本文關(guān)鍵詞： 慢性盆腔痛 慢性盆腔疼痛綜合征 盆底解剖學(xué) 盆底超聲 肌筋膜肛提肌痙攣　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:慢性盆腔痛(Chronic Pelvic Pain,CPP)是一種非常普遍的疾病,對女性的生活產(chǎn)生巨大的負(fù)面影響。慢性盆腔痛起病隱匿,涉及多因素、多系統(tǒng)的共同作用,診斷較難明確病因而針對性進(jìn)行治療。目前能夠明確病因的慢性盆腔痛已經(jīng)逐漸被人們攻克,而未能明確病因的慢性盆腔疼痛綜合征(Chronic Pelvic Pain Syndrome,CPPS)患者仍遭受痛苦的折磨。近年來,隨著人們對于高品質(zhì)健康生活的追求,人們已經(jīng)越來越意識到慢性盆腔痛的重要性,更加意識到慢性盆腔疼痛綜合征診療的重要性,并積極投身于相關(guān)的研究中。本文通過采用盆底二維、三維超聲影像學(xué)檢查,比較女性慢性盆腔疼痛綜合征患者與正常女性的盆底解剖結(jié)構(gòu),探討女性CPPS患者的盆底超聲影像學(xué)改變特征,為慢性盆腔疼痛綜合征的診治提供依據(jù),以期給臨床預(yù)防及診治慢性盆腔痛提供一定參考,促進(jìn)患者恢復(fù),解除患者疼痛,從而緩解患者的疼痛癥狀,提高其生活質(zhì)量。方法:隨機(jī)選取2015年1月-2016年12月就診于大連市婦女兒童醫(yī)療中心女性盆底泌尿整復(fù)中心的66例女性CPPS患者為研究組,同期選取81例非CPPS健康人群作為對照組。兩組研究對象均如實(shí)填寫相關(guān)的調(diào)查表格,采集人口信息資料和病歷資料。采用經(jīng)會(huì)陰盆底二維超聲及經(jīng)陰道盆底三維超聲(360°旋轉(zhuǎn)以產(chǎn)生3D圖像的線性陣列探頭)進(jìn)行盆底二維及三維超聲檢查,同時(shí)進(jìn)行�？频呐璧滋弁礄z查。比較兩組患者在靜息狀態(tài)下和Valsalva狀態(tài)下二維超聲圖像上膀胱頸和恥骨聯(lián)合后下緣水平線之間的距離(BND)、膀胱底和恥骨聯(lián)合后下緣水平線之間的距離(BSD)、尿道的長度、生殖道裂孔的前后徑、肛直腸角度等參數(shù)的變化。比較兩組患者靜息狀態(tài)下三維超聲圖像上肛提肌裂孔的前后徑、橫徑及面積,陰道旁間隙的面積,肛提肌的面積,肛提肌的厚度等參數(shù)的變化特征。采用SPSS21.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析。結(jié)果:1.研究組靜息狀態(tài)下生殖道裂孔前后徑(53.23±7.70mmvs 56.72±10.19mm)小于對照組(P0.05),肛直腸角度(115.69° ±13.28° vs 109.22° ±13.03°)大于對照組(P0.05);Vals3lva狀態(tài)下BSD(6.70±14.91mm vs-0.67±20.23mm)大于對照組(P0.05)。2.研究組肛提肌裂孔前后徑(51.25±6.14mmvs 59.36±7.52mm)、肛提肌裂孔橫徑(39.44±6.07mm vs 48.15±8.10mm)、肛提肌裂孔面積(13.74±2.51mm2 vs 18.54±3.58 mm2)、陰道旁間隙左右側(cè)面積(2.07±0.71mm2 vs 2.96±1.2mm2;2.02±0.52mm2vs2.87±0.90mm2)均明顯小于對照組(P0.0001),肛提肌中間厚度(5.59±1.99mm vs 4.54±1.94mm)大于對照組(P0.05)。結(jié)論:1.女性CPPS盆底超聲影像學(xué)顯示為肛提肌痙攣性特征,結(jié)果提示可能通過肛提肌解痙療法治療此類患者。2.采用隨機(jī)、多中心、大樣本的前瞻性研究,對慢性盆腔疼痛綜合征的病因及發(fā)病機(jī)制進(jìn)行深入研究是十分必要的。
[Abstract]:Objective: chronic pelvic pain (chronic Pelvic PainP) is a very common disease, which has a great negative impact on the life of women. Involving multi-factors, multi-system interaction, diagnosis is difficult to identify the etiology and targeted treatment. At present, chronic pelvic pain which can identify the etiology has been gradually overcome. Patients with chronic pelvic pain syndrome (chronic Pelvic Pain Syndromes) who do not have a definite etiology are still suffering from the disease in recent years. With the pursuit of high-quality healthy life, people have become increasingly aware of the importance of chronic pelvic pain, more aware of the importance of diagnosis and treatment of chronic pelvic pain syndrome. The pelvic floor anatomy of female patients with chronic pelvic pain syndrome was compared with that of normal women by using two-dimensional and three-dimensional ultrasound imaging of pelvic floor. To explore the characteristics of pelvic floor ultrasound imaging in female patients with CPPS, to provide evidence for the diagnosis and treatment of chronic pelvic pain syndrome, to provide a reference for clinical prevention and treatment of chronic pelvic pain, and to promote the recovery of patients. Relieve the patient's pain, thereby relieving the patient's pain symptoms. Improving their quality of life. Methods:. From January 2015 to December 2016, 66 female patients with CPPS in female pelvic floor uroplasty center of Dalian Women and Children Medical Center were randomly selected as the study group. In the same period, 81 non-#en0# healthy people were selected as the control group. The two groups of subjects truthfully filled out the relevant investigation forms. Collection of demographic information and medical records. Linear array probe with two-dimensional transperineal pelvic floor ultrasound and transvaginal pelvic floor 360 擄rotation to generate 3D images). The pelvic floor was examined by two-dimensional and three-dimensional ultrasound. The distance between bladder neck and posterior inferior margin of pubic syndesmosis was compared between two groups of patients in resting state and Valsalva state. The distance between the bottom of the bladder and the horizontal line of the posterior lower margin of the symphysis pubis, the length of the urethra, and the anterior and posterior diameter of the genital fissure. To compare the anterior and posterior diameter, transverse diameter and area of levator ani muscle hiatus, the area of paravaginal space, and the area of levator ani muscle in the resting state of the two groups. The variation of the thickness of levator ani muscle and other parameters. The data were analyzed by SPSS21.0 software. Results: 1. 53.23 鹵7.70 mm vs 56.72 鹵10.19 mm) was lower than that of the control group (P 0.05). The anorectal angle was 115.69 擄鹵13.28 擄vs 109.22 擄鹵13.03 擄), which was higher than that of the control group (P 0.05). BSD(6.70 鹵14.91 mm vs-0.67 鹵20.23 mm in Vals3lva was higher than that in control group (P 0.05). The anterior and posterior diameters of the sphincter fissure in the study group were 51.25 鹵6.14mm vs 59.36 鹵7.52mm). The transverse diameter of the hiatus of levator ani muscle was 39.44 鹵6.07mm vs 48.15 鹵8.10mm). The area of the hiatus of levator ani muscle was 13.74 鹵2.51 mm ~ 2 vs 18.54 鹵3.58 mm ~ 2). The area of paravaginal space was 2.07 鹵0.71 mm ~ 2 vs 2.96 鹵1.2 mm ~ 2; 2.02 鹵0.52 mm 2 vs 2.87 鹵0.90 mm 2) was significantly lower than that of the control group (P 0.0001). The median thickness of levator ani muscle was 5.59 鹵1.99 mm vs 4.54 鹵1.94 mm, which was higher than that of the control group (P 0.05). Conclusions\\\. The results suggest that spasmolysis therapy of levator ani muscle may be used to treat this kind of patients. 2. A randomized, multicenter, large sample prospective study was carried out. It is necessary to study the etiology and pathogenesis of chronic pelvic pain syndrome.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R711.5;R445.1
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本文編號：1443877