断层超声联合盆底肌力评估界定产后妇女肛提肌尿道间隙正常值的探讨
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摘要
目的探讨产后妇女肛提肌尿道间隙(LUG)的正常值。方法选择2016年12月～2018年5月于徐州市妇幼保健院产后门诊复查的患者95例,对这些患者进行盆底肌力评估及经会阴盆底三维超声检查,分别采集静息及最大缩肛状态下的肛提肌裂孔的断层超声显像(TUI),分别测量两种状态下左右侧LUG。结果在预测盆底肌力降低中,盆底各类肌纤维不同工作状态下,静息期及缩肛期的LUG左右两侧测值及均值的诊断效能均较高(0.7 Objective To discuss the normal value of levator-urethra gap(LUG) in postpartum women. Methods From December 2016 to May 2018, in Xuzhou Maternal and Child Health Hospital, 95 patients re-examined in the postpartum clinic were selected, they were performed transperineal 3 D pelvic ultrasound and pelvic floor muscle strength assessment, the TUI images of levator ani hiatus in resting and maximal anal retraction states were respectively collected,and the left and right LUG value in both states were measured. Results In predicting the decrease of pelvic floor muscle strength, under different working conditions of all kinds of muscle fibers, the diagnostic efficacy of the measured values and mean values of the left and right LUG in resting and maximal anal retraction states was higher(0.7 < AUC <0.9)(P < 0.05). The cut-off value as a normal value reference indicates had a high clinical guiding significance. Conclusion Tomographic ultrasound combined with pelvic floor muscle strength assessment has certain guiding value for the definition of normal value of LUG in postpartum women.
引文
[1]Dietz HP,Abblu A,Shek K.The levator urethral gap measure-ment:A more objective means of determining levator avulsion[J].Ultrasound Obstet Gynecol,2008,32(7):941-945.
[2]徐莲,刘菲菲,陶均佳,等.肛提肌尿道间隙评价产后女性肛提肌损伤的初步应用[J].中华超声影像学杂志,2013,22(7):602-605.
[3]Kozma B,Larson K,Scott L,et al.Association between pelvic organ prolapse types and levator-urethra gap as measured by 3D transperineal ultrasound[J].J Ultrasound Med,2018,37(12):2849-2854.
[4]谢伟,孙峰.肛提肌损伤与盆底功能障碍性疾病关系研究[J].局解手术学杂志,2016,25(7):534-537.
[5]许瑶璇,张丽,袁秀珍,等.断层超声评估肛提肌肌力的可行性探讨[J].中国医药导报,2016,13(28):111-115.
[6]郎景和.妇科泌尿学与盆底重建外科:过去、现在与将来(之二)[J].中华妇产科杂志,2005,40(3):145-147.
[7]刘跃华,何桂香,李艳群,等.老年尿失禁流行病学研究进展[J].中国老年学杂志,2015,35(23):6935-6937.
[8]张莉娟,陈雅芬,秦文桦,等.无锡市盆底功能障碍性疾病的流行病学调查[J].中国妇幼保健,2015,30(16):2613-2615.
[9]陈芸,王良娟.孕期张力性尿失禁的影响因素调查[J].现代实用医学,2012,24(5):553-555.
[10]黄淑卿,张新玲,郑志娟,等.盆底超声在产后早期压力性尿失禁中的应用[J].中国超色医学杂志,2015,31(5):433-435.
[11]袁文琳,李盈,黎月薇.盆底超色综合测量诊断产后早期压力性尿失禁[J].中国医学影像技术,2017,33(10):1601-1603.
[12]李雪,王学梅,姜镔.经会阴超声与X线排粪造影对直肠前突与盆底失弛缓综合征诊断价值的比较研究[J].中国临床医学影像杂志,2017,28(11):817-821.
[13]高珊,孙彩霞,杨晓丹,等.女性慢性盆腔疼痛综合征患者盆底超声影像学改变特征的分析[J].中国实用妇科与产科杂,2018,34(2):219-223.
[14]Dietz HP,Simpson JM.Levator trauma is associated with pelvic organ prolapse[J].BJOG,2008,115(8):979-984.
[15]Dietz HP,Shek C,Deleon J,et al.Ballooning of the levator hiatus[J].Ultrasound Obstet Gynecol,2008,31(6):676-680.
[16]Dietz HP,Garnham AP,Rojas RG.Is the levator-urethra gap helpful for diagnosing avulsion?[J].Int Urogynecol J,2016,27(6):909-913.
[17]翟凤丹,林萍.经会阴三维超声评估不同分娩方式对初产妇产后早期肛提肌弹性的影响[J].中国医学影像技术,2018,34(4):577-580.
[18]牛旺,史铁梅,张原溪.剪切波弹性成像技术定量评估盆腔器官脱垂患者耻骨直肠肌功能[J].中国医学影像技术,2018,34(2):270-274.
[19]朱兆领,应涛,胡兵.女性肛提肌的解剖功能和影像学研究[J].中国医学影像技术,2010,26(6):1179-1181.
[20]陈娟,郎景和,朱兰,等.压力性尿失禁及盆底组织膨出患者肛提肌肌纤维直径和分型的研究[J].中华妇产科杂志,2003,38(12):733-736.
[2]徐莲,刘菲菲,陶均佳,等.肛提肌尿道间隙评价产后女性肛提肌损伤的初步应用[J].中华超声影像学杂志,2013,22(7):602-605.
[3]Kozma B,Larson K,Scott L,et al.Association between pelvic organ prolapse types and levator-urethra gap as measured by 3D transperineal ultrasound[J].J Ultrasound Med,2018,37(12):2849-2854.
[4]谢伟,孙峰.肛提肌损伤与盆底功能障碍性疾病关系研究[J].局解手术学杂志,2016,25(7):534-537.
[5]许瑶璇,张丽,袁秀珍,等.断层超声评估肛提肌肌力的可行性探讨[J].中国医药导报,2016,13(28):111-115.
[6]郎景和.妇科泌尿学与盆底重建外科:过去、现在与将来(之二)[J].中华妇产科杂志,2005,40(3):145-147.
[7]刘跃华,何桂香,李艳群,等.老年尿失禁流行病学研究进展[J].中国老年学杂志,2015,35(23):6935-6937.
[8]张莉娟,陈雅芬,秦文桦,等.无锡市盆底功能障碍性疾病的流行病学调查[J].中国妇幼保健,2015,30(16):2613-2615.
[9]陈芸,王良娟.孕期张力性尿失禁的影响因素调查[J].现代实用医学,2012,24(5):553-555.
[10]黄淑卿,张新玲,郑志娟,等.盆底超声在产后早期压力性尿失禁中的应用[J].中国超色医学杂志,2015,31(5):433-435.
[11]袁文琳,李盈,黎月薇.盆底超色综合测量诊断产后早期压力性尿失禁[J].中国医学影像技术,2017,33(10):1601-1603.
[12]李雪,王学梅,姜镔.经会阴超声与X线排粪造影对直肠前突与盆底失弛缓综合征诊断价值的比较研究[J].中国临床医学影像杂志,2017,28(11):817-821.
[13]高珊,孙彩霞,杨晓丹,等.女性慢性盆腔疼痛综合征患者盆底超声影像学改变特征的分析[J].中国实用妇科与产科杂,2018,34(2):219-223.
[14]Dietz HP,Simpson JM.Levator trauma is associated with pelvic organ prolapse[J].BJOG,2008,115(8):979-984.
[15]Dietz HP,Shek C,Deleon J,et al.Ballooning of the levator hiatus[J].Ultrasound Obstet Gynecol,2008,31(6):676-680.
[16]Dietz HP,Garnham AP,Rojas RG.Is the levator-urethra gap helpful for diagnosing avulsion?[J].Int Urogynecol J,2016,27(6):909-913.
[17]翟凤丹,林萍.经会阴三维超声评估不同分娩方式对初产妇产后早期肛提肌弹性的影响[J].中国医学影像技术,2018,34(4):577-580.
[18]牛旺,史铁梅,张原溪.剪切波弹性成像技术定量评估盆腔器官脱垂患者耻骨直肠肌功能[J].中国医学影像技术,2018,34(2):270-274.
[19]朱兆领,应涛,胡兵.女性肛提肌的解剖功能和影像学研究[J].中国医学影像技术,2010,26(6):1179-1181.
[20]陈娟,郎景和,朱兰,等.压力性尿失禁及盆底组织膨出患者肛提肌肌纤维直径和分型的研究[J].中华妇产科杂志,2003,38(12):733-736.