经会阴超声诊断女性前盆腔功能障碍性疾病的应用价值
|
摘要
目的探讨经会阴超声诊断女性前盆腔功能障碍性疾病的应用价值。方法选择2015年4~11月因尿频、尿急、排尿困难、阴道内脱出物等原因于广州医科大学附属第一医院妇产科就诊,并采用盆腔器官脱垂定量分度法(POP-Q)初步诊断或疑似为阴道前壁脱垂、子宫脱垂等前盆腔功能障碍性疾病的68例患者为研究对象。根据经会阴超声诊断结果,将其分为前盆腔功能障碍性疾病组(n=58)与前盆腔组织正常组(n=10)。同时,根据是否合并膀胱脱垂,将前盆腔功能障碍性疾病组患者进一步分为合并膀胱脱垂亚组(n=28)与未合并膀胱脱垂亚组(n=30)。应用经会阴超声检查对本组68患者在安静状态和最大Valsalva动作下的各项盆腔超声指标进行观察和测量,包括膀胱位置、尿道内口漏斗是否形成、膀胱颈距耻骨联合下缘的垂直距离(BSD)、膀胱尿道后角、膀胱颈下降度(BND)、尿道旋转角度及膀胱颈旋转角度,并对合并膀胱脱垂亚组患者进行膀胱脱垂分型。采用统计学方法比较前盆腔功能障碍性疾病组与前盆腔组织正常组,以及合并膀胱脱垂亚组与未合并膀胱脱垂亚组BND、尿道旋转角度、膀胱颈旋转角度、患者安静状态及最大Valsalva动作下膀胱尿道后角。前盆腔功能障碍性疾病组与前盆腔组织正常组,以及合并膀胱脱垂亚组与未合并膀胱脱垂亚组患者年龄、体重、孕次、产次及POP-Q分度等基本资料比较,差异均无统计学意义(P>0.05)。本研究遵循的程序符合广州医科大学附属第一医院人体试验委员会制定的伦理学标准,得到该委员会批准,并与所有患者签署临床研究知情同意书。结果 1根据膀胱位置、BND、膀胱尿道后角、尿道旋转角度及膀胱颈旋转角度,本组68例患者中,58例经会阴超声诊断为前盆腔功能障碍性疾病,均存在压力性尿失禁(SUI),10例为尿道内口呈漏斗状开放状态,28例合并膀胱脱垂,其中Ⅰ型为7例、Ⅱ型为10例、Ⅲ型为11例;其余10例未被检出前盆腔组织异常。258例前盆腔功能障碍性疾病组患者在安静状态及最大Valsalva动作下膀胱尿道后角分别为122.2°(113.3°~136.3°)与137.7°(119.4°~159.2°),均分别较10例前盆腔组织正常组的91.2°(81.3°~99.0°)与111.0°(88.3°~117.7°)显著增大,并且差异均有统计学意义(Z=-3.775,P=0.000;Z=-3.152,P=0.002)。两组BND、尿道旋转角度及膀胱颈旋转角度分别比较,差异均无统计学意义(P>0.05)。3合并膀胱脱垂亚组患者的BND、尿道旋转角度、膀胱颈旋转角度分别为(26.4±7.3)mm、64.0°(43.2°~78.9°)、67.7°(42.7°~84.5°),均分别较未合并膀胱脱垂亚组患者的(14.2±3.6)mm、15.5°(10.1°~24.9°)、29.6°(26.4°~38.7°)显著增大,并且差异均有统计学意义(t=9.090,P=0.000;Z=5.275,P=0.000;Z=5.322,P=0.000)。患者在安静状态及最大Valsalva动作下,膀胱尿道后角两亚组比较,则差异均无统计学意义(P>0.05)。结论经会阴超声检查可无创、快捷、较为准确地观察前盆腔解剖位置及功能改变情况,有助于早期诊断女性前盆腔功能障碍性疾病,具有较高的临床应用价值。
Objective To explore the value of transperineal ultrasonography in diagnosis of female anterior pelvic cavity dysfunction.Methods From April to November 2014,a total of 68 cases of outpatients with frequent urination,urgency,dysuria and rotor of vagina who were primary diagnosed or suspected as anterior vaginal wall prolapse or uterine prolapse by pelvic organ prolapse quantitation(POP-Q)in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Guangzhou Medical University were enrolled as research objects.They were classified into two groups by transperineal ultrasound diagnosed results,anterior pelvic cavity dysfunction group(n=58)and normal anterior pelvic cavity function group(n=10).At the same time,according to whether patients in anterior pelvic cavity dysfunction group were combined with cystocele or not,they were classified into cystocele subgroup(n=28)and without cystocele subgroup(n=30).The parameters of resting and max Valsalva conditions were observed and measured,respectively by transperineal ultrasound,including bladder position,funneling of the internal urethral orifice,bladder necksymphyseal distance(BSD),vesicourethral angle,the bladder neck descent(BND),rotation angle of urethra and bladder neck.And the cystocele subtypes of patients were classified.The BND,rotation angle of urethra and bladder neck,retrovesical angle of resting and max Valsalva conditions were compared between anterior pelvic cavity dysfunction group and normal anterior pelvic cavity function group,and with cystocele subgroup,and without cystocele subgroup,respectively by statistical methods.There were no statistical differences among the age,body weight,gravidity,parity and POP-Q degree between anterior pelvic cavity dysfunction group and normal anterior pelvic cavity function group,and with cystocele subgroup and without cystocele subgroup(P >0.05).The research followed the ethical standards of the human trials of the First Affiliated Hospital of Guangzhou Medical University,approved by the committee,and clinical research informed consent was signed by each patient.Results 1Among 68 cases of patients in this research,58 cases of anterior pelvic cavity dysfunction diseases were diagnosed by transperineal ultrasound based on the position of bladder,BND,vesicourethral angle,rotation angle of urethra and bladder neck.All the58 cases were stress urinary incontinence(SUI),and there were 10 cases with funneling of bladder neck,28 cases with cystocele(7cases with typeⅠ,10 cases with type Ⅱ,11 cases with type Ⅲ).The anterior pelvic cavity function of rest 10 cases all were normal.2The average of vesicourethral angles of resting and max Valsalva conditions of 58 cases of patients in anterior pelvic cavity dysfunction group were 122.2°(113.3°-136.3°)and 137.7°(119.4°-159.2°),respectively,and both were larger than those of 10 cases in normal anterior pelvic cavity function group which was 91.2°(81.3°-99.0°)and 111.0°(88.3°-117.7°),respectively,and both the differences were statistically significant(Z=-3.775,P=0.000;Z=-3.152,P=0.002).But as to the BND,angle rotation of urethra and bladder neck between two groups,there were no statistical differences(P>0.05).3The BND,rotation angle of urethra and bladder neck in the patients with cystocele subgroup were(26.4±7.3)mm,64.0°(43.2°-78.9°),67.7°(42.7°-84.5°),respectively,all were larger than those of patients without cystocele subgroups,which were(14.2±3.6)mm,15.5°(10.1°-24.9°),29.6°(26.4°-38.7°),respectively,and all the differences were statistically significant(t=9.090,P=0.000;Z=5.275,P=0.000;Z=5.322,P=0.000).But as to the retrovesical angles of resting and max Valsalva conditions in two subgroups,there were no statistical differences(P > 0.05).Conclusions Transperineal ultrasound is a noninvasive,shortcut and more accurate method to observe the anatomical position and function of anterior pelvic cavity.It is useful for the diagnosis of female anterior pelvic cavity dysfunction,and has a great application value.
Objective To explore the value of transperineal ultrasonography in diagnosis of female anterior pelvic cavity dysfunction.Methods From April to November 2014,a total of 68 cases of outpatients with frequent urination,urgency,dysuria and rotor of vagina who were primary diagnosed or suspected as anterior vaginal wall prolapse or uterine prolapse by pelvic organ prolapse quantitation(POP-Q)in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Guangzhou Medical University were enrolled as research objects.They were classified into two groups by transperineal ultrasound diagnosed results,anterior pelvic cavity dysfunction group(n=58)and normal anterior pelvic cavity function group(n=10).At the same time,according to whether patients in anterior pelvic cavity dysfunction group were combined with cystocele or not,they were classified into cystocele subgroup(n=28)and without cystocele subgroup(n=30).The parameters of resting and max Valsalva conditions were observed and measured,respectively by transperineal ultrasound,including bladder position,funneling of the internal urethral orifice,bladder necksymphyseal distance(BSD),vesicourethral angle,the bladder neck descent(BND),rotation angle of urethra and bladder neck.And the cystocele subtypes of patients were classified.The BND,rotation angle of urethra and bladder neck,retrovesical angle of resting and max Valsalva conditions were compared between anterior pelvic cavity dysfunction group and normal anterior pelvic cavity function group,and with cystocele subgroup,and without cystocele subgroup,respectively by statistical methods.There were no statistical differences among the age,body weight,gravidity,parity and POP-Q degree between anterior pelvic cavity dysfunction group and normal anterior pelvic cavity function group,and with cystocele subgroup and without cystocele subgroup(P >0.05).The research followed the ethical standards of the human trials of the First Affiliated Hospital of Guangzhou Medical University,approved by the committee,and clinical research informed consent was signed by each patient.Results 1Among 68 cases of patients in this research,58 cases of anterior pelvic cavity dysfunction diseases were diagnosed by transperineal ultrasound based on the position of bladder,BND,vesicourethral angle,rotation angle of urethra and bladder neck.All the58 cases were stress urinary incontinence(SUI),and there were 10 cases with funneling of bladder neck,28 cases with cystocele(7cases with typeⅠ,10 cases with type Ⅱ,11 cases with type Ⅲ).The anterior pelvic cavity function of rest 10 cases all were normal.2The average of vesicourethral angles of resting and max Valsalva conditions of 58 cases of patients in anterior pelvic cavity dysfunction group were 122.2°(113.3°-136.3°)and 137.7°(119.4°-159.2°),respectively,and both were larger than those of 10 cases in normal anterior pelvic cavity function group which was 91.2°(81.3°-99.0°)and 111.0°(88.3°-117.7°),respectively,and both the differences were statistically significant(Z=-3.775,P=0.000;Z=-3.152,P=0.002).But as to the BND,angle rotation of urethra and bladder neck between two groups,there were no statistical differences(P>0.05).3The BND,rotation angle of urethra and bladder neck in the patients with cystocele subgroup were(26.4±7.3)mm,64.0°(43.2°-78.9°),67.7°(42.7°-84.5°),respectively,all were larger than those of patients without cystocele subgroups,which were(14.2±3.6)mm,15.5°(10.1°-24.9°),29.6°(26.4°-38.7°),respectively,and all the differences were statistically significant(t=9.090,P=0.000;Z=5.275,P=0.000;Z=5.322,P=0.000).But as to the retrovesical angles of resting and max Valsalva conditions in two subgroups,there were no statistical differences(P > 0.05).Conclusions Transperineal ultrasound is a noninvasive,shortcut and more accurate method to observe the anatomical position and function of anterior pelvic cavity.It is useful for the diagnosis of female anterior pelvic cavity dysfunction,and has a great application value.
引文
1 Dietz HP,Haylen BT,Broome J.Ultrasound in the quantification of female pelvic organ prolapse[J].Ultrasound Obstet Gynecol,2001,18(5):511-514.
2 Green TH Jr.Urinary stress incontinence:differential diagnosis,pathophysiology and management[J].Am J Obstet Gynecol,1975,122(3):368-400.
3 Mouritsen L,Rasmussen A.Bladder neck mobility evaluated by vaginal ultrasonography[J].Br J Urol,1993,71(2):166-171.
4 朱兰,郎景和.女性盆底功能障碍性疾病的防治策略[J].中华妇产科杂志,2007,42(12):793-794.
5 谢幸,苟方丽,主编.妇产科学.8版[M].北京:人民卫生出版社,2013:290.
6 王毅,龚水根,张伟国,等.正常女性盆底解剖、形态的动态MRI研究[J].中国医学影像技术,2003,19(12):1711-1714.
7 Hoyte L,Thomas J,Foster RT,et al.Racial differences in pelvic morphology among asymptomatic nulliparous women as seen on three-dimensional magnetic resonance images[J].Am J Obstet Gynecol,2005,193(6):2035-2040.
8 Sendag F,Vidinli H,Kazandi M,et al.Role of perineal sonography in the evaluation of patients with stress urinary incontinence[J].Aust N Z J Obstet Gynaecol,2003,43(1):54-57.
9 马乐,王雪影,张蕾.女性膀胱过度活动症的诊治进展:2012美国泌尿外科学会膀胱过度活动症指南解读[J/CD].中华妇幼临床医学杂志:电子版,2012,8(5):561-567.
10 Dietz HP,Hoyte LPJ,Steensma AB.盆底超声学图谱[M].王慧芳,谢红宁,译.北京:人民卫生出版社,2011:38.
11 陈忠.女性压力性尿失禁的诊治进展[J/CD].中华临床医师杂志:电子版,2014,8(3):359-362.
12 李环,吴瑞芳,李瑞珍,等.压力性尿失禁诊疗135例临床分析[J/CD].中华临床医师杂志:电子版,2011,5(21):6336-6341.
13 Tunn R,Goldammer K,Gauruder-Burmester A.Pathogenesis of urethral funneling in women with stress urinary incontinence assessed by introital ultrasound[J].Ultrasound Obstet Gynecol,2005,26(3):287-292.
14 Dietz HP,Clarke B.The urethral pressure profile and ultrasound imaging of the lower urinary tract[J].Int Urogynecol J Pelvic Floor Dysfunct,2001,12(1):38-41.
15 Huang WC,Yang JM.Bladder neck funneling on ultrasound cystourethrography in primary stress urinary incontinence:a sign associated with urethral hypermobility and intrinsic sphincter deficiency[J].Urology,2003,61(5):936-941.
16 徐莲,刘菲菲,陶均佳,等.超声定量评估女性盆底器官脱垂[J].中国医学影像技术,2012,28(12):2229-2232.
17 王慧芳,陈华,折瑞莲,等.经会阴超声评估前盆腔器官脱垂程度与临床盆底器官脱垂定量分期的相关性研究[J].中华超声影像学杂志,2013,22(8):684-687.
18 Dietz HP,Haylen BT,Vancaillie TG.Female pelvic organ prolapse and voiding function[J].Int Urogynecol J Pelvic Floor Dysfunct,2002,13(5):284-288.
2 Green TH Jr.Urinary stress incontinence:differential diagnosis,pathophysiology and management[J].Am J Obstet Gynecol,1975,122(3):368-400.
3 Mouritsen L,Rasmussen A.Bladder neck mobility evaluated by vaginal ultrasonography[J].Br J Urol,1993,71(2):166-171.
4 朱兰,郎景和.女性盆底功能障碍性疾病的防治策略[J].中华妇产科杂志,2007,42(12):793-794.
5 谢幸,苟方丽,主编.妇产科学.8版[M].北京:人民卫生出版社,2013:290.
6 王毅,龚水根,张伟国,等.正常女性盆底解剖、形态的动态MRI研究[J].中国医学影像技术,2003,19(12):1711-1714.
7 Hoyte L,Thomas J,Foster RT,et al.Racial differences in pelvic morphology among asymptomatic nulliparous women as seen on three-dimensional magnetic resonance images[J].Am J Obstet Gynecol,2005,193(6):2035-2040.
8 Sendag F,Vidinli H,Kazandi M,et al.Role of perineal sonography in the evaluation of patients with stress urinary incontinence[J].Aust N Z J Obstet Gynaecol,2003,43(1):54-57.
9 马乐,王雪影,张蕾.女性膀胱过度活动症的诊治进展:2012美国泌尿外科学会膀胱过度活动症指南解读[J/CD].中华妇幼临床医学杂志:电子版,2012,8(5):561-567.
10 Dietz HP,Hoyte LPJ,Steensma AB.盆底超声学图谱[M].王慧芳,谢红宁,译.北京:人民卫生出版社,2011:38.
11 陈忠.女性压力性尿失禁的诊治进展[J/CD].中华临床医师杂志:电子版,2014,8(3):359-362.
12 李环,吴瑞芳,李瑞珍,等.压力性尿失禁诊疗135例临床分析[J/CD].中华临床医师杂志:电子版,2011,5(21):6336-6341.
13 Tunn R,Goldammer K,Gauruder-Burmester A.Pathogenesis of urethral funneling in women with stress urinary incontinence assessed by introital ultrasound[J].Ultrasound Obstet Gynecol,2005,26(3):287-292.
14 Dietz HP,Clarke B.The urethral pressure profile and ultrasound imaging of the lower urinary tract[J].Int Urogynecol J Pelvic Floor Dysfunct,2001,12(1):38-41.
15 Huang WC,Yang JM.Bladder neck funneling on ultrasound cystourethrography in primary stress urinary incontinence:a sign associated with urethral hypermobility and intrinsic sphincter deficiency[J].Urology,2003,61(5):936-941.
16 徐莲,刘菲菲,陶均佳,等.超声定量评估女性盆底器官脱垂[J].中国医学影像技术,2012,28(12):2229-2232.
17 王慧芳,陈华,折瑞莲,等.经会阴超声评估前盆腔器官脱垂程度与临床盆底器官脱垂定量分期的相关性研究[J].中华超声影像学杂志,2013,22(8):684-687.
18 Dietz HP,Haylen BT,Vancaillie TG.Female pelvic organ prolapse and voiding function[J].Int Urogynecol J Pelvic Floor Dysfunct,2002,13(5):284-288.