study,there are 182 women including patients who undergo hysterectomy and normal females,and the study will be divided into four groups,that is,want to undergo hysterectomy group(group I),unborn group(group II),caesarean section group(group III),eutocia group(group IV).Group I needs to meet the following criteria : for benign or malignant diseases undergoing hysterectomy,natural childbirth or no fertility,no history of pelvic surgery,can effectively complete the Vlasalva action;Group II needs to satisfy the following conditions : no history of delivery,no pelvic tumor or pelvic surgery,and can effectively complete the Vlasalva action.Group III(III-1:Caesarean section time=1;III-2:Caesarean section times >1)needs to satisfy the following conditions: a history of childbirth and cesarean section,no history of pelvic tumor or pelvic surgery,and can effectively complete the Vlasalva action;Group IV(IV-1:The number of birth=1 time;IV-2: The number of birth >1 time)needs to satisfy the following conditions: a history of childbirth and natural labor,no previous pelvic tumor or pelvic surgery history,and can effectively complete the Vlasalva action.The instrument is the PHILIPS IU-22 color Doppler ultrasound diagnostic apparatus,convex array probe first.Check the conditions of machine pre-selected abdominal inspection conditions.Focus to the center of the target.Patients with moderate filling bladder,bladder lithotomy position,the probe covering disposable and condom placedin the perineum.Separate the labia majora on both sides,adjust the probe to maintain stability,appropriate pressure,and try to make the pubic symphysis axis and the lower edge of the horizontal line by the pubic symphysis at 45 degree or so.In the sagittal section,it can clearly show the lower edge of pubic symphysis,bladder,urethra,vaginal,rectal and anal canal.The changes of the pelvic organs were observed in resting state and maximal Valsalva state,measuring parameters including bladder neck-symphyseal distance(BSD),bladder neck descent(BND),urthral tilt angle(UTA),retrovesical angle of bladder(RA),urethral rotation angle(UR)etc.Freezing and saving the satisfied images.All the data are input by Excel,using SPSS21.0 statistical software for data analysis.Describing the normal distribution data as mean ±standard deviation(—X± S),non-normal distribution data as median ± quartile spacing[M±(Q3-Q1)].The results are analyzed using the rank sum test or T test,inspection level a=0.05,P < 0.05 means that the difference was statistically significant;The comparison between the two groups is performed using the Wilcoxcon paired rank-sum test,adjust the test level a'= 2a/k(k-1)[k represents number of the groups],P < a ' means that the difference was statistically significant;Result:1 In pelvic floor median sagittal plane,the two-dimensional ultrasound images of the perineum from the ventral to dorsal in order to clearly show the pubic symphysis,bladder neck and urethra,vagina,rectum and anal canal.Under normal circumstances,the resting state,the pelvic organs locate in the reference line side,under the Valsalva action,the organs move to the human dorsal lateral,but still in the reference line side.Bladder and / or uterus appear(s)below the reference line in the study(group I,IV)at Valsalva action.2 Before operation(group I-1),3 months after operation(group I-2)and more than 3 months after surgery(group I-3),the comparison of the observed values in group I(want to undergo hysterectomy group):2.1 There is significant difference in the distance between the bladder neck and the pubic symphysis in the maximal Valsalva state(P <0.05).TheWilcoxcon paired rank-sum test showed that there is significant difference between group I-1 and group I-2,group I-1 and group I-3,group I-2 and group I-3(P <0.017).Three groups of numerical values were: group I-1 > group I-2 > group I-3.2.2 There is significant difference in the posterior urethral angle of the bladder and urethra in the Valsalva state(P<0.05),and the Wilcoxcon paired rank sum test showed that there is significant difference between group I-1 and group I-2,group I-1 and group I-3,group I-2 and group I-3(P<0.017).Three groups of numerical values were: group I-1 < group I-2 < group I-3.2.3 There is significant differences in the urethral inclination angle in the Valsalva state between the three groups(P<0.05),and Wilcoxcon paired rank-sum test showed that there is statistical difference between group I-1 and group I-2(P <0.017).UTA numerical size: group I-1 < group I-2.2.4 There is significant differences in the bladder neck descent between the three groups(P <0.05),and Wilcoxcon paired rank-sum test showed that there is statistical difference between group I-1 and group I-2,group I-1 and group I-3,group I-2 and group I-3(P<0.017).Three groups of numerical values were:group I-1<group I-2<group I-3.2.5 There is significant difference in the urethral rotation angle between the three groups(P <0.05),Three groups of numerical values were: group I-1 <group I-2 < group I-3.2.6 There is no statistically significant difference in the distance between the bladder neck and the pubic symphysis,posterior urethral angle of the bladder and urethra,urethral inclination angle at rest between the three groups(P>0.05).3 Comparison of the observed values in caesarean section group(group III)and eutocia group(group IV):3.1 There is significant difference in the posterior urethral angle of the bladder and urethra in the Valsalva state(P <0.05),numerical values ?were: group III <group IV.3.2 There is no statistically significant difference in the distance between thebladder neck and the pubic symphysis,posterior urethral angle of the bladder and urethra,urethral inclination angle at rest etc.between the two groups(P>0.05).3.3 There is no statistically significant difference(P> 0.05)in group III.3.4 In group IV,there is significant differences in the urethral inclination angle,in the distance between the cervical and the pubic symphysis in the maximal Valsalva state(P<0.05).There is no significant difference in the rest of the values(P> 0.05).Conclusion:1 The transperineal real-time two-dimensional ultrasound can be used to dynamically observe the female pelvic floor organ structure,shape,location and movement,and assess pelvic floor function.2 Hysterectomy has a greater impact on the anterior chamber of the patients,and the possibility of pelvic floor dysfunction increased.The parameters of the Valsalva condition of the total hysterectomy are more valuable.3 Many times of caesarean section have a limited impact on pelvic floor.4 Natural birth may influence increase the possibility of the female anterior pelvic floor dysfunction,especially many times.The parameters of the Valsalva condition are more valuable,for example urethral inclination angle and the distance between the cervical and the pubic symphysis in the maximal Valsalva state. |
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