三维超声对压力性尿失禁妇女的盆底超声分析
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摘要
目的运用三维超声探究盆底超声检测在压力性尿失禁妇女中的应用。方法选取2015年5月～2017年3月在我院进行盆底超声检查的163例患者,按照是否确诊为压力性尿失禁疾病将其分为观察组和对照组,观察组为有明显压力性尿失禁症状,如腹压增加时尿液会不自主地流出的患者共78例,对照组为无压力性尿失禁的患者共85例,采用盆底超声测量比较两组患者的膀胱颈移动度(Mu)、尿道旋转角(θ)、Valsalva状态下膀胱尿道后角(αs、αr)等超声指标,并研究观察组中Mu、θ、αs、αr与疾病严重度是否有相关性及术前术后Mu、θ、αs、αr指标的变化。结果观察组患者的膀胱颈移动度Mu(1.79±0.24)cm、尿道旋转角θ(29.79±5.13)°和膀胱尿道后角αs(135.71±14.32)°、αr(120.04±11.27)°明显高于对照组的Mu(0.87±0.14)cm、θ(15.36±2.62)°、αs(103.82±8.94)°、αr(92.87±6.29)°,差异具有统计学意义(P<0.05);观察组治疗后的Mu(0.76±0.17)cm、θ(16.34±2.72)°、αs(98.65±9.56)°、αr(90.28±7.59)°超声指标明显低于治疗前的Mu(1.24±0.21)cm、θ(29.87±5.37)°、αs(135.13±14.02)°、αr(120.78±11.75)°,差异有统计学意义(P<0.05)。结论盆底超声检测膀胱颈移动度、尿道旋转角和膀胱尿道后角等指标对于诊断压力性尿失禁具有重要价值,并为患者术后治疗效果的检验提供理论依据。
Objective To explore the application of pelvic ultrasonography by three-dimensional ultrasonography in women with stress urinary incontinence. Methods 163 outpatient and inpatient patients,who were referred to our hospital for pelvic floor ultrasound examination from January 2015 to March 2017,were selected in this work. According to whether the stress urinary incontinence was diagnosed or not,those patients were divided into observation group and control group. In the observation group,there were 78 patients with abnormal urinary incontinence symptoms such as increased abdominal pressure and,whilst,in the control group,there were 85 patients who had no urinary incontinence. By means of pelvic floor ultrasonography,the bladder neck mobility( Mu),urethral rotation angle( θ),Valsalva state of bladder urethral angle( αs,αr) and other ultrasound indicators of patients in two groups were measured and whether the Mu,θ,αs,and were related to disease severity as well as preoperative and postoperative changes of those indexes of patients in the observation group were studied. Results The Mu(1. 79 ± 0. 24) cm,θ(29. 79 ± 5. 13) °,αs(135. 71 ± 14. 32) °,and αr(120. 04 ± 11. 27) ° were significantly higher than those of(0. 87± 0. 14) cm,θ(15. 36 ± 2. 62) °,αs(103. 82 ± 8. 94) ° and αr(92. 87 ± 6. 29) ° in the control group,the difference was statistically significant( P < 0. 05). After treatment,Mu( 0. 16 ± 0. 17) cm,θ( 16. 34 ± 2. 72) °,αs( 98. 65 ±9. 56) ° and αr(90. 28 ± 7. 59) ° were significantly lower than those of Mu(1. 24 ± 0. 21)(29. 87 ± 5. 37) °,αs(135. 13± 14. 02) ° and αr(120. 78 ± 11. 75) ° in observation group,the difference was statistically significant( P < 0. 05). Conclusion Ultrasound detection of bladder neck movement,urethral rotation angle and bladder urethral posterior angle is of great value in the diagnosis of stress urinary incontinence and provides the theoretical basis for the treatment of postoperative treatment.
Objective To explore the application of pelvic ultrasonography by three-dimensional ultrasonography in women with stress urinary incontinence. Methods 163 outpatient and inpatient patients,who were referred to our hospital for pelvic floor ultrasound examination from January 2015 to March 2017,were selected in this work. According to whether the stress urinary incontinence was diagnosed or not,those patients were divided into observation group and control group. In the observation group,there were 78 patients with abnormal urinary incontinence symptoms such as increased abdominal pressure and,whilst,in the control group,there were 85 patients who had no urinary incontinence. By means of pelvic floor ultrasonography,the bladder neck mobility( Mu),urethral rotation angle( θ),Valsalva state of bladder urethral angle( αs,αr) and other ultrasound indicators of patients in two groups were measured and whether the Mu,θ,αs,and were related to disease severity as well as preoperative and postoperative changes of those indexes of patients in the observation group were studied. Results The Mu(1. 79 ± 0. 24) cm,θ(29. 79 ± 5. 13) °,αs(135. 71 ± 14. 32) °,and αr(120. 04 ± 11. 27) ° were significantly higher than those of(0. 87± 0. 14) cm,θ(15. 36 ± 2. 62) °,αs(103. 82 ± 8. 94) ° and αr(92. 87 ± 6. 29) ° in the control group,the difference was statistically significant( P < 0. 05). After treatment,Mu( 0. 16 ± 0. 17) cm,θ( 16. 34 ± 2. 72) °,αs( 98. 65 ±9. 56) ° and αr(90. 28 ± 7. 59) ° were significantly lower than those of Mu(1. 24 ± 0. 21)(29. 87 ± 5. 37) °,αs(135. 13± 14. 02) ° and αr(120. 78 ± 11. 75) ° in observation group,the difference was statistically significant( P < 0. 05). Conclusion Ultrasound detection of bladder neck movement,urethral rotation angle and bladder urethral posterior angle is of great value in the diagnosis of stress urinary incontinence and provides the theoretical basis for the treatment of postoperative treatment.
引文
[1]刘娟,曾洁,王海兰,等.生物反馈盆底肌训练治疗压力性尿失禁的疗效分析[J].中华妇产科杂志,2014,49(10):754-757.
[2]邹琴,陈吉辉,李晓玲,等.盆底肌肉锻炼对女性压力性尿失禁患者术后生命质量的影响[J].中国实用护理杂志,2017,33(13):993-997.
[3]Minassian,Vatche A,Sun,Haiyan,Yan,Xiaowei S,et al.The interaction of stress and urgency urinary incontinence and its effect on quality of life[J].International Urogynecology Journal and Pelvic Floor Dysfunction,2015,26(2):269-276.
[4]贾俊华,夏志军.不同生物反馈电刺激方案治疗女性压力性尿失禁的疗效[J].中国医科大学学报,2015,44(8):717-720,724.
[5]陈玉清,裴慧慧,姚书忠,等.经闭孔经阴道无张力尿道中段悬吊带术治疗女性压力性尿失禁28例疗效分析[J].实用妇产科杂志,2014,30(2):120-123.
[6]Cavkaytar S,Kokanali MK,Topcu HO,et al.Effect of homebased Kegel exercises on quality of life in women with stress and mixed urinary incontinence[J].Journal of Obstetrics and Gynaecology:The Journal of The Institute of Obstetrics and Gynaecology,2015,35(4):407-410.
[7]冯玲.生物刺激反馈治疗女性压力性尿失禁:可提高轻、中度压力性尿失禁时盆底肌肉收缩表面肌电值[J].中国组织工程研究,2014,(33):5346-5350.
[8]Malallah,Mariam A,Al-Shaiji,Tariq F.Pharmacological treatment of pure stress urinary incontinence:a narrative review[J].International Urogynecology Journal and Pelvic Floor Dysfunction,2015,26(4):477-485.
[9]朱红艳,熊永红.女性压力性尿失禁患者生活质量的影响因素分析[J].护士进修杂志,2012,27(15):1416-1417.
[10]李卫林,卢子文,李飞平,等.无张力尿道悬吊改良术与尿道中段悬吊带术治疗女性压力性尿失禁的临床观察[J].中华医学杂志,2016,96(28):2238-2240.
[11]Hillary,Christopher James,Osman,Nadir,Chapple,Christopher et al.Considerations in the modern management of stress urinary incontinence resulting from intrinsic sphincter deficiency[J].World Journal of Urology,2015,33(9):1251-1256.
[12]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].中国超声医学杂志,2015,31(5):433-435.
[13]Del Vescovo R,Piccolo CL,Vecchia ND,et al.MRI role in morphological and functional assessment of the levator ani muscle:Use in patients affected by stress urinary incontinence(SUI)before and after pelvic floor rehabilitation[J].European Journal of Radiology,2014,83(3):479-486.
[14]肖汀,张新玲,杨丽新,等.超声观察膀胱颈在压力性尿失禁诊断中的研究[J].中国超声医学杂志,2016,32(9):822-825.
[15]Dillon BE,Seideman CA,Lee D,et al.A surprisingly low prevalence of demonstrable stress urinary incontinence and pelvic organ prolapse in women with multiple sclerosis followed at a tertiary neurogenic bladder clinic[J].The Journal of Urology,2013,189(3):976-979.
[16]皮永前,潘永寿,秦蕾,等.经直肠三维超声测量逼尿肌厚度在诊断膀胱出口梗阻的临床意义[J].医学影像学杂志,2016,26(12):2265-2267.
[17]阮坚,潘永寿,庾红玉,等.实时三维超声心动图容积-时间曲线评价心力衰竭患者左室舒张功能的研究[J].医学影像学杂志,2013,23(8):1190-1192.
[18]夏亮,范俊飞,刘健华,等.尿外渗和尿瘤的病因及影像学诊断价值[J].中国中西医结合影像学杂志,2017,15(2):224-226.
[2]邹琴,陈吉辉,李晓玲,等.盆底肌肉锻炼对女性压力性尿失禁患者术后生命质量的影响[J].中国实用护理杂志,2017,33(13):993-997.
[3]Minassian,Vatche A,Sun,Haiyan,Yan,Xiaowei S,et al.The interaction of stress and urgency urinary incontinence and its effect on quality of life[J].International Urogynecology Journal and Pelvic Floor Dysfunction,2015,26(2):269-276.
[4]贾俊华,夏志军.不同生物反馈电刺激方案治疗女性压力性尿失禁的疗效[J].中国医科大学学报,2015,44(8):717-720,724.
[5]陈玉清,裴慧慧,姚书忠,等.经闭孔经阴道无张力尿道中段悬吊带术治疗女性压力性尿失禁28例疗效分析[J].实用妇产科杂志,2014,30(2):120-123.
[6]Cavkaytar S,Kokanali MK,Topcu HO,et al.Effect of homebased Kegel exercises on quality of life in women with stress and mixed urinary incontinence[J].Journal of Obstetrics and Gynaecology:The Journal of The Institute of Obstetrics and Gynaecology,2015,35(4):407-410.
[7]冯玲.生物刺激反馈治疗女性压力性尿失禁:可提高轻、中度压力性尿失禁时盆底肌肉收缩表面肌电值[J].中国组织工程研究,2014,(33):5346-5350.
[8]Malallah,Mariam A,Al-Shaiji,Tariq F.Pharmacological treatment of pure stress urinary incontinence:a narrative review[J].International Urogynecology Journal and Pelvic Floor Dysfunction,2015,26(4):477-485.
[9]朱红艳,熊永红.女性压力性尿失禁患者生活质量的影响因素分析[J].护士进修杂志,2012,27(15):1416-1417.
[10]李卫林,卢子文,李飞平,等.无张力尿道悬吊改良术与尿道中段悬吊带术治疗女性压力性尿失禁的临床观察[J].中华医学杂志,2016,96(28):2238-2240.
[11]Hillary,Christopher James,Osman,Nadir,Chapple,Christopher et al.Considerations in the modern management of stress urinary incontinence resulting from intrinsic sphincter deficiency[J].World Journal of Urology,2015,33(9):1251-1256.
[12]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].中国超声医学杂志,2015,31(5):433-435.
[13]Del Vescovo R,Piccolo CL,Vecchia ND,et al.MRI role in morphological and functional assessment of the levator ani muscle:Use in patients affected by stress urinary incontinence(SUI)before and after pelvic floor rehabilitation[J].European Journal of Radiology,2014,83(3):479-486.
[14]肖汀,张新玲,杨丽新,等.超声观察膀胱颈在压力性尿失禁诊断中的研究[J].中国超声医学杂志,2016,32(9):822-825.
[15]Dillon BE,Seideman CA,Lee D,et al.A surprisingly low prevalence of demonstrable stress urinary incontinence and pelvic organ prolapse in women with multiple sclerosis followed at a tertiary neurogenic bladder clinic[J].The Journal of Urology,2013,189(3):976-979.
[16]皮永前,潘永寿,秦蕾,等.经直肠三维超声测量逼尿肌厚度在诊断膀胱出口梗阻的临床意义[J].医学影像学杂志,2016,26(12):2265-2267.
[17]阮坚,潘永寿,庾红玉,等.实时三维超声心动图容积-时间曲线评价心力衰竭患者左室舒张功能的研究[J].医学影像学杂志,2013,23(8):1190-1192.
[18]夏亮,范俊飞,刘健华,等.尿外渗和尿瘤的病因及影像学诊断价值[J].中国中西医结合影像学杂志,2017,15(2):224-226.