经会阴超声检查对重度盆腔器官脱垂患者行手术治疗后下尿路结构的评估作用

Evaluation effect of transperineal ultrasound examination on lower urinary tract structure of patients with severe pelvic organ prolapse after surgery treatment

目的分析经会阴超声检查对重度盆腔器官脱垂患者行手术治疗后下尿路结构的评估作用。方法选取2017年11月至2019年5月在我院进行治疗的62例重度盆腔器官脱垂患者为研究对象,所有患者均接受手术治疗,根据手术方式的不同将患者分为对照组和观察组,各31例。对照组患者接受经阴道植入网片盆底重建术治疗,观察组患者在对照组的基础上接受经闭孔无张力尿道中段悬吊术治疗。在治疗后使用经会阴超声对所有患者下尿路结构情况进行评估。比较两组患者的膀胱颈移动度(BND)、尿道倾斜角(∠α)、尿道膀胱后角(RVA)、肛提肌-尿道间隙(LUG),并观察术后经阴道超声的下尿路结构。结果术后,两组的BND均明显小于术前(P<0.05)。在进行最大Valsalva动作时,观察组患者术后的∠α与术前比较,差异显著(P<0.05)。在进行最大Valsalva动作时,两组患者术后的LUG与术前比较,差异显著(P<0.05)。观察组有2例(6.45%)患者在术后出现排尿困难症状,有4例(12.90%)出现压力性尿失禁症状;超声检查显示,有2例(6.45%)出现吊带脱落现象,2例(6.45%)在进行最大Valsalva动作时,其吊带位移情况较大。对照组术后有1例(3.23%)患者出现排尿困难现象,有5例(16.13%)出现压力性尿失禁症状;超声检查显示,有3例(9.68%)在进行最大Valsalva动作时,其膀胱经出现明显下移现象,并且膀胱向后下方的移动幅度较大,另外2例(6.45%)患者尿道内镜出现增宽现象,尿道自然闭合功能缺失。结论经会阴超声检查能够清晰显示重度盆腔器官脱垂患者下尿路的解剖结构,可为盆底重建手术后评估下尿路结构提供直观的影像学证据,值得临床推广应用。

Objective To analyze of the evaluation effect of transperineal ultrasound examination on lower urinary tract structure of patients with severe pelvic organ prolapse after surgery treatment.Methods A total of 62 patients with severe pelvic organ prolapse who received treatment in our hospital from November 2017 to May 2019 were selected as the research objects.All patients received surgical treatment.According to different surgical methods,the patients were divided into control group and observation group,with 31 cases in each group.Patients in the control group received pelvic floor reconstruction with transvaginal insertion mesh,and patients in the observation group received trans-obturator tension-free vaginal tape on the basis of the control group.The structure of the lower urinary tract in all patients was assessed by using transperineal ultrasound after treatment.The bladder neck descent(BND),urethral inclination Angle(∠α),retro vesicourethral angle(RVA)and levator-urethra gap(LUG)were compared between the two groups,and the structure of lower urinary tract after surgery was observed by transvaginal ultrasonography.Results After surgery,the BND of patients in both groups were significantly smaller than those before surgery(P<0.05).When the maximum Valsalva action was performed,there were statistically differences in∠αof patients in the observation groups before and after surgery(P<0.05).When the maximum Valsalva action was performed,there were statistically differences in LUG of patients in both groups before and after surgery(P<0.05).In the observation group,2 patients(6.45%)had dysuria symptoms after surgery,and 4 patients(12.90%)had stress urinary incontinence symptoms;ultrasonic examination showed that 2 patients(6.45%)had sling detachment phenomenon,and 2 patients(6.45%)had greater sling displacement during the maximum Valsalva action.In the control group,1 patients(3.23%)had dysuria symptoms after surgery,and 5 patients(16.13%)had stress urinary incontinence symptoms;ultrasonic examination showed that 3 cases(9.68%)had significant downward movement phenomenon of the bladder meridian during the maximum Valsalva action,and the backward and downwards movement range of bladder is larger,the other 2 patients(6.45%)had the urethra endoscopic broadening phenomena,and the natural urethral closure function was lost.Conclusion Transperineal ultrasound examination can clearly display the anatomical structure of the lower urinary tract in patients with severe pelvic organ prolapse,and provide visualized imaging evidence for the evaluation of structure of the lower urinary after pelvic floor reconstruction surgery,which is worthy of promotion and application in clinic.