本文選題：盆底超聲 + 壓力性尿失禁��； 參考：《中華全科醫(yī)學(xué)》2016年08期

【摘要】：目的探討盆底超聲在觀察產(chǎn)后近期壓力性尿失禁患者前腔室結(jié)構(gòu)變化的應(yīng)用價(jià)值。方法隨機(jī)選取經(jīng)陰道自然分娩、并在產(chǎn)后6~8周接受產(chǎn)后復(fù)查的初產(chǎn)婦182例進(jìn)行經(jīng)會(huì)陰盆底超聲檢查,其中壓力性尿失禁組(SUI組)72例,對(duì)照組110例。觀察靜息狀態(tài)下及最大Valsalva動(dòng)作時(shí)前腔室結(jié)構(gòu)的超聲改變。超聲觀察及測量的參數(shù)包括:靜息狀態(tài)下膀胱頸位置、逼尿肌厚度、膀胱后角以及最大Valsalva動(dòng)作時(shí)膀胱頸的移動(dòng)度、尿道旋轉(zhuǎn)角、有無尿道內(nèi)口漏斗形成、有無膀胱膨出。結(jié)果靜息狀態(tài)下SUI組的逼尿肌厚度為(3.21±0.86)mm,對(duì)照組為(3.11±0.76)mm,2組差異無統(tǒng)計(jì)學(xué)意義(t=0.798,P=0.426),但靜息狀態(tài)下SUI組膀胱頸位置更低[(23.61±4.57)mm vs.(25.35±4.05)mm]、膀胱后角更大[(134.14±21.04)°vs.(114.29±10.53)°],差異有統(tǒng)計(jì)學(xué)意義(t值分別為-2.697、8.422,P值分別為0.008、0.000)。最大Valsalva動(dòng)作時(shí)膀胱頸移動(dòng)度[(30.39±8.37)mm vs.(21.82±7.65)mm]和尿道旋轉(zhuǎn)角[(45.21±12.78)°vs.(33.25±14.58)°]SUI組均較對(duì)照組明顯增大,2組比較差異有統(tǒng)計(jì)學(xué)意義(t值分別為7.115、5.673,P值均為0.000),尿道內(nèi)口漏斗形成率(55.56%vs.30.00%)、膀胱膨出率(63.89%vs.24.55%)SUI組亦增高,差異均有統(tǒng)計(jì)學(xué)意義(χ2值分別為11.831、28.041,P值分別為0.001、0.000)。結(jié)論產(chǎn)后壓力性尿失禁的發(fā)生與膀胱頸、尿道支持結(jié)構(gòu)及肛提肌的損傷有關(guān)。利用盆底超聲動(dòng)態(tài)觀察前腔室結(jié)構(gòu)和功能狀態(tài),可早期發(fā)現(xiàn)盆底組織異常改變,為臨床及早診治產(chǎn)后壓力性尿失禁提供客觀依據(jù)。
[Abstract]:Objective to investigate the value of pelvic floor ultrasound in observing the changes of anterior chamber structure in patients with postpartum stress urinary incontinence. Methods 182 cases of primipara undergoing postpartum reexamination at 6 and 8 weeks after delivery were randomly selected for transperineal pelvic floor ultrasound examination. 72 cases in the SUI group and 110 cases in the control group in the stress urinary incontinence group were examined by transperineal pelvic floor ultrasound. The ultrasonic changes of anterior chamber structure were observed at rest and maximum Valsalva motion. The parameters included bladder neck position, detrusor thickness, bladder posterior angle and the movement of bladder neck during maximum Valsalva movement, urethral rotation angle, urethral funnel formation and vesicocele. Results the detrusor thickness of SUI group was 3.21 鹵0.86 鹵0.86 mm in resting state, while that in control group was 3.11 鹵0.76 mm, but the position of bladder neck in SUI group was lower [23.61 鹵4.57)mm vs.(25.35 鹵4.05)mm] and the posterior horn of bladder was larger [134.14 鹵21.04 擄vs.(114.29 鹵10.53 擄]. The bladder neck movement degree [30.39 鹵8.37)mm vs.(21.82 鹵7.65)mm] and the urethral rotation angle [45.21 鹵12.78 擄vs.(33.25 鹵14.58 擄] in the maximal Valsalva movement group were significantly larger than those in the control group. The significant difference was found between the two groups (P = 7.115, 5.673P, P = 0.000,55.56vs.30.00,65.56vs.30.00,63.89vs.24.55SUI). The difference was statistically significant (蠂 ~ 2 = 11.831 鹵28.041) (P = 0.001 ~ 0.000). Conclusion postpartum stress urinary incontinence is related to the injury of bladder neck, urethral supporting structure and levator ani muscle. Dynamic observation of the structure and function of anterior chamber by pelvic floor ultrasound can early find abnormal changes of pelvic floor tissue and provide objective basis for early diagnosis and treatment of postpartum stress urinary incontinence.
【作者單位】： 廣東藥學(xué)院附屬第一醫(yī)院超聲科;
【基金】：廣東省醫(yī)學(xué)科研基金資助項(xiàng)目(A2014366)
【分類號(hào)】：R445.1;R714.6
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本文編號(hào)：2048166