三维经会阴超声对绝经后女性压力性尿失禁患者行无张力阴道吊带术的疗效评价
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摘要
目的研究三维经会阴超声对绝经后女性压力性尿失禁(stress urinary incontinence,SUI)患者行无张力阴道吊带术(tension-free viginal tape-obturator system,TVT-O)手术前后膀胱和尿道超声参数变化,评价其临床价值。方法选取西安医学院第二附属医院2014年6月至2016年6月收治的绝经后SUI患者42例为研究组,以同年龄段健康体检者42例为对照组。两组在静息和Valsalva状态(令患者行强力闭呼动作)下行超声检查,观察、测量两组患者膀胱颈活动度、膀胱尿道后角和尿道角等参数;SUI患者TVT-O后再次行超声检查,并与术前和对照组的超声参数分别进行比较。结果 TVT-O术后研究组临床治疗有效率为95.2%;研究组手术前膀胱颈活动度、膀胱尿道后角、尿道角与对照组比较差异有统计学意义(t=27.32、7.76、9.09,P<0.05);研究组行TVT-O手术后的膀胱颈活动度和膀胱尿道后角比手术前缩小,尿道角与术前相比增大,各指标与术前比较差异有统计学意义(t=28.41、6.74、8.68,P<0.05);研究组手术后膀胱颈活动度、膀胱尿道后角、尿道角与对照组比较差异无统计学意义(t=1.92、0.89、1.55,P>0.05)。结论三维经会阴超声对于TVT-O术中吊带位置的确定有重要作用,为临床治疗效果的评价提供形态学依据。
Objective To study the changes of bladder and urethral ultrasonography parameters before and after tension free vaginal tape obturator(TVT-O) in postmenopausal women with stress urinary incontinence by three-dimensional perineal ultrasonography and evaluate its clinical value.Methods 42 patients with stress urinary incontinence(SUI) in Second Affiliated Hospital of Xi'an Medical University from June 2014 to June 2016 were selected as the study group,while 42 cases of healthy women in the same age group were selected as the control group.The two groups were in the resting and Valsalva state(making the patient line a strong closed call) during the ultrasound examination.The bladder neck activity,bladder urethral posterior angle and urethral angle were observed and measured.SUI patients with TVT-O had ultrasound examination again,and compared with the preoperative and control group of ultrasound parameters.Results After TVT-O,clinical treatment effective rate of study group was 95.2 %;There were significant differences in bladder activity,bladder urethral angle and urethral angle compared with control group(t = 27.32,7.76,9.09,P < 0.05).In the study group,the bladder neck activity and bladder urethral posterior angle after TVT-O were smaller than those before operation,and the urethral angle increased compared with that before operation.There were significant differences between each index and preoperative comparison(t = 28.41,6.74,8.68,P < 0.05).There were no significant differences in bladder activity,bladder urethral angle and urethral angle compared with control group(t = 1.92,0.89,1.55,P > 0.05).Conclusion Three-dimensional perineal ultrasonography plays an important role in the determination of the position of the sling in TVT-O,and provides the morphological basis for the evaluation of clinical therapeutic effect.
Objective To study the changes of bladder and urethral ultrasonography parameters before and after tension free vaginal tape obturator(TVT-O) in postmenopausal women with stress urinary incontinence by three-dimensional perineal ultrasonography and evaluate its clinical value.Methods 42 patients with stress urinary incontinence(SUI) in Second Affiliated Hospital of Xi'an Medical University from June 2014 to June 2016 were selected as the study group,while 42 cases of healthy women in the same age group were selected as the control group.The two groups were in the resting and Valsalva state(making the patient line a strong closed call) during the ultrasound examination.The bladder neck activity,bladder urethral posterior angle and urethral angle were observed and measured.SUI patients with TVT-O had ultrasound examination again,and compared with the preoperative and control group of ultrasound parameters.Results After TVT-O,clinical treatment effective rate of study group was 95.2 %;There were significant differences in bladder activity,bladder urethral angle and urethral angle compared with control group(t = 27.32,7.76,9.09,P < 0.05).In the study group,the bladder neck activity and bladder urethral posterior angle after TVT-O were smaller than those before operation,and the urethral angle increased compared with that before operation.There were significant differences between each index and preoperative comparison(t = 28.41,6.74,8.68,P < 0.05).There were no significant differences in bladder activity,bladder urethral angle and urethral angle compared with control group(t = 1.92,0.89,1.55,P > 0.05).Conclusion Three-dimensional perineal ultrasonography plays an important role in the determination of the position of the sling in TVT-O,and provides the morphological basis for the evaluation of clinical therapeutic effect.
引文
[1]崔宏伟,刘晓,李博.TVT-O治疗女性压力性尿失禁的临床疗效及5年随访观察[J].泌尿外科杂志(电子版),2014,6(4):24-30.
[2]闫骏,朱小军,斯钦布和,等.经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁3年随访分析[J].现代生物医学进展,2015,15(8):1488-1491.
[3]胡丽蓉,冉海涛,胡丽娜,等.盆底超声和肌电生理检查在女性压力性尿失禁中的临床应用[J].重庆医科大学学报,2015,40(12):1532-1536.
[4]仲丹,沈宇飞.尿动力学检查在压力性尿失禁诊疗中的应用价值[J].江苏医药,2016,42(11):1264-1266.
[5]徐净,张奥华,毛永江,等.膀胱颈移动度对女性压力性尿失禁患者的诊断价值[J].中华腔镜泌尿外科杂志(电子版),2016,10(1):20-22.
[6]王婧霖,侯瑞,吕卓,等.经会阴实时三维超声评价女性压力性尿失禁的应用价值[J].医学影像学杂志,2016,26(10):1867-1869.
[7]王李洁,何立红.经会阴实时三维超声对产后女性压力性尿失禁的诊断价值[J].中国医学创新,2016,13(35):105-109.
[8]李宁,马琳,阚艳敏.妊娠晚期压力性尿失禁患者的盆底超声观察及ROC曲线分析[J].中国医科大学学报,2015,44(2):156-159.
[9]李小鹏,余珊珊,乞艳华,等.40例女性压力性尿失禁患者经超声诊断的价值探讨[J/OL].中国妇幼健康研究,2016,27(9):1148-1151.
[10]耿京,唐军,谈诚,等.经会阴超声评价压力性尿失禁患者尿道括约肌弹性改变的初步研究[J].中国妇产科临床杂志,2016,17(5):419-421.
[11]农立明.产后压力性尿失禁女性患者膀胱移动度超声变化特点及其诊断价值[J].中外医学研究,2016,14(21):53-54.
[12]汤佩玲,何炼图,汤庆.经会阴超声诊断女性前盆腔功能障碍性疾病的应用价值[J].中华妇幼临床医学杂志(电子版),2016,12(3):299-304.
[13]李一冰.盆底超声对产后早期压力性尿失禁的诊断价值分析[J].中国继续医学教育,2015,7(21):56-57.
[14]张桂欣.妊娠期下尿路解剖支持缺陷与产后压力性尿失禁相关因素的探讨[J].中国地方病防治杂志,2014,29(S1):255-256.
[2]闫骏,朱小军,斯钦布和,等.经闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁3年随访分析[J].现代生物医学进展,2015,15(8):1488-1491.
[3]胡丽蓉,冉海涛,胡丽娜,等.盆底超声和肌电生理检查在女性压力性尿失禁中的临床应用[J].重庆医科大学学报,2015,40(12):1532-1536.
[4]仲丹,沈宇飞.尿动力学检查在压力性尿失禁诊疗中的应用价值[J].江苏医药,2016,42(11):1264-1266.
[5]徐净,张奥华,毛永江,等.膀胱颈移动度对女性压力性尿失禁患者的诊断价值[J].中华腔镜泌尿外科杂志(电子版),2016,10(1):20-22.
[6]王婧霖,侯瑞,吕卓,等.经会阴实时三维超声评价女性压力性尿失禁的应用价值[J].医学影像学杂志,2016,26(10):1867-1869.
[7]王李洁,何立红.经会阴实时三维超声对产后女性压力性尿失禁的诊断价值[J].中国医学创新,2016,13(35):105-109.
[8]李宁,马琳,阚艳敏.妊娠晚期压力性尿失禁患者的盆底超声观察及ROC曲线分析[J].中国医科大学学报,2015,44(2):156-159.
[9]李小鹏,余珊珊,乞艳华,等.40例女性压力性尿失禁患者经超声诊断的价值探讨[J/OL].中国妇幼健康研究,2016,27(9):1148-1151.
[10]耿京,唐军,谈诚,等.经会阴超声评价压力性尿失禁患者尿道括约肌弹性改变的初步研究[J].中国妇产科临床杂志,2016,17(5):419-421.
[11]农立明.产后压力性尿失禁女性患者膀胱移动度超声变化特点及其诊断价值[J].中外医学研究,2016,14(21):53-54.
[12]汤佩玲,何炼图,汤庆.经会阴超声诊断女性前盆腔功能障碍性疾病的应用价值[J].中华妇幼临床医学杂志(电子版),2016,12(3):299-304.
[13]李一冰.盆底超声对产后早期压力性尿失禁的诊断价值分析[J].中国继续医学教育,2015,7(21):56-57.
[14]张桂欣.妊娠期下尿路解剖支持缺陷与产后压力性尿失禁相关因素的探讨[J].中国地方病防治杂志,2014,29(S1):255-256.