本文關鍵詞： 盆底超聲 女性壓力性尿失禁 膀胱脫垂分型 尿道括約肌缺陷　出處：《蘭州大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的本研究主要探討經(jīng)會陰盆底二維超聲、實時三維超聲在女性壓力性尿失禁(stress urinary incontinence,SUI)中的表現(xiàn),研究盆底超聲關于膀胱、尿道的各參數(shù)測量值在SUI中的臨床意義,尤其是膀胱頸部“漏斗”形成及尿道括約肌厚度評估尿道括約肌缺陷在女性SUI患者中的意義;同時經(jīng)會陰盆底超聲評估前盆腔膀胱脫垂不同分型的表現(xiàn),并進一步分析不同膀胱脫垂分型與女性SUI之間的相關性。資料與方法首先對經(jīng)臨床或尿動力學證實的女性SUI或前盆腔膀胱脫垂患者進行基本信息采集,包括年齡、身高、體重、生育史、絕經(jīng)史、產后康復訓練史、重體力勞動史、臨床癥狀進行對比分析;將其分為壓力性尿失禁組(SUI組)、膀胱脫垂組,回顧性分析每組患者的盆底超聲測量參數(shù),包括在靜息狀態(tài)下膀胱逼尿肌的厚度、膀胱頸及膀胱后壁最低點位置距恥骨聯(lián)合(Symphysis Pubis,SP)的距離、尿道傾斜角、膀胱尿道后角(posterior urethrovesical angle,PUA)及膀胱頸漏斗形成等,最大Valsalva狀態(tài)膀胱頸及膀胱后壁最低點位置距SP的距離、尿道傾斜角、PUA及膀胱頸“漏斗”形成等,分析計算膀胱頸及膀胱后壁最低點的移動度、尿道旋轉角,評估膀胱脫垂的不同分型;同時在靜息狀態(tài)下測量尿道中段括約肌的厚度,對比尿動力學評估尿道括約肌缺陷(Intrinsic Urethral Sphincter Deficiency,ISD)。實時三維超聲及斷層成像模式下,觀察靜息狀態(tài)及Valsalva狀態(tài)下雙側肛提肌的對稱性、完整性及最大Valsalva狀態(tài)下肛提肌裂孔的面積大小。正常體檢女性為對照組。結果(1)最大Valsalva狀態(tài)下,SUI組中患者的膀胱頸“漏斗”形成率66%明顯高于對照組患者5%,有統(tǒng)計學差異(P0.05);(2)SUI組患者的膀胱頸部下降值及PUA明顯大于對照組,差異均有統(tǒng)計學意義(P0.05);(3)SUI組經(jīng)尿動力學證實有ISD 9例,均出現(xiàn)膀胱頸“漏斗”形成,其尿道中段括約肌厚度與無尿道括約肌缺陷及正常對照組的尿道括約肌厚度對比,差異無明顯統(tǒng)計學意義(P0.05);(4)經(jīng)會陰超聲診斷SUI組膀胱尿道膨出73例,孤立性膀胱膨出10例,脫垂組膀胱尿道膨出37例,孤立性膀胱膨出41例,SUI組與脫垂組的膀胱脫垂分型有統(tǒng)計學差異(P0.05);(5)不論SUI組或脫垂組,膀胱尿道膨出與孤立性膀胱膨出的膀胱頸部下降值無明顯差異(P0.05),而兩種不同膀胱膨出類型的膀胱后壁最低點下降值、PUA及尿道旋轉角有明顯統(tǒng)計學差異(P0.05);(6)Valsalva動作后,SUI組、脫垂組與對照組相互比較,膀胱頸及膀胱后壁下降值、PUA、尿道旋轉角等均有統(tǒng)計學差異(P0.05)。結論(1)經(jīng)會陰盆底超聲可動態(tài)評估SUI和膀胱脫垂患者的盆底解剖結構,可為臨床診斷及治療盆底功能障礙疾病提供一種經(jīng)濟、簡便、實用的影像學方法;(2)膀胱頸及膀胱后壁最低點下降值、PUA、尿道旋轉角等超聲指標在評估SUI及膀胱脫垂患者中有一定的指導意義;(3)膀胱頸“漏斗”形成是SUI的重要指征,與盆底支持組織結構功能受損、ISD密切相關,但通過尿道括約肌的厚度評估ISD還需要進一步研究;(4)經(jīng)會陰盆底超聲能夠根據(jù)超聲各測量指標診斷不同膀胱脫垂類型,不同膀胱脫垂類型的盆底解剖結構改變不同,其病理解剖及形成的原因也不同,其中膀胱尿道膨出與SUI關系密切。
[Abstract]:The purpose of this research is to investigate the transperineal pelvic two-dimensional echocardiography, real-time three-dimensional echocardiography in female stress urinary incontinence (stress urinary, incontinence, SUI) in the performance of the pelvic floor ultrasound on bladder, urethral measured the parameters value of clinical significance in SUI, especially the bladder neck funnel formation and urethral sphincter thickness assessment the significance of urethral sphincter defects in female patients with SUI; at the same time the transperineal ultrasound assessment of pelvic anterior pelvic prolapse of bladder in different types of performance, and further analysis of the different points the relationship between bladder prolapse and female SUI. Materials and methods firstly confirmed by clinical or urodynamics female SUI or anterior pelvic prolapse of bladder basic information collection, including age, height, weight, family history, menopause, postpartum rehabilitation training history, heavy labor history, to analysis the clinical symptoms; Stress urinary incontinence group (SUI group), bladder prolapse group, retrospective analysis of pelvic ultrasound measurement parameters of patients in each group, including in the resting state of the detrusor thickness, bladder neck and bladder wall after the lowest position from the pubic symphysis (Symphysis Pubis SP) distance, urethral angle, posterior urethra vesical angle (posterior urethrovesical angle, PUA) and bladder neck funnel formation, the largest Valsalva state of bladder neck and bladder wall after the lowest point of distance from SP, the urethra and bladder neck angle, PUA "funnel" formation, analysis and calculation of bladder neck and bladder wall after low mobility, urethral rotation angle and different types of assessment of bladder prolapse; mid urethral sphincter and measured in the resting state of the thickness, comparison of urodynamic evaluation of urethral sphincter defects (Intrinsic Urethral Sphincter Deficiency, ISD) by real-time three-dimensional echocardiography and fault. The imaging mode, observe the symmetry of the levator muscle of the resting state and the Valsalva state of the integrity of the bilateral anal, Valsalva state and the maximum size of levator ani muscle hiatus. Normal healthy women as control group. Results (1) the maximum under the condition of Valsalva, patients in the SUI group of bladder neck "funnel" formation rate 66% of 5% patients was significantly higher than the control group, there was significant difference (P0.05); (2) SUI patients with bladder neck drop value and PUA significantly higher than the control group, the differences were statistically significant (P0.05); (3) SUI group by urodynamics confirmed 9 cases of ISD were bladder neck "funnel" formation. The thickness of the urethral sphincter mid urethral sphincter thickness contrast and urethral sphincter defects and the normal control group, the difference was not statistically significant (P0.05); (4) the transperineal ultrasound diagnosis of SUI group bladder urethral prolapse in 73 cases, 10 cases of solitary bladder prolapse, bladder and urethral prolapse group. Out of 37 cases, 41 cases of isolated cystocele, SUI group and the group of prolapse of bladder prolapse type had significant difference (P0.05); (5) either group SUI or group prolapse, cystourethrocele and isolated cystocele decreased bladder neck had no significant difference (P0.05), and the lowest value decline wall two different types of bladder after cystocele, PUA and urethral rotation angle has significant difference (P0.05); (6) after the action of Valsalva, SUI group, prolapse group and control group comparison, bladder neck and bladder wall decrease, PUA, urethral rotation angle were statistically different (P0.05) conclusion. (1) dynamic transperineal pelvic floor ultrasound assessment of SUI and bladder prolapse pelvic structure, can provide an economic, clinical diagnosis and treatment of pelvic floor dysfunction is simple and practical method of imaging; (2) bladder neck and bladder wall after the lowest point decline in the value of PUA, urethral rotation angle super The sound index has certain guiding significance in the assessment of SUI and bladder prolapse; (3) bladder neck "funnel" formation is the important indication of SUI, and the pelvic floor structure function damaged, closely related to the ISD, but through the thickness evaluation of ISD urethral sphincter is also the need for further research; (4) the transperineal pelvic floor according to the measurements of ultrasound ultrasound in diagnosis of bladder prolapse of different types, different types of pelvic floor prolapse of bladder anatomical changes, the pathological anatomy and the causes are different, the bladder urethrocele has close relationship with SUI.

【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R711.59;R445.1

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