经会阴超声评价子宫全切术后盆底前腔室结构的变化

Transperineal ultrasonography in evaluation of pelvic floor structure changes in post-hysterectomy patients

目的采用经会阴超声评价子宫全切手术前后盆底前腔室结构的变化。方法收集拟行子宫全切术的患者45例,于术前1天、术后1、3、6个月采用经会阴超声观察盆底前腔室结构,分别记录和计算静息状态和最大瓦氏动作下膀胱颈距耻骨联合下缘的距离(BSD)、膀胱颈移动度(BND)、尿道旋转角(UR)和膀胱尿道后角(PUA),并对不同时间各参数进行统计学分析。结果不同时间点最大瓦氏动作下BSD、PUA,BND,UR差异有统计学意义(P均<0.05)。与术前比较,术后3个月最大瓦氏状态下BSD减小(H=2.627,P=0.009)、BND增大(q=-3.095,P=0.002),术后6个月最大瓦氏状态下BSD减小(H=4.379,P<0.001),BND(q=-4.379,P<0.001)、UR(H=-2.861,P=0.004)和最大瓦氏状态下PUA(q=-2.686,P=0.007)增大;余两两时间点比较差异均无统计学意义(P均>0.05)。结论子宫全切术后初期盆底前腔室最大瓦氏动作下BSD、PUA,BND,UR已发生变化;明确子宫全切术对盆底结构的损伤,可为临床早期进行盆底康复治疗提供理论依据。

Objective To evaluate the changes in anterior chamber structure of pelvic floor before and after total hysterectomy with transperineal ultrasonography. Methods Forty-five patients who would receive total hysterectomy were enrolled. The structures of the anterior pelvic floor were observed with transperineal ultrasonography 1 day pre-operation and 1, 3 and 6 months after operation. The parameters at rest and max Valsalva were recorded and calculated, including the bladder neck-symphyseal distance （BSD）, bladder neck descent （BND）, urethral rotation angle （UR） and posterior urethrovesical angle （PUA）. The changes of the parameters at different time were analyzed statistically. Results BSD at max Valsalva, BND, UR and PUA at max Valsalva at different time were significantly different （all P〈0.05）. Compared with those pre-operative, BSD at max Valsalva decreased （H=2.627, P=0.009） and BND increased （q=-3.095, P=0.002） 3 months after operation, BSD at max Valsalva decreased （H=4.379, P〈0.001）, BND （q=-4.379, P〈0.001）, UR （H=-2.861, P=0.004） and PUA at max Valsalva （q=-2.686, P=0.007） increased 6 months after operation. The remaining parameters were not significantly different between every two time points （all P〉0.05）. Conclusion The changes of BSD, BND at max Valsalva, UR and PUA at max Valsalva occur at the initial period after the total hysterectomy. The total hysterectomy can damage the pelvic floor and early pelvic floor rehabilitation need to be provided.