本文關(guān)鍵詞： 經(jīng)腹子宮全切除術(shù) 盆底功能障礙 經(jīng)會(huì)陰盆底超聲 壓力性尿失禁 盆腔臟器脫垂　出處：《山東大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年08期 　論文類型：期刊論文

【摘要】：目的探討經(jīng)腹子宮全切除術(shù)(TAH)后經(jīng)會(huì)陰盆底超聲評(píng)價(jià)患者早期盆底功能改變的價(jià)值。方法預(yù)行TAH 40例未絕經(jīng)患者,均在術(shù)前1周內(nèi)及術(shù)后3個(gè)月行經(jīng)會(huì)陰盆底超聲檢查,分別觀察其在靜息、收縮及Valsalva狀態(tài)的盆底情況,記錄Valsalva狀態(tài)的膀胱頸旋轉(zhuǎn)角度(△v BA),膀胱尿道后角(v UJV),膀胱頸、陰道穹窿及肛管直腸連接部移動(dòng)度(v BND、v FND、v AND),Valsalva狀態(tài)及收縮期肛提肌裂隙的變化度(△v M、△c M)等超聲參數(shù)16項(xiàng)。對(duì)比術(shù)前和術(shù)后3個(gè)月各超聲參數(shù),分析盆底功能的變化。結(jié)果根據(jù)盆底超聲各參數(shù)測(cè)量結(jié)果,診斷TAH術(shù)后出現(xiàn)膀胱脫垂、直腸脫垂、壓力性尿失禁等盆底功能障礙性疾病共7例,其中壓力性尿失禁2例,直腸脫垂3例,壓力性尿失禁合并膀胱脫垂1例,壓力性尿失禁合并膀胱脫垂、直腸脫垂1例;術(shù)后3個(gè)月△v BA、v UJV、△v UIA、v BND、v FND、v AND、vs B、vs F、vs A、△v M較術(shù)前比較有所增大,術(shù)后盆腔器官的活動(dòng)度增加,盆底組織抗腹壓功能減低;術(shù)后3個(gè)月v Dx B、vx F、vx A、△cx B、△cy B、△c M較術(shù)前比較有所減小,術(shù)后盆底肌肉及韌帶的支持能力減弱,肛提肌的收縮功能降低。上述參數(shù)差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 TAH后早期即可出現(xiàn)盆底功能降低,術(shù)后經(jīng)會(huì)陰盆底超聲檢查能在患者出現(xiàn)臨床癥狀之前發(fā)現(xiàn)盆底功能減退,為臨床早期干預(yù),延緩或預(yù)防盆底功能障礙性疾病的發(fā)生提供量化依據(jù)。
[Abstract]:Objective to evaluate the value of transperineal pelvic floor ultrasound in evaluating early pelvic floor function changes after total abdominal hysterectomy (TAH). Methods TAH was performed in 40 premenopausal patients. The pelvic floor was examined by transperineal pelvic floor ultrasound within 1 week before operation and 3 months after operation. The pelvic floor was observed in resting, contractile and Valsalva state. The rotation angle of bladder neck (v BAN), posterior horn of bladder urethra (v UJV), bladder neck, vagina fornix and anorectal junction were recorded in Valsalva. V FNDV ANDU Valsalva state and the change degree of the fissures of the levator ani muscle during systolic period (VM). The changes of pelvic floor function were analyzed by comparing the ultrasonic parameters before and 3 months after operation. Results according to the results of pelvic floor ultrasound parameters, bladder prolapse was diagnosed after TAH. There were 7 cases of pelvic floor dysfunction such as rectal prolapse and stress urinary incontinence, including 2 cases of stress urinary incontinence, 3 cases of rectal prolapse and 1 case of stress urinary incontinence with bladder prolapse. Stress urinary incontinence combined with bladder prolapse, rectal prolapse in 1 case; Three months after operation, v BAVV, v UIAA v BNDV ANDV vs BND v ANDV vs BN vs FN vs A. Compared with the pre-operation, VM increased, the pelvic organ activity increased, and the pelvic floor tissue anti-abdominal pressure function decreased. At 3 months after operation, vDX BX VX VX VX, CX B, CY B, CM decreased compared with those before operation, and the supporting ability of pelvic floor muscles and ligaments decreased after operation. The contractile function of levator ani muscle was decreased, and the difference of the above parameters was statistically significant (P 0.05). Conclusion the pelvic floor function can be decreased early after TAH. Transperineal pelvic floor ultrasound examination can find pelvic floor dysfunction before clinical symptoms, which provides quantitative basis for clinical early intervention, delay or prevention of pelvic floor dysfunction disease.
【作者單位】： 華北理工大學(xué)附屬醫(yī)院超聲科;華北理工大學(xué)臨床醫(yī)學(xué)院;
【分類號(hào)】：R445.1;R713.42
【正文快照】： 子宮全切除術(shù)是婦科常見的手術(shù)之一,根據(jù)手術(shù)途徑的不同一般分為開腹、陰式及腹腔鏡3種方式。美國(guó)每年行子宮全切除術(shù)者達(dá)60余萬人次[1-2]。由于子宮全切除術(shù)破壞盆底組織結(jié)構(gòu),已經(jīng)成為盆底功能障礙性疾病發(fā)生的重要影響因素之一[3-4],因此,患者術(shù)后盆底功能變化情況逐漸受到

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