Clinical Application Of Ultrasound In Evaluating Pelvic Floor Dysfunction After Hysterectomy

Objectives To observe the changes of pelvic floor structure after total hysterectomy by transperineal ultrasound.To evaluate the pelvic floor structure and function quantitatively in patients with total hysterectomy under different surgical procedures.And to estimate the incidence of pelvic floor disorders in different periods of time after total hysterectomy.Methods The subjects of this study were reexamination of 105 cases after hysterectomy for various reasonsfrom and 120 cases of normal physical examination of gynecology ultrasound.Research object grouping:(1)Total hysterectomy group(n = 105)and control group(n = 120).(2)All postoperative patients were grouped according to the postoperative time: 1 year after operation(n=29),more than 1 year to less than 5 years(n=33),more than 5 years to less than 10years(n=28),more than 10 years(n=15).(3).All the observers were divided into three groups according to the age: more than 40 years old to less than 50 years old,more than 50 years old to less than 60 years old,more than 60 years old.(4)According to the different operation methods,the subjects were divided into normal patients as the control group(GroupⅠ,n =120),patients of transabdominal hysterectomy,transvaginal hysterectomy and laparoscopically hysterectomy as experimental group(GroupⅡ,n =49;GroupⅢ,n =33;GroupⅣ,n =23).All subjects were observed and measured ultrasound parameters in resting state and maximum valsalva state.Such as urethral funnel formation,bladder detrusor thickness(BDT),the distance between bladder neck and lower margin of pubic symphysis(BNSD),the distance from the lowest point of the bladder to the posterior inferior margin of the pubic symphysis(BLSD),the distance from anal angle to posterior inferior margin of pubic symphysis(ASD),the degree of urethral obliquity angle(UOA)and posterior urethrovesical angle(PUA).And Calculated the bladder neck descent(BND)and the degree of urethral rotation angle(URA)in two states.To observed the changes of the pelvic floor parameters,analysed the pelvic floor structure and function in postoperative patients.To evaluated the incidence of pelvic floor disorders(PFD)after operation,including stress urinary incontinence(SUI)and pelvic organ prolapse(POP).To evaluate the effects of different surgical procedures on pelvic floor structure and function.Results(1)At rest state(r)and maximum valsalva state(v),compared with the control group,the BNSD,BLSD,ASD values of the patients after total hysterectomy were significantly decreased,and the values of UOA,PUA,BDT,BND,URA were all obviously increased.With the exception of rUOA,the differences in other parameters were statistically significant,P<0.05.(2)Comparison between group Ⅱ,Ⅲ and Ⅳ,patients in both states,the BNSD,BLSD,ASD values of the patients after total hysterectomy were significantly decreased,and the values of UOA,PUA,BDT,BND,URA were all obviously increased.The differences in all parameters were statistically significant,P<0.05.(3)The percentage of urethral funnel formation inⅡ,Ⅲ and IV group was4.76%,1.90% and 0.95%,respectively.(4)The incidence of PFD after hysterectomy is about62.86%,SUI is about 33.33% and POP is about 36.19%.The incidence of SUI and POP in groupⅡwas higher than that in groupⅢandⅣ.(5)There was no significant difference in parameters between Ⅲ group and Ⅳ group.(6)PFD occurred mainly in SUI within 1 year after total hysterectomy,and POP in ≥ 10 years after hysterectomy.(7)The incidence of PFD in 40-50 years after operation was higher than that in one year,P < 0.05.There was no significant difference in the incidence of PFD in group more than 1 year to less than 5 years,group more than 5 years to less than 10 years,and group more than 10 years.Conclusions(1)The changes of pelvic floor structure and function after hysterectomy can be observed dynamically by transperineal ultrasound.And quantitative analysis of pelvic floor parameters to evaluate the occurrence of postoperative PFD.(2)Pelvic floor structures can be changed and function can be decreased after hysterectomy.(3)Comparison between transabdominal hysterectomy,transvaginal hysterectomy and laparoscopically hysterectomy,the former has greater influence on pelvic floor structure and function,and more prone to pelvic floor dysfunction.(4)The incidence of PFD in patients aged 40-50 years after total hysterectomy is mainly related to surgical factors.But the this incidence in patients more than 50 years old is related to age and hormone level in addition to surgery.