本文選題：經(jīng)會(huì)陰三維超聲 + 盆膈裂孔　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:采用經(jīng)會(huì)陰三維超聲觀察子宮全切術(shù)后患者盆膈裂孔的形態(tài),探討經(jīng)會(huì)陰盆底三維超聲對(duì)子宮全切術(shù)后患者盆底功能評(píng)估的臨床應(yīng)用價(jià)值;對(duì)比子宮全切術(shù)后患者與正常生育后女性盆底結(jié)構(gòu)的靜態(tài)及動(dòng)態(tài)學(xué)變化,探討子宮全切手術(shù)對(duì)盆底功能的影響。方法:選取2015年1月到2016年12月子宮全切術(shù)后1年來濟(jì)寧醫(yī)學(xué)院附屬醫(yī)院救診的患者50例作為研究對(duì)象,選取因月經(jīng)不調(diào)、陰道炎等癥狀來我院婦科就診的50例未行子宮切除術(shù)的產(chǎn)后婦女作為對(duì)照組。采用美國GE VOLUSON E8彩色多普勒診斷儀,配置RIC5-9-D三維容積經(jīng)腹部3D/4D凸陣探頭(RAB6-D),頻率5-9Mhz,最大掃描角度120°。病例組與對(duì)照組在同一盆底超聲檢查條件下完成圖像采集,以恥骨聯(lián)合下緣作為參考點(diǎn),分別測(cè)量患者在靜息狀態(tài)、Valsalva動(dòng)作和縮肛狀態(tài)下盆膈裂孔的前后徑、橫徑、面積及恥骨直腸肌厚度等相關(guān)參數(shù)。對(duì)比分析研究組與對(duì)照組不同參數(shù)的統(tǒng)計(jì)學(xué)差異。結(jié)果:1.經(jīng)會(huì)陰三維超聲可清晰顯示所有患者盆膈裂孔并測(cè)量其前后徑、橫徑及面積;2.研究組與對(duì)照組相比較:縮肛狀態(tài)下,兩組盆膈裂孔橫徑比較無明顯統(tǒng)計(jì)學(xué)意義(p0.05),在靜息狀態(tài)、Valsalva狀態(tài)及縮肛狀態(tài)下盆膈裂孔的前后徑、面積大小以及恥骨直腸肌的厚度兩組比較有統(tǒng)計(jì)學(xué)差異(p0.05),且研究組盆膈裂孔前后徑、面積及恥骨直腸肌的厚度均高于對(duì)照組,其中Valsalva狀態(tài)下盆膈裂孔面積變化兩組比較有顯著的統(tǒng)計(jì)學(xué)差異;3.子宮切除組在Valsalva動(dòng)作中,出現(xiàn)了膀胱頸位置低下,膀胱頸、膀胱最低點(diǎn)降至恥骨聯(lián)合下緣水平參考線足側(cè)以及盆膈裂孔面積的增大,結(jié)合臨床及盆底超聲測(cè)量結(jié)果診斷子宮全切術(shù)后盆底功能障礙(28)例。結(jié)論:1.經(jīng)會(huì)陰三維超聲可以動(dòng)態(tài)觀察女性盆膈裂孔平面的解剖結(jié)構(gòu)、位置及運(yùn)動(dòng)。2.子宮全切組與正常未切除組在三種不同狀態(tài)下,均能夠?qū)ε桦趿芽椎拇笮�、形態(tài)進(jìn)行有效評(píng)估,對(duì)盆膈裂孔的形態(tài)改變具有較好的診斷價(jià)值;3.子宮全切除組與正常未切除組在三種不同狀態(tài)下盆膈裂孔各參數(shù)變化,可間接提示女性盆底功能不全性疾病的發(fā)生;4.通過子宮全切除組與正常未切除組盆膈裂孔參數(shù)的比較,提示子宮全切手術(shù)對(duì)女性盆底支持結(jié)構(gòu)存在影響,希望為臨床改良手術(shù)方式、減少女性盆底功能不全性疾病的發(fā)生提供理論支持。
[Abstract]:Objective: to observe the shape of pelvic and phrenic hiatus after hysterectomy by transperineal three-dimensional ultrasound, and to explore the clinical application value of transperineal pelvic floor three-dimensional ultrasound in the evaluation of pelvic floor function after hysterectomy. To investigate the effect of total hysterectomy on pelvic floor function, the static and dynamic changes of pelvic floor structure in women after hysterectomy and normal birth were compared. Methods: from January 2015 to December 2016, 50 patients who had been rescued from the affiliated Hospital of Jining Medical College were selected as the subjects of the study. Vaginitis and other symptoms came to our hospital gynecological treatment of 50 postpartum women without hysterectomy as the control group. A GE VOLUSON E8 color Doppler diagnostic instrument was used in this study. The RIC5-9-D 3D volume was transabdominal 3D/4D convex array probe with a frequency of 5-9 MHz and a maximum scanning angle of 120 擄. The patients in the case group and the control group completed the image collection under the same pelvic floor ultrasound condition. The lower margin of pubic symphysis was used as the reference point to measure the anteroposterior and transverse diameters of the pelvic and phrenic fissure in the resting state of Valsalva and the contraction of the anus. Area and thickness of pubic rectum muscle. The statistical differences of different parameters between the study group and the control group were compared and analyzed. The result is 1: 1. Transperineal 3D ultrasound could clearly display the pelvic diaphragm hiatus and measure the anteroposterior diameter, transverse diameter and area of all patients. Compared with the control group, the transverse diameter of the pelvic diaphragm hiatus in the two groups was not significantly different from that in the control group (P < 0.05), but the anteroposterior diameter of the pelvic diaphragm fissure in the resting state and in the anus contraction state. The area size and the thickness of puborectum muscle were significantly different between the two groups (p 0.05), and the anterior and posterior diameter, area and thickness of the puborectum muscle in the study group were higher than those in the control group. There was significant statistical difference between the two groups in the area change of the pelvic diaphragm hiatus under Valsalva. In the hysterectomy group, the position of the bladder neck was low, the lowest point of the bladder decreased to the horizontal reference line of the lower margin of the pubic symphysis and the area of the pelvic and phrenic fissure increased in the Valsalva group. 28 cases of pelvic floor dysfunction were diagnosed after hysterectomy combined with clinical and pelvic floor ultrasonography. Conclusion 1. The transperineal three-dimensional ultrasound can dynamically observe the anatomical structure, position and movement of the pelvic phrenic hiatus in women. The total hysterectomy group and the normal unresectable group could effectively evaluate the size and shape of the pelvic diaphragm hiatus in three different states, and had a better diagnostic value for the morphological changes of the pelvic diaphragm hole. The changes of the parameters of pelvic and phrenic hole in total hysterectomy group and normal unresectable group under three different conditions may indirectly indicate the occurrence of pelvic floor insufficiency disease in female. By comparing the parameters of pelvic and phrenic hiatus between the total hysterectomy group and the normal unresectable group, it is suggested that the total hysterectomy has an effect on the pelvic floor supporting structure of the female. To reduce the incidence of pelvic floor dysfunction in women provides theoretical support.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.1;R713.42

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