發(fā)布時(shí)間：2018-03-10 04:37

  本文選題：隱匿性壓力性尿失禁　切入點(diǎn)：重度盆腔臟器脫垂　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的經(jīng)會(huì)陰超聲檢測(cè)女性重度盆腔臟器脫垂(POP)合并隱匿性壓力性尿失禁(OSUI)患者以及單純性重度盆腔臟器脫垂(POP)患者下尿路、膀胱頸及肛提肌的相關(guān)超聲學(xué)參數(shù),結(jié)合患者的術(shù)前婦科檢查進(jìn)行的盆腔器官脫垂定量評(píng)分系統(tǒng)(POP-Q)的相關(guān)分析,客觀的了解隱匿性尿失禁患者盆底組織形態(tài)學(xué)改變,評(píng)估經(jīng)會(huì)陰超聲及術(shù)前POP-Q評(píng)分在隱匿性尿失禁中的應(yīng)用及價(jià)值,進(jìn)而為重度POP合并隱匿性尿失禁的術(shù)前評(píng)估選擇提供新的思路及方法。資料與方法1研究對(duì)象2014年9月至2016年6月就診于鄭大三附院盆底重建病區(qū)79例重度POP患者,尿動(dòng)力學(xué)檢查是否合并壓力性尿失禁將其分為盆腔臟器脫垂(POP)合并隱匿性尿失禁組(OSUI)組和單純盆腔臟器脫垂(POP)組。分別記錄患者術(shù)前盆腔器官脫垂定量分度(POP-Q)評(píng)分、年齡、孕產(chǎn)次、脫垂情況等相關(guān)信息。2超聲參數(shù)分析經(jīng)會(huì)陰三維彩超分別測(cè)量患者靜息狀態(tài)及Valsalva動(dòng)作后尿道口形態(tài)、尿道傾斜角(UIA)、膀胱頸與恥骨聯(lián)合下緣的垂直距離(BN-S)及肛提肌裂孔面積(LHA)。計(jì)算尿道旋轉(zhuǎn)角度(URA)、膀胱頸移動(dòng)度(BND)。所有數(shù)據(jù)均錄入EXCEL表格。使用SPSS21.0統(tǒng)計(jì)軟件處理數(shù)據(jù)后比較兩組患者POP-Q評(píng)分及超聲各參數(shù)的差異性。3統(tǒng)計(jì)學(xué)方法采用SPSS 21.0統(tǒng)計(jì)軟件處理數(shù)據(jù)。計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差表示,即?X±S;計(jì)數(shù)資料描述其數(shù)量及比率,不符合正態(tài)性分布的計(jì)量資料以四分位間距表示。定量資料組間比較采用獨(dú)立樣本t檢驗(yàn),不符合正態(tài)性分布的定量資料組間對(duì)比采用獨(dú)立樣本的秩和(Z)檢驗(yàn)。定性資料組間對(duì)比采用x2檢驗(yàn)。檢驗(yàn)水準(zhǔn)取α=0.05,P值0.05為差異有統(tǒng)計(jì)學(xué)意義。診斷價(jià)值采用受試者工作特征(ROC)曲線分析。結(jié)果1.兩組的年齡、孕產(chǎn)次、脫垂程度等基本情況對(duì)比差異無統(tǒng)計(jì)意義2.對(duì)比單純盆腔臟器脫垂患者組,盆腔臟器脫垂合并隱匿性尿失禁的患者組POP-Q評(píng)分中Aa、Ba指示點(diǎn)有顯著差異,差異有統(tǒng)計(jì)學(xué)意義(P=0.028、P=0.003)。ROC曲線選取+2.5 cm為Aa指示點(diǎn)預(yù)測(cè)是否合并OSUI的閾值,ROC曲線下面積為0.642(95%CI為0.519~0.765,P=0.03),敏感度為75.6%,特異度為52.6%;選擇+3.5 cm為Ba指示點(diǎn)預(yù)測(cè)是否合并OSUI的閾值,ROC曲線下面積為0.699(95%CI為0.583~0.815,P=0.002),敏感度為92.7%,特異度為60.5%。3.靜息狀態(tài)下,盆腔臟器脫垂合并隱匿性尿失禁組肛提肌裂孔面積為(21.67±4.90)平方厘米。單純盆腔器官脫垂組肛提肌裂空面積為(18.97±5.27)平方厘米。兩組對(duì)比盆腔臟器脫垂合并隱匿性尿失禁組參數(shù)明顯增大,差異有統(tǒng)計(jì)學(xué)意義(P=0.021)。ROC曲線選取16.77 cm2為靜息狀態(tài)下肛提肌裂孔面積預(yù)測(cè)是否合并OSUI的閾值,ROC曲線下面積為0.647(95%CI為0.525~0.770,P=0.024),敏感度為87,8%,特異度為55.3%。4.Valsalva動(dòng)作后,盆腔臟器脫垂合并隱匿性尿失禁組肛提肌裂空面積為(31.82±7.14)平方厘米,單純盆腔臟器脫垂組肛提肌裂空面積為(26.32±6.60)平方厘米,兩組對(duì)比盆腔臟器脫垂合并隱匿性尿失禁組各參數(shù)均增大,差異有統(tǒng)計(jì)學(xué)意義(P=0.010)。ROC曲線選取31.05 cm2為Valsalva動(dòng)作下肛提肌裂孔面積預(yù)測(cè)是否合并OSUI的閾值,ROC曲線下面積為0.728(95%CI為0.614~0.841,P=0.000),敏感度為84.2%,特異度為58.3%。5.靜息狀態(tài)轉(zhuǎn)為Valsalva動(dòng)作后,盆腔臟器脫垂合并隱匿性尿失禁組膀胱頸的移動(dòng)度、尿道旋轉(zhuǎn)角度分別為(24.54±6.60)毫米、(77.49±19.76)度,單純盆腔臟器脫垂組膀胱頸的移動(dòng)度、尿道旋轉(zhuǎn)角度分別為(17.42±5.11)毫米、(67.94±15.91)度,兩組參數(shù)對(duì)比差異有顯著統(tǒng)計(jì)學(xué)意義(P=0.000、P=0.021)。膀胱頸的移動(dòng)度、尿道旋轉(zhuǎn)角度曲線下面積分別為0.451、0.521,診斷價(jià)值很低。6、盆腔器官脫垂合并隱匿性尿失禁組,在靜息狀態(tài)及Valsalva動(dòng)作漏斗形尿道口發(fā)生率為36.6%(15/41)、51.2%(21/41),單純盆腔臟器脫垂組在靜息狀態(tài)及Valsalva動(dòng)作后漏斗形尿道口發(fā)生率為15.8%(6/38)、23.7%(9/38),兩組兩種狀態(tài)下分別對(duì)比,差異具有統(tǒng)計(jì)學(xué)意義(P值均0.05)。結(jié)論1.重度盆腔臟器脫垂是否合并隱匿性尿失禁,POP-Q評(píng)分中反應(yīng)前盆腔指示點(diǎn)中Aa、Ba點(diǎn)與其有一定相關(guān)性。2.經(jīng)會(huì)陰超聲可以清晰、準(zhǔn)確的顯示盆底解剖學(xué)結(jié)構(gòu)形態(tài),同時(shí)可動(dòng)態(tài)觀查盆底組織由靜息狀態(tài)到Valsalva動(dòng)作解剖學(xué)結(jié)構(gòu)的改變,可以為重度盆腔臟器是否合并OSUI提供影像學(xué)基礎(chǔ)的解剖學(xué)定位。3.肛提肌是盆腔完整支持組織的首要的部分,肛提肌的損傷會(huì)導(dǎo)致盆底整體構(gòu)造的異常,導(dǎo)致重度盆腔臟器合并隱匿性尿失禁的發(fā)生,肛提肌裂孔面積可為是否合并隱匿性尿失禁提供依據(jù)。4.術(shù)前評(píng)估重度POP患者中,POP-Q評(píng)分結(jié)合盆底超聲多參數(shù)的觀察及測(cè)量,可以提高隱匿性尿失禁的診斷率及準(zhǔn)確性,為術(shù)前評(píng)估提供新的思路及方法。
[Abstract]:The purpose of transperineal ultrasound detection of female pelvic organ prolapse (POP) with occult stress urinary incontinence (OSUI) patients and simple pelvic organ prolapse (POP) patients with lower urinary tract, related to ultrasonic levator muscle of bladder neck and anus parameters, combined with pelvic organ prolapse quantitative scoring system of patients with gynecological examination before the (POP-Q) correlation analysis, objective understanding of the morphological changes of occult patients with urinary incontinence pelvic tissue, evaluate transperineal ultrasound and preoperative POP-Q score and application value in the occult incontinence, and to evaluate the choice to provide new ideas and methods of severe POP patients with occult urinary incontinence before operation. Materials and methods 1 research objects from September 2014 to June 2016 at the Zheng Dasan hospital in 79 cases of severe pelvic floor reconstruction in patients with POP, urodynamic examination with stress urinary incontinence and pelvic organ will be divided into Vertical (POP) with occult urinary incontinence group (OSUI group) and simple pelvic organ prolapse (POP) group. The patients were recorded before operation of pelvic organ prolapse quantitation (POP-Q) score, age, gravidity, prolapse and other related information.2 to analyse the ultrasonic parameters were measured in patients with resting state and Valsalva action of transperineal three-dimensional ultrasound after urethral mouth shape, urethral angle (UIA), the vertical distance between the bladder neck and the lower edge of the symphysis (BN-S) and levator hiatus area (LHA). The calculation of rotation angle (URA), transurethral resection of the bladder neck mobility (BND). All the data were input into EXCEL table. The difference was.3 methods using SPSS21.0 statistical software to process data of two groups were compared after POP-Q score and ultrasonic parameters using SPSS 21 statistical software to process data. The measurement data expressed by the mean and standard deviation, namely? X + S; count data. The number and ratio, do not accord with normal The measurement data of the said distribution with four points spacing. Comparison between quantitative data were analyzed by independent sample t test, does not meet the normal distribution of the quantitative data between the groups by using independent sample rank sum test (Z). The qualitative data comparison between the two groups by x2 test. Take a =0.05 level test, P value of 0.05 the difference was statistically significant. The diagnostic value of the receiver operating characteristic (ROC) curve analysis. Results 1. two groups of age, gravidity, prolapse degree difference had no statistical significance of the basic situation of 2. compared to pure pelvic organ prolapse patients, pelvic organ prolapse with occult urinary incontinence in patients with POP-Q score in Aa group Ba, indicating there is a significant difference, the difference was statistically significant (P=0.028, P=0.003).ROC +2.5 cm Aa curve indicating point prediction with OSUI threshold, ROC area under the curve was 0.642 (95%CI, 0.519~0.765, P= 0.03), the sensitivity was 75 .6%, the specificity was 52.6%; +3.5 cm Ba selection indicator point prediction with OSUI threshold, ROC area under the curve was 0.699 (95%CI, 0.583~0.815, P=0.002), the sensitivity was 92.7%, specificity of 60.5%.3. in resting state, pelvic organ prolapse with occult urinary incontinence group levator hiatus area (21.67 + 4.90) cm. Simple pelvic organ prolapse group levator hiatus area (18.97 + 5.27) cm. Two groups of pelvic organ prolapse with occult urinary incontinence group parameters increased significantly, the difference was statistically significant (P=0.021).ROC curve 16.77 cm2 levator hiatus area to predict whether the merger the OSUI threshold for the resting state of anus, area under the ROC curve was 0.647 (95%CI, 0.525~0.770, P=0.024), the sensitivity is 87,8%, the specificity of 55.3%.4.Valsalva action, pelvic organ prolapse with occult urinary incontinence group levator hiatus area (31.82 + 7.14) cm, simple pelvic organ prolapse group levator hiatus area (26.32 + 6.60) cm, between the two groups of pelvic organ prolapse with occult urinary incontinence group parameters were increased, the difference was statistically significant (P=0.010).ROC curve 31.05 cm2 levator hiatus area prediction with OSUI threshold is Valsalva under the action of anus, area under the ROC curve was 0.728 (95%CI, 0.614~0.841, P=0.000), the sensitivity was 84.2%, specificity of 58.3%.5. in resting state to Valsalva after operation, pelvic organ prolapse with occult urinary incontinence group of bladder neck mobility, urethral rotation respectively (24.54. 6.60 mm), (77.49 + 19.76), simple group of bladder pelvic organ prolapse neck mobility, urethral rotation angle respectively (17.42 + 5.11) mm, (67.94 + 15.91), the two groups have statistical significance of parameter difference (P=0.000, P=0.02 1). The bladder neck mobility, the area under the curve of urethral rotation angle were 0.451,0.521, the diagnostic value of.6 was very low, pelvic organ prolapse with occult urinary incontinence group in the resting state and Valsalva action funnel-shaped urethra incidence rate was 36.6% (15/41), 51.2% (21/41), simple pelvic organ prolapse group funnel in the resting state and after Valsalva action form urethral mouth occurrence rate was 15.8% (6/38), 23.7% (9/38), the two groups under two different conditions were compared, the difference was statistically significant (P < 0.05). Conclusion: 1. pelvic organ prolapse and whether occult urinary incontinence, pelvic anterior point indication in Aa reaction the score of POP-Q, Ba and.2. have a certain correlation transperineal ultrasound can clearly display the pelvic anatomy structure accurately, at the same time, the dynamic inspection of pelvic tissue from resting state to the Valsalva movement anatomy structure change, can be severe pelvic viscera Anus anatomical location.3. combined with OSUI imaging based on levator muscle is the most important part of the complete pelvic supporting tissue, levator ani muscle injury may lead to abnormal integral structure, leading to severe pelvic organ with occult urinary incontinence, levator hiatus area can be with occult urine provide the basis for.4. incontinence preoperative evaluation in patients with severe POP, POP-Q score of observation and measurement combined with pelvic ultrasound parameters, can improve the diagnostic accuracy rate and occult urinary incontinence, to provide new ideas and methods for preoperative evaluation.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R711.2;R711.59

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 朱蘭;婁文佳;郎景和;孫智晶;陳娟;范融;劉小春;商曉;;無穿刺加用網(wǎng)片盆底重建術(shù)治療癥狀性Ⅱ～Ⅲ度盆腔器官脫垂的近期療效分析[J];實(shí)用婦產(chǎn)科雜志;2011年03期

2 葛靜;魯永鮮;張弈;黎新宇;;北京地區(qū)成年女性尿失禁患病率及就診率調(diào)查[J];中國(guó)婦產(chǎn)科臨床雜志;2010年01期

，

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