40例女性压力性尿失禁患者经超声诊断的价值探讨

Preliminary investigation on diagnostic value of 2D/3D transperineal ultrasound for pelvic anatomy in 40 patients with stress urinary incontinence

目的探讨二维及三维超声在压力性尿失禁患者中的诊断价值。方法选择2014年10月至2015年12月在西安交通大学第二附属医院泌尿外科门诊就诊的压力性尿失禁患者40名,选取同期健康女性40例为正常对照组,所有受检者均分别行二维及三维盆底超声检查,测量并记录数据。结果压力性尿失禁组与对照组二维测量参数比较,最大Valsalva动作后压力性尿失禁患者膀胱颈向后下方移位,膀胱颈移动度显著大于对照组(t=2.31,P<0.05);静息状态及最大Valsalva动作后膀胱尿道后角显著大于对照组(t值分别为2.57、3.09,均P<0.05);最大Valsalva动作后尿道旋转度显著大于对照组(t=2.67,P<0.05);静息状态下压力性尿失禁组与对照组的尿道长度及尿道倾斜角,差异均无统计学意义(t值分别为1.26、1.91,均P>0.05)。三维超声观察耻骨内脏肌及盆膈裂孔结构清晰可辨,最大Valsalva状态下,耻骨内脏肌厚度,尿失禁组显著小于对照组(t=2.98,P<0.05),盆膈裂孔面积尿失禁组显著大于对照组(t=5.01,P<0.05)。结论压力性尿失禁发生的主要机制是膀胱颈和尿道支持结构的异常,经会阴二维及三维超声可良好评价不同状态下上述支持结构的改变。

Objective To preliminarily investigate the diagnostic value of 2D/3D ultrasound in the patients with stress urinary incontinence （SUI）. Methods Totally 40 out-patients diagnosed with SUI in the department of urology in Second Affiliated Hospital of Xi＇ an Jiaotong University from October 2014 to December 2015 were recruited in study in SUI group, and 40 healthy women were selected into control group during the same period. 2D/3D pelvic ultrasound was performed in both groups, and the measurements were recorded. Results Comparison of 2D parameters between two groups showed that the bladder neck shifted slightly backward and downward in SUI group, and the displacements of bladder neck were found lager in SUI group than in the control group after maximum Valsalva （ t = 2. 31, P 〈 0.05 ）. Larger posterior urethra-vesical angle was found in SUI group compared to that in the control group both during resting and after maximum Valsalva（ t value was 2.57 and 3.09, respectively, both P 〈 0.05 ）. The urethral rotation was significantly greater after maximum Valsalva in SUI group （ t = 2.67, P 〈 0.05 ）. No statistically significant differences both in urethral length and urethral tilt angle were indicated between two groups during resting （t value was 1.26 and 1.91, respectively, both P 〉 0.05 ）. The pubovisceral muscle and pelvic diaphragm hiatus were clearly identified using 3D ultrasound, and the thickness of pubovisceral muscle after maximum Valsalva in SUI group was smaller than that in the control group （ t = 2. 98, P 〈 0.05 ）. The area of pelvic diaphragm hiatus increased significantly after maximum Valsalva in SUI group compared to the control group （ t = 5. 01, P 〈 0.05 ）. Conclusion The primary pathogenesis of SUI is related to abnormal structural support of the neck of bladder and the urethra. And 2D/3D transperineal ultrasound can be used to effectively evaluate the chan^es of such suooort structure in various conditions.