三维超声对压力性尿失禁孕妇盆底结构的动态观察

Characteristics of pelvic diaphragm hiatus in late-pregnant women with stress urinary incontinence detected by transperineal 3D ultrasonography

目的经会阴盆底三维超声动态观察压力性尿失禁(SUI)妊娠晚期女性盆底的解剖及功能改变。方法选取2016年1月至2017年12月在陕西省人民医院产科定期产检的单胎初产孕妇,同时伴有SUI的妊娠晚期女性58例(SUI组),同期选取无漏尿及便秘症状的健康孕妇60例(对照组)。比较两组孕妇的肛提肌裂孔特征,分别测量静息状态、缩肛动作和Valsalva动作3种状态下的肛提肌裂孔周长和面积,观察孕妇尿道内口有无开放。结果在静息状态、缩肛动作及Valsalva动作3种状态下,SUI组孕妇的肛提肌裂孔周长和面积分别为(16.90±1.20)cm、(15.10±1.70)cm、(20.90±2.20)cm和(16.10±1.90)cm2、(14.90±1.60)cm2、(19.90±2.10)cm2,均明显大于对照组孕妇的(14.40±1.50)cm、(13.70±1.30)cm、(16.10±1.30)cm和(13.90±2.30)cm2、(13.20±1.90)cm2、(16.60±2.10)cm2,差异有统计学意义(P<0.05);SUI组孕妇中24例(41.38%)出现尿道内口开放,明显高于对照组的6例(10.00%),差异有统计学意义(P<0.05)。结论盆底三维超声可以用于妊娠期女性的盆底功能评估,伴有SUI的晚期妊娠女性肛提肌裂孔增大,且可伴有尿道内口开放。

Objective To study the correlation of morphological and functional characteristics of pelvic diaphragm hiatus in late-pregnant women with stress urinary incontinence（SUI） by transperineal 3 D ultrasonography.Methods From Jan. 2016 to Dec. 2017, 58 late-pregnant women with SUI undergoing transperineal 3 D ultrasound investigation in Shaanxi Provincial People＇s Hospital were selected as the SUI group. At the same time, 60 normal healthy late-pregnant women without SUI or constipation were chosen as control group. The morphological characteristics of pelvic diaphragm hiatus were compared, and the perimeter and area of pelvic diaphragm hiatus were measured at rest, on maximum pelvic floor contraction, and on maximum Valsalva by 3 D ultrasound, respectively. The opening of internal orifice of urethra was also observed. Results The perimeter and area of pelvic diaphragm hiatus at rest, on maximum pelvic floor contraction, on maximum Valsalva were（16.90±1.20） cm,（15.10±1.70） cm,（20.90±2.20） cm, and（16.10±1.90） cm2,（14.90±1.60） cm2,（19.90±2.10） cm2 in SUI group, significantly higher than（14.40±1.50） cm,（13.70±1.30） cm,（16.10±1.30） cm,（13.90±2.30） cm2,（13.20±1.90） cm2,（16.60±2.10） cm2 in control group（P〈0.05）. A total of 24 women（41.38%,24/58） in SUI group had the opening of internal orifice of urethra, versus 6 women（10.00%, 6/60） in the control group（P〈0.05）. Conclusion Transperineal 3 D ultrasonography has great value for pelvic diaphragm hiatus change in late-pregnant women with SUI.