盆底重建手术前后经会阴超声对下尿路状况的评估

Evaluation of lower urinary tract in patients before and after pelvic floor reconstruction

目的探讨基于会阴超声评估下盆底重建手术前后下尿路状况的指标差异比较,旨在为改善盆腔器官脱垂患者的临床症状提供一定的理论依据。方法选取2016年6月至2017年6月期间在丽水市中心医院行盆底重建术的76例盆腔器官脱垂患者为研究对象,所有患者分别于盆底重建术前及术后6个月进行会阴超声检查。采用自身对照设计,比较患者术前及术后6个月的超声参数,肛提肌裂口面积、尿道漏斗及尿道膨出的发生率。结果患者术后膀胱颈移动度显著低于术前(2.26±0.51 vs.3.21±0.66,t=2.75,P<0.05);术后最大Valsalva动作状态下的肛提肌-尿道间隙也显著低于术前(3.22±0.63 vs.3.77±0.73,t=2.39,P<0.05);患者术后静息状态、缩肛状态以及最大Valsalva动作状态的肛提肌裂口面积均显著低于术前,差异均具有显著性统计学意义(t值分别为2.19,2.48,2.39,均P<0.05);与盆底重建术前对比,患者术后尿道膨出发生率(3.95%vs.14.47%,χ^2=102.19,P<0.05)、尿道漏斗发生率(10.53%vs.25.00%,χ^2=64.53,P<0.05)均显著下降。结论会阴超声可较好地应用于盆底重建术妇女下尿路状况的评估。

Objective To investigate the difference of perineal ultrasound evaluation index of lower urinary tract condition of women with pelvic organ prolapse before and after pelvic floor reconstruction,in order to provide a certain theoretical basis for improving the survival condition for these patients.Methods 76 patients with pelvic organ prolapse who underwent pelvic floor reconstruction in Lishui Central Hospital from June 2016 to June 2017 were selected as subjects.All patients underwent perineal ultrasound examination before and 6 months after pelvic floor reconstruction.Using the self-controlled design,the ultrasound parameters,the area of levator ani hiatus,the incidence of urethral funnel and urethral protrusion were compared.Results The postoperative bladder neck mobility was significantly lower than that before surgery(2.26±0.51 vs.3.21±0.66,t=2.75,P<0.05).The levator ani gap and urethra under the maximum postoperative Valsalva movement was also significantly lower than that before surgery(3.22± 0.63 vs.3.77±0.73,t=2.39,P<0.05).The levator ani tear area in postoperative resting state,anal contraction state and the maximum Valsalva movement state of the patients were all significantly lower than that before surgery,with statistically significant differences(t values were 2.19,2.48,2.39,all P<0.05).Compared with that before pelvic floor reconstruction,the incidence of postoperative urethral dilation(3.95% vs.14.47,χ^2=102.19,P<0.05) and the incidence of urethral funnel(10.53% vs.25.00%,χ^2=64.53,P<0.05) were significantly reduced.Conclusion Perineal ultrasound can better evaluate the lower urinary tract in women with pelvic floor reconstruction.