盆底重建手术前子宫质量超声评估的方法及意义

Method and significance of ultrasonographic assessment of the uterine weight before pelvic floor reconstruction

目的 探讨超声评估子宫质量的准确性及其在盆底重建手术中的指导意义.方法 （1）选取2011年8月至2012年8月在南京军区福州总医院因子宫良性疾病或子宫脱垂行子宫全切除术的81例患者,术前超声测量子宫体、子宫颈各径线值,并采用公式法计算子宫体、子宫颈质量,与术后离体子宫的测量和称重相应结果进行比较.（2）对46例行经阴道保留子宫的植入网片盆底重建术患者的子宫测量参数进行分析.结果 （1）术前超声测量子宫体、子宫颈各径线值与术后离体测量值比较,差异均无统计学意义（P＞0.05）;术前采用公式法计算所得子宫体、子宫颈及全子宫质量[分别为（87 ±55）、（32±6）、（120±50）g]与术后离体称重值[分别为（88±57）、（33±6）、（123±48）g]分别比较,差异均无统计学意义（P＞0.05）.（2）46例保留子宫盆底重建术患者中,术后复发4例.手术成功的42例患者,全子宫平均质量为（49 ±13） g（95％ CI为39.90～49.88 g）;复发的4例患者切除子宫称重,全子宫质量分别为85.24、82.69、92.67、120.06 g,与超声评估计算出的全子宫质量（分别为87.36、82.00、90.88、123.12 g）比较,差异均无统计学意义（P＞0.05）.结论 超声方法可准确评估在体子宫大小及质量;子宫质量是影响保留子宫的盆底重建术成功的重要因素;盆底重建手术前子宫质量超声评估为盆底重建手术的术式选择提供了参考依据.

Objective To investigate the accuracy of ultrasonographic assessment of the total uterine weight and the feasibility of using this method in the pelvic floor reconstruction.Methods Firstly,81 cases with hysterectomy due to benign uterine diseases or uterine prolapse were studied.The preoperative dimensions and gravities of corpus uteri and cervix were calculated by formulas,and were then compared with the postoperative measurements.Subsequently,46 cases with pelvic floor reconstruction and preserved the uterus were subjected to retrospectively analysis of uterine measurement parameters.Results There were no statistically differences between the preoperative and postoperative diameters of corpus uteri and cervix （P 〉 0.05）,and no statistically differences between the weight of corpus uteri and cervix estimated by the formulas [（87±55）,（32±6） g] and the true weight [（88±57）,（33±6） g; P〉0.05].In 46 cases that underwent the pelvic floor reconstruction by transvaginal mesh repair and preserved the uterus,42 cases were successful treated and the average weight of total uterus was （49 ± 13） g （95%CI：39.90-49.88 g） ; the 4 relapsed cases were treated with hysterectomy and the weight of total uterus were 85.24,82.69,92.67 and 120.06 g which were consistent with the weights estimated by the formulas （87.36,82.00,90.88,123.12 g ; all P 〉 0.05）.Conclusions The uterine weight might be a significant factor for uterus preservation in pelvic floor reconstruction,while ultrasonographic assessment can accurately estimate the uterine weight preoperatively.All these raised the feasibility of assessing uterine weight preoperatively in pelvic floor reconstruction.