女性壓力性尿失禁應用TVT-O治療術(shù)中超聲參數(shù)分析
發(fā)布時間：2019-03-18 19:20
【摘要】：目的：隨著診療技術(shù)的不斷更新發(fā)展,以及女性患者對疾病本身認識和對生活質(zhì)量的要求不斷提高,在臨床上工作中女性壓力性尿失禁患者越來越多見,就診率的提高,更要求我們有比較系統(tǒng)的診治體系�，F(xiàn)在臨床上對SUI患者的治療,輕度主要以藥物、鍛煉等保守措施進行醫(yī)治,而對于中重度患者常采取外科手術(shù)以達到緩解或治愈。手術(shù)治療,是我們對中重度SUI患者在臨床上療效較為肯定的治療方式,TVT-O術(shù)式的出現(xiàn),成為我們臨床上一個較好的手術(shù)方式,此手術(shù)較之前的TVT或TOT手術(shù)更減小了術(shù)中對膀胱或其他腹內(nèi)臟器的損傷,但是因為無特殊的參數(shù),在術(shù)中對患者進行的手術(shù)操作大部分是憑借手術(shù)醫(yī)師長期的經(jīng)驗,使用咳嗽-漏尿等實驗對吊帶放置的松緊程度進行大致的判斷,以便對術(shù)后的恢復情況進行預測和評估。我們的研究是對SUI患者行經(jīng)陰道閉孔無張力尿道中段懸吊術(shù)(Tension-free vaginal tape-obturator, TVT-O),并應用經(jīng)會陰超聲來觀察術(shù)中盆腔的膀胱、尿道等情況實時圖像,同時對TVT-O手術(shù)前后膀胱和尿道超聲學參數(shù)進行分析并和對照組數(shù)據(jù)進行比較。 方法：本實驗設置SUI組21例和對照組17例,SUI組選擇在2012年2月——2014年2月在我院因壓力性尿失禁行TVT-O術(shù)的女性患者,而對照組選擇健康的體檢人群。根據(jù)下文中的詳細入組條件,對入組的人群進行嚴格挑選,在年齡、孕次、產(chǎn)次、體重指數(shù)無統(tǒng)計學差異的條件下進行我們的研究。術(shù)前對兩個研究組的人員分別進行評估,對于入選實驗的人員進行一般檢查和超聲檢查。被研究對象取截石位,預設膀胱容量為300ml,在靜息和Valsalva狀態(tài)下用超聲對盆腔內(nèi)器官和解剖結(jié)構(gòu)進行觀察,以測量膀胱頸活動度、膀胱尿道后角、吊帶角度和尿道角等相關(guān)參數(shù)。對SUI組的患者還需進行尿動力學、指壓實驗等,TVT-O術(shù)后重復測量以上數(shù)值。最后對所得數(shù)值分別進行對比分析,即SUI組手術(shù)前后、SUI組術(shù)前和對照組以及SUI組術(shù)后和對照組分別進行對照研究,以判斷其對手術(shù)效果的影響。 結(jié)果：對所得到的超聲參數(shù)使用SPSS應用t檢驗進行比較,通過實驗數(shù)據(jù)及計算結(jié)果可以看出,TVT-O術(shù)后的膀胱頸活動度和膀胱尿道后角和術(shù)前相比均減小(p0.001),但是和對照組的超聲參數(shù)相比無統(tǒng)計學差異(p0.05),而尿道角的統(tǒng)計結(jié)果和前兩個數(shù)值相反,術(shù)后的超聲參數(shù)和術(shù)前參數(shù)相比是增大的。SUI組與對照組的參數(shù)是有統(tǒng)計學意義的,而SUI組在術(shù)后和對照組的參數(shù)是無統(tǒng)計學意義。在術(shù)前,SUI組患者的膀胱頸活動度和膀胱尿道后角和對照組相比均較大。 結(jié)論：中、重度壓力性尿失禁的女性患者使用TVT-O手術(shù)在臨床上有著較好的療效,且手術(shù)操作相對便捷,恢復較快,不良并發(fā)癥較少。尿道的高活動性是女性壓力性尿失禁發(fā)病機制之一。超聲在術(shù)中對膀胱和尿道的參數(shù)及TVT-O吊帶的定位發(fā)揮重要作用。術(shù)中的超聲參數(shù)可作為TVT-O吊帶的位置參考。
[Abstract]:Objective: With the continuous development of the diagnosis and treatment technology, as well as the improvement of the requirement of the female patients to the disease itself and the quality of life, the patients with stress urinary incontinence are more and more common in the clinical work, and the rate of the visit is increased. We are more demanding that we have a system of diagnosis and treatment of the system. The treatment of the SUI patients is now clinically indicated, and the mild is mainly treated by conservative measures such as medicine, exercise and the like, and the surgical operation is often taken for moderate and severe patients to achieve the remission or cure. Surgical treatment is a more positive treatment for patients with moderate to severe SUI, and the occurrence of TVT-O operation is a good surgical method in our clinical practice. The previous TVT or TOT procedure has reduced the damage to the bladder or other internal organs in the operation. However, because there is no special parameter, most of the operation performed by the patient during the operation is based on the experience of the surgeon for a long time, and the degree of tightness of the hanging strip is judged by using the experiments such as cough and urine leakage, so as to predict and evaluate the postoperative recovery. Our study was to apply transvaginal closed-cell suspension (TVT-O) to SUI patients without tension-free vaginal tape-obtuator (TVT-O), and to apply transperineal ultrasound to observe real-time images of the bladder, urethra, etc. of the pelvis. At the same time, the parameters of the bladder and the urethra before and after TVT-O operation were analyzed and compared with the control data. Methods: In this experiment,21 cases of SUI group and 17 cases of control group were set. The group of SUI was selected to be a female patient with TVT-O operation in our hospital from February to February,2014. The population of the enrolled group was selected strictly according to the detailed entry conditions set out below, and our study was conducted under the conditions of age, pregnancy, birth, and body mass index without statistical difference. Study. The personnel of the two study groups were evaluated before operation, and the general and ultrasonic tests were performed on the personnel selected for the experiment. The internal organs and the anatomical structure of the pelvic cavity were observed under the condition of resting and Valsalva in order to measure the range of the bladder neck, the posterior angle of the urinary bladder, the angle of the sling and the angle of the urethra. The number of patients in the SUI group should also be subject to urodynamics, finger pressure test, etc., and the above number should be repeated after TVT-O. The results were compared with the control group before and after the operation of the SUI group and the control group after the operation of the SUI group and the control group. Results: The obtained ultrasonic parameters were compared with the t-test of the SPSS. The results of the experimental data and the calculation results showed that the bladder neck motion and the posterior angle of the bladder after TVT-O were all decreased compared with that of the pre-operation (p0.05). 01), but no statistical difference (p0.05) was found in the ultrasound parameters of the control group, whereas the statistical results for the urethral angle and the first two values were opposite, and the postoperative ultrasound parameters were compared to the pre-operative parameters The parameters of the SUI group and the control group were statistically significant and the parameters of the SUI group and the control group were not statistically significant. Study significance. Before the operation, the bladder neck motion of the patients in the SUI group and the posterior angle of the urinary bladder were compared with the control group. Conclusion: The use of TVT-O in female patients with moderate and severe stress urinary incontinence has a good curative effect in clinic, and the operation is relatively convenient, and the recovery is fast and bad. Low complications. The high mobility of the urethra is a female stress urinary incontinence. One of the mechanisms of the disease mechanism. The parameters of the bladder and the urethra and the positioning of the TVT-O sling during the operation The intraoperative ultrasound parameters can be used as TVT-O sling
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R699
本文編號：2443154
[Abstract]:Objective: With the continuous development of the diagnosis and treatment technology, as well as the improvement of the requirement of the female patients to the disease itself and the quality of life, the patients with stress urinary incontinence are more and more common in the clinical work, and the rate of the visit is increased. We are more demanding that we have a system of diagnosis and treatment of the system. The treatment of the SUI patients is now clinically indicated, and the mild is mainly treated by conservative measures such as medicine, exercise and the like, and the surgical operation is often taken for moderate and severe patients to achieve the remission or cure. Surgical treatment is a more positive treatment for patients with moderate to severe SUI, and the occurrence of TVT-O operation is a good surgical method in our clinical practice. The previous TVT or TOT procedure has reduced the damage to the bladder or other internal organs in the operation. However, because there is no special parameter, most of the operation performed by the patient during the operation is based on the experience of the surgeon for a long time, and the degree of tightness of the hanging strip is judged by using the experiments such as cough and urine leakage, so as to predict and evaluate the postoperative recovery. Our study was to apply transvaginal closed-cell suspension (TVT-O) to SUI patients without tension-free vaginal tape-obtuator (TVT-O), and to apply transperineal ultrasound to observe real-time images of the bladder, urethra, etc. of the pelvis. At the same time, the parameters of the bladder and the urethra before and after TVT-O operation were analyzed and compared with the control data. Methods: In this experiment,21 cases of SUI group and 17 cases of control group were set. The group of SUI was selected to be a female patient with TVT-O operation in our hospital from February to February,2014. The population of the enrolled group was selected strictly according to the detailed entry conditions set out below, and our study was conducted under the conditions of age, pregnancy, birth, and body mass index without statistical difference. Study. The personnel of the two study groups were evaluated before operation, and the general and ultrasonic tests were performed on the personnel selected for the experiment. The internal organs and the anatomical structure of the pelvic cavity were observed under the condition of resting and Valsalva in order to measure the range of the bladder neck, the posterior angle of the urinary bladder, the angle of the sling and the angle of the urethra. The number of patients in the SUI group should also be subject to urodynamics, finger pressure test, etc., and the above number should be repeated after TVT-O. The results were compared with the control group before and after the operation of the SUI group and the control group after the operation of the SUI group and the control group. Results: The obtained ultrasonic parameters were compared with the t-test of the SPSS. The results of the experimental data and the calculation results showed that the bladder neck motion and the posterior angle of the bladder after TVT-O were all decreased compared with that of the pre-operation (p0.05). 01), but no statistical difference (p0.05) was found in the ultrasound parameters of the control group, whereas the statistical results for the urethral angle and the first two values were opposite, and the postoperative ultrasound parameters were compared to the pre-operative parameters The parameters of the SUI group and the control group were statistically significant and the parameters of the SUI group and the control group were not statistically significant. Study significance. Before the operation, the bladder neck motion of the patients in the SUI group and the posterior angle of the urinary bladder were compared with the control group. Conclusion: The use of TVT-O in female patients with moderate and severe stress urinary incontinence has a good curative effect in clinic, and the operation is relatively convenient, and the recovery is fast and bad. Low complications. The high mobility of the urethra is a female stress urinary incontinence. One of the mechanisms of the disease mechanism. The parameters of the bladder and the urethra and the positioning of the TVT-O sling during the operation The intraoperative ultrasound parameters can be used as TVT-O sling
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R699
【參考文獻】
相關(guān)期刊論文 前5條
1 陳志琴;宋巖峰;朱建平;;超聲在女性壓力性尿失禁診治中的應用價值[J];國外醫(yī)學.婦產(chǎn)科學分冊;2006年06期
2 宋梅;朱建平;江麗;;超聲檢查在女性壓力性尿失禁中的應用[J];國際婦產(chǎn)科學雜志;2011年01期
3 張玉良;;四維超聲、斷層成像和容積對比成像對膽囊疾病的應用價值[J];中國臨床醫(yī)學影像雜志;2011年03期
4 朱英堅,葉敏,陳建華,張良,王偉明;尿動力學檢查在女性壓力性尿失禁診治中的應用[J];上海第二醫(yī)科大學學報;2002年03期
5 黃澤萍;王小立;張新玲;毛永江;;經(jīng)會陰四維超聲在女性壓力性尿失禁診斷中的初步應用[J];中華腔鏡泌尿外科雜志(電子版);2013年05期
，本文編號：2443154
本文鏈接：http://sikaile.net/yixuelunwen/mjlw/2443154.html
最近更新
教材專著
