肛提肌阴道裂孔大小与女性压力性尿失禁之间的关系

Association between the size of levator ani hiatus and female stress urinary incontinence

目的探讨肛提肌阴道裂孔大小对压力性尿失禁患者控尿机能的影响,从而阐释阴道后盆对其的支持作用以及尿失禁患者相关病因、病理机制。方法选取于昆明医科大学第一附属医院住院并诊断为尿失禁的65名女性患者,按照阴道松弛症的分度,用手指对患者肛提肌阴道裂孔大小进行粗略估算。超声测量患者尿生殖膈裂孔面积。选择65例没有压力性尿失禁症状的患者作为对照组。结果在静息状态下压力性尿失禁患者平均肛提肌阴道裂孔为3指半,平均尿生殖膈裂孔面积为25.74 cm^(2),正常对照组女性的肛提肌阴道裂孔为2指,尿生殖膈裂孔面积为17.49 cm^(2)。结论肛提肌阴道裂孔其病理本质反映的是阴道后壁、会阴体的支持作用不足。手术设计应当重视会阴体阴道后壁对膀胱颈、尿道中近端的支撑。

Objective To explore the effects of the size of levator ani hiatus on the urinary control mechanism of patients with stress urinary incontinence(SUI),so as to explain the supporting effects of posterior vaginal basin and the related etiology and pathological mechanism.Methods A total of 65 SUI patients hospitalized in our department were enrolled.According to the graduation of vaginal relaxation,the size of vaginal fissure of levator ani muscle was roughly estimated with fingers.The area of urogenital diaphragmatic hole was measured with ultrasound.Another 65 patients without SUI symptoms were selected as controls.Results In resting state,the average levator ani vaginal hole in SUI patients was 3.5 fingerbreadths wide,and the average urogenital diaphragmatic hole area was 25.74 cm^(2).In the control group,the average levator ani vaginal hole was 2 fingerbreadths wide,and the urogenital diaphragmatic hole area was 17.49 cm^(2).Conclusion The cause of hiatus of levator ani muscle is the lack of support of the posterior vaginal wall and perineal body.The operation design should pay attention to the support of the posterior wall of perineum and vagina to the bladder neck and the middle and proximal urethra.