Application Of Transperineal Real-Time Three-Dimensional Ultrasound In The Etiological Diagnosis Of Female Outlet Obstructive Constipation

Objective:To explore the value of transperineal real-time three-dimensional ultrasound in the etiological diagnosis of female outlet obstructive constipation and its possible pathogenesis.Methods:We retrospectively analyzed the data of 56 female patients with outlet obstructive constipation and 25 healthy women with no symptoms of constipation in the Anorectal Department of Fujian Provincial People’s Hospital from January 2019 to July 2021.(1)To evaluate the consistency of real-time three-dimensional pelvic floor ultrasonography and X-ray defecography in the diagnosis of rectal mucosal prolapse,rectocele and pelvic floor Achalasia Syndrome;(2)To compare and analyze the changes of anterior rectalwall bulge,degree of bulge and anal right angle in patients with outlet obstructive constipation;(3)Transperineal real-time threedimensional ultrasound was used to observe whether the front,middle and back pelvic organs prolapsed,whether the levator ani muscle and anal sphincter were intact in the resting state and the force output state of all subjects.According to the ultrasound examination results,they were divided into relaxation groups(bladder prolapse,uterus prolapse,rectal protrusion,intrarectal mucosal prolapse),achalasia group and normal group(healthy women without constipation),compare the changes of puborectal muscle thickness between the three groups in the resting state and the force displacement state,and study and explore the causes The possible mechanism of female outlet obstructive constipation.Results:(1)Among the 56 female patients with outlet obstruction constipation,42 cases were positive for intrarectal mucosal prolapse by perineal real-time threedimensional ultrasound,and 14 cases were negative;47 cases were positive for rectal mucosal prolapse by X-ray defecography,and 9 cases were negative;the two cases were common positive in 42 cases and common negative in 9 cases.The diagnosis results were good consistent(Kappa=0.73).35 cases were diagnosed as positive for rectal protrusion by perineal real-time three-dimensional ultrasound,and 21 cases were negative;38 cases were diagnosed as positive for rectal protrusion by X-ray defecography,and 18 cases were negative;the two cases were common positive in35 cases and common negative in 18 cases;the diagnosis results of the two were excellent consistent(Kappa=0.88).Both of them diagnosed 16 cases of pelvic floor achalasia syndrome,and were common negative in 40 cases;the diagnosis results of the two were completely consistent(Kappa=1).Both of them observed that the angle of the anus in 16 patients was smaller than the resting state,and the difference was not statistically significant(P>0.05).(2)Among 56 female patients with outlet obstruction constipation,35 cases of rectal protrusion were diagnosed collectively by real-time three-dimensional ultrasound and X-ray defecography through perineum.The two examinations had a certain consistency in the diagnosis of protrusion scale(κ=0.490,P=0.001<0.05),the two examinations have statistically significant differences in the depth measurement of rectal protrusion(t=2.699,P=0.010<0.05),and the depth of rectal protrusion measured by the two examinations is highly correlated(r=0.808,P<0.05).There was no statistically significant difference between the two examinations on the measurement results of the anal right angle in resting and force discharge states(P>0.05).(3)The levator ani muscle and anal sphincter in 25 cases of the normal group diagnosed by real-time three-dimensional ultrasound via perineum were intact,and there was no prolapse in the front,middle and back of the pelvis;all patients with outlet obstructive constipation had complete levator ani muscle and anal sphincter.Among them,19 cases were accompanied by anterior and middle pelvic prolapse;40cases were included in the relaxation group,and the other 16 cases were included in the achalasia group.The thickness of the puborectalis muscle of the patients in the achalasia group was thicker than the relaxation group and the normal group at rest and force output,and it was statistically significant(P<0.05);the ultrasound performance of the achalasia group was that the force output was higher than the puborectalis muscle at rest was contrary to the changes in the relaxation group and the normal group,and the difference was statistically significant(P<0.05);the thickness of the relaxation group was smaller than the normal group in the force displacement state,and the difference was statistically significant(P<0.05).Conclusion:This study draws the following three conclusions.First,transperineal real-time three-dimensional ultrasound and X-ray defecography are consistent in the diagnosis of intrarectal mucosal prolapse,rectal protrusion and pelvic achalasia syndrome;second,real-time three-dimensional ultrasound through the perineum can accurately classify and quantify the types of outlet obstructive constipation,diagnose and differentially diagnose the cause of constipation,and provide important information for the selection of clinical diagnosis and treatment plans;third,the pelvic floor is a whole.Transperineal real-time three-dimensional ultrasound has special advantages in observing the pelvic floor muscles and the front,middle and back pelvic organs.It can provide help for finding more possible causes of outlet obstructive constipation.