经会阴超声观察经腹子宫全切除术后远期压力性尿失禁的应用价值

The value of perineal ultrasonography in long-term stress urinary incontinence after total abdominal hysterectomy

目的探讨经会阴超声(TPUS)对经腹全子宫切除术(TAH)后远期压力性尿失禁(SUI)的评估价值。方法 TAH术后2年以上患者120例,根据临床标准及超声标准诊断是否为SUI,分为非SUI组(Ⅱ组)66例和SUI组(Ⅲ组)54例,另选择72例健康体检患者作为对照组(Ⅰ组)。分别在静息状态(r)及Valsalva状态(v)下测量并记录膀胱颈旋转角度(ΔvBA),静息期、Valsalva状态膀胱尿道后角(rUJV、vUJV),尿道旋转角度(ΔvUIA),膀胱颈活动度(BND)、膀胱颈位移(vsB)。结果根据超声所见结合盆底各参数测量结果,与Ⅰ组比较,Ⅱ组ΔvBA、rUJV、vUJV、ΔvUIA、BND、vsB绝对值均增大(P<0.01),表明TAH术后远期前盆腔盆底组织的支持功能减低;与Ⅱ组比较,Ⅲ组ΔvBA、rUJV、ΔvUJV、vUIA、BND、vsB绝对值均增大(P<0.01),表明TAH术后,与非SUI患者比较,SUI患者盆底超声参数值增大更明显。结论 TAH术后远期盆底组织的支持功能降低,经TPUS可以对TAH术后远期患者的盆底功能进行动态检测,以早期发现盆底功能的减退。

Objective To evaluate the value of transperineal pelvic ultrasound（TPUS） on long-term stress urinary incontinence （SUI） after total abdominal hysterectomy （TAH）. Methods Thirty patients with TAH at least 2 years after operation were diagnosed as SUI according to clinical criteria and ultrasound criteria.They were divided into non-SUI group （Group Ⅱ,66 cases ） and SUI group （Group Ⅲ,54 cases）,72 cases of healthy patients were selected as the control group （group Ⅰ）.TPUS was performed.The bladder neck rotation angle （ΔvBA）,bladder urethral relief angle （rUJV,vUJV）,urethral rotation angle （ΔvUIA）,bladder neck mobility （BND）,and the displacement of the bladder neck （vsB） were measured and recorded during the rest period and Valsalva state. Results According to the findings of ultrasound combined with pelvic floor parameters,the absolute values of ΔvBA,rUJV,vUJV,ΔvUIA,BND,vsB were increased in group Ⅱ compared with group Ⅰ （ P 〈0.05）,which indicated that supportive function of the long-term pelvic floor tissue after TAH for a long-term was reduced.Compared with the non SUI group,the absolute values of ΔvBA,rUJV,vUJV,ΔvUIA,BND and vsB increased in the SUI group after TAH for a long term （ P 〈0.05）.The absolute values of ΔvBA,rUJV,vUJV,ΔvUIA,BND,and vsB increased in the SUI group compared with the non-SUI group （ P 〈0.05）,which indicated that after TAH,compared with non-SUI patients,the value of pelvic ultrasound parameters in patients with SUI increased more significantly. Conclusion The pelvic floor support function decreased after TAH,and pelvic floor function could be dynamically detected by TPUS in the early stage of TAH.