经会阴二维超声对压力性尿失禁女性患者盆底的动态观察与评估

Dynamic observation and evaluation of pelvic floor in female with stress urinary incontinence by perineal two-dimensional ultrasound

目的应用经会阴二维超声动态观察与评估压力性尿失禁(SUI)女性患者盆底形态。方法选择32例SUI女性患者(SUI组)、35例生育后无盆底功能障碍女性(对照组),采用经会阴二维超声分别在静息、Valsalva及缩肛状态下观查盆底器官的位置、形态及运动,测量及分析比较盆底二维超声系列参数。结果二维超声声像图动态观察结果:在静息至Valsalva状态的转变过程中,对照组及SUI组女性膀胱颈及尿道均向后下方移动;在静息至缩肛状态的转变过程中,对照组及SUI组女性膀胱颈及尿道均向前上方移动。对照组71.40%(25/35)尿道为直线型,在静息至Valsalva状态转变过程中,28.60%(10/35)尿道后倾,8.60%(3/35)形成漏斗状结构,SUI组在静息至Valsalva状态转变过程中,87.50%(28/32)尿道后倾明显,28.10%(9/32)形成漏斗状结构。二维超声参数测量结果:静息状态时,SUI组膀胱颈到耻骨联合下缘的水平距离x为(1.38±0.56)cm,大于对照组的(0.61±0.59)cm,差异有统计学意义(t=-5.467,P=0.000);SUI组膀胱颈到耻骨联合下缘的垂直距离y为-(2.01±0.47)cm,尿道膝部到X轴的距离为-(0.05±0.04)cm,尿道角为(137.48±22.26)°,均小于对照组的-(2.73±0.36)cm、-(0.50±0.44)cm、(157.41±18.07)°,且差异均有统计学意义(t值分别为7.075、5.760、4.038,P均=0.000);SUI组尿道长度、近段功能尿道长度均小于对照组,但差异均无统计学意义(t=1.724、1.702,P均>0.05)。Valsalva状态下,SUI组膀胱颈到耻骨联合下缘的水平距离x为(2.14±0.77)cm,大于对照组的(1.38±0.57)cm,差异有统计学意义(t=-4.618,P=0.000);SUI组膀胱颈到耻骨联合下缘的垂直距离y为-(1.04±0.52)cm,近段功能尿道长度为(1.28±0.32)cm,尿道角为(129.09±12.72)°,均小于对照组的-(2.13±0.51)cm、(2.02±0.27)cm、(144.66±14.92)°,且差异均有统计学意义(t值分别为1.259、8.657、4.574,P均=0.000);SUI组尿道膝部到X轴的距离为(0.36±0.34)cm(耻骨联合下缘上方),对照组尿道膝部到X轴的距离-(0.28±0.27)cm(耻骨联合下缘下方),差异有统计学意义(t=-8.568,P=0.000);SUI组尿道长度小于对照组,但差异无统计学意义(t=1.974,P=0.053)。缩肛状态下,SUI组膀胱颈到耻骨联合下缘的水平距离x为(0.90±0.55)cm,大于对照组的(0.23±0.13)cm,且差异有统计学意义(t=-7.001,P=0.000);SUI组膀胱颈到耻骨联合下缘的垂直距离y为-(2.08±0.53)cm,近段功能尿道长度为(2.19±0.59)cm,尿道角为(142.78±22.56)°,均小于对照组的-(2.82±0.42)cm、(2.51±0.48)cm、(154.91±20.90)°,且差异均有统计学差异(t值分别为6.361、2.444、、2.285,P均<0.01或0.05);SUI组尿道膝部到X轴的距离为(0.04±0.03)cm(耻骨联合下缘上方),对照组尿道膝部到X轴的距离-(0.33±0.25)cm(耻骨联合下缘下方),差异有统计学意义(t=-8.312,P=0.000);SUI组尿道长度较对照组小,但差异无统计学意义(t=1.972,P=0.053)。结论经会阴二维超声能够清晰显示生育后无盆底功能障碍女性及SUI女性患者在静息、Valsalva及缩肛状态下的盆底形态结构的动态改变,提示SUI的发生可能与膀胱颈及尿道支持结构的缺陷有关。

Objective To observe and evaluate the dynamic changes of pelvic floor in female with stress urinary incontinence（SUI） by perineal two-dimensinal ultrasound.Methods Perineal two-dimensinal ultrasound were performed in 32 female with SUI（SUI group） and 35 postpartum women without SUI（control group） in the condition of resting,Valsalva maneuver and anal sphincter contraction.The position,shape and movement of pelvic organs were observed and two-dimensional diameters of pelvic structures were measured and analyzed.Results By two-dimensional ultrasound,the bladder neck and urethra in both groups were observed moving backward and down on movement Valsalva,while they both moved forward and above during anal sphincter contracting.The urethra of 71.4%（25/35） cases in control group were liner type on Valsalva movement,28.6%（10/35） went backward,8.6%（3/35） became funnel form.On Valsalva movement,87.5%（28/32） of urethra in SUI group went back obviously,28.1%（9/32）became funnel form.When resting state,the horizon distance（x） between the bladder neck and symphysis pubis in SUI group was significantly greater than that in control group（t=-5.467,P=0.000）.The vertical distance（y） between the bladder neck and symphysis pubis,the distance between the knee portion of urethra and X-axis,and the angle of the urethra in SUI group were significantly less than those in control group（t=7.075,5.760,4.038,all P=0.000）.The length of whole urethra and the functional segment of proximal urethra in SUI group were both less than those in control group,but they were no significant difference（t=1.724,1.702,all P0.05）.On Valsalva movement,the horizon distance（x） between the bladder neck and symphysis pubis in SUI group was significantly greater than that in control group（t=-4.618,P=0.000）.The vertical distance（y） between the bladder neck and symphysis pubis,the length of proximal urethra and the angle of the urethra in SUI group were all significantly less than those of control group（t=1.259,8.657,4.574,all P=0.000）.The distance between the knee portion of urethra and X-axis were（0.36±0.34）cm（above the inferior part of symphysis pubis） and-（0.28±0.27）cm（blow the inferior part of symphysis pubis）,and there was significant difference between them（t=-8.568,P=0.000）.The length of urethra in SUI group was less than that in control group,but there was no significant difference between them（t=1.974,P=0.053）.When anal sphincter contracting,the horizon distance（x） between the bladder neck and symphysis pubis in SUI group was significantly greater than that in control group（t=-7.001,P=0.000）.The vertical distance（y） between the bladder neck and symphysis pubis,the length of proximal urethra and the angle of urethra in SUI group were all significantly less than those in control group（t=6.361,2.444,2.285,all P 0.01 or 0.05）.The distance between the knee of urethra and X-axis in SUI group were（0.04±0.03）cm（above the inferior of symphysis pubis） and-（0.33±0.25）cm（blow the inferior of symphysis pubis）,and there was significant difference between them（t=-8.312,P=0.000）.The length of urethra in SUI group was less than that in control group,but there was no significant difference（t=1.972,P=0.053）.Conclusions Perineal two-dimensional ultrasound is helpful to assess the dynamic changes of pelvic structures in female with and without SUI at states of resting,Valsalva movement and anal contracting.It indicates that SUI may be due to the defect of supporting structures for bladder neck and urethral.