超声评价膀胱颈漏斗形成在女性压力性尿失禁中的意义

Ultrasonographic Evaluation of Infundibular Bladder Neck Formation in Female Stress Urinary Incontinence

目的探讨膀胱颈漏斗形成与盆底支持结构损伤及尿道括约肌缺陷之间的关联,及其在女性压力性尿失禁中的意义。资料与方法回顾性分析2015年4月-2016年8月于兰州大学第二医院门诊就诊的74例女性压力性尿失禁患者盆底图像。经会阴超声观察静息状态和最大Valsalva状态下膀胱颈位置、膀胱尿道后角及膀胱颈漏斗形成等,同时在静息状态下测量尿道中段括约肌厚度。同时纳入81例正常体检女性为对照组。结果最大Valsalva状态下,压力性尿失禁组中膀胱颈漏斗形成率(66.2%)明显高于对照组(4.9%),差异有统计学意义(P<0.05);压力性尿失禁组的膀胱颈下降值及膀胱尿道后角明显大于对照组,差异均有统计学意义(P<0.05);压力性尿失禁组经尿动力学证实9例存在尿道括约肌缺陷,均出现膀胱颈漏斗形成,其尿道中段括约肌厚度与无尿道括约肌缺陷及对照组对比,差异无统计学意义(P>0.05)。结论膀胱颈漏斗形成是压力性尿失禁的重要指征,与盆底支持结构功能受损、尿道括约肌缺陷密切相关;但通过尿道括约肌厚度评估括约肌缺陷尚需进一步研究。

Purpose To investigate the relationship of infundibular bladder neck formation with pelvic floor support structure injury and urethral sphincter defect and its significance in female stress urinary incontinence. Materials and Methods The pelvic floor images of seventy-four female patients with stress urinary incontinence treated in the outpatient Department of Lanzhou University Second Hospital from April 2015 to August 2016 were analyzed retrospectively. The location of the bladder neck, posterior vesicourethral angle and the infundibular bladder neck formation were observed by the transperineal ultrasound under the resting state and the maximum Valsalva status. Meanwhile the thickness of middle urethral sphincter was measured under resting state. At the same time, eighty-one women visiting our hospital for regular physical examination were enrolled as control group. Results The infundibular urinary bladder neck formation rate（66.2%） in the stress urinary incontinence group was significantly higher than that in the control group（4.9%） under maximum Valsalva state, the difference was statistically significant（P〈0.05）. The extent of the bladder neck descending and posterior vesicourethral angle in the stress urinary incontinence group were notably higher than those in the control group, both of the difference was statistically significant（P〈0.05）. Stress urinary incontinence was confirmed with urethral sphincter defect by urodynamics in nine patients, in whom the infundibular bladder neck occurred. The thickness of the middle urethral sphincter in these nine patients showed no obvious difference with that in patients without sphincter defect and subjects in normal control group（P〉0.05）. Conclusion The infundibular bladder neck formation, which is closely related to the pelvic floor support structure dysfunction and urethral sphincter defect, is an important indication of stress urinary incontinence. However, the assessment of urethral sphincter defect through urethral sphincter thickness need to be further studied.