经会阴超声在压力性尿失禁患者TVT-O术后疗效评估中的应用

目的 评价经会阴二维联合三维及四维超声在压力性尿失禁(SUI)患者经闭孔无张力尿道中段悬吊术(TVT-O)中的作用,分析导致不同转归的原因.方法 回顾性分析40例SUI患者TVT-O术后3~30个月盆底超声声像图,根据临床症状将其分为有效组(n=33)和无效组(n=7),比较两组在静息状态及Valsalva状态下吊带运行的轨迹、形态及位置.结果 静息状态下所有患者吊带均位于尿道后方,Valsalva状态下有效组中28例吊带两侧臂对称,3例出现吊带折叠,2例吊带紧贴尿道,吊带运行的轨迹与尿道的位置改变保持一致,无效组7例出现吊带位置异常,吊带远离尿道,2例伴有吊带两侧臂不对称,1例伴有吊带折叠,吊带运行的轨迹与尿道的位置改变不一致.静息及Valsalva状态下,有效组与无效组吊带距耻骨联合后下缘距离、吊带距尿道中点距离及吊带成角差异均有统计学意义(P<0.05).但吊带距膀胱颈距离、尿道长度有效组与无效组差异均无统计学意义(P>0.05).结论 经会阴超声可动态观察SUI患者TVT-O术后转归,并有助于分析产生不同临床症状的原因.

Objective To evaluate the role of trans perineal 2D combined with 3D and 4D ultrasound in observing the surgical outcome of tension-free vaginal tape-obturator(TVT-O)in patients with stress urinary incontinence(SUI)and to analyze the causes of different regressions.Methods Retrospective analysis of pelvic floor ultrasound sonograms from 3 to 30 months after TVT-O was performed.40 patients with SUI were divided into the effective(n=33)and the ineffective(n=7)groups according to their clinical symptoms.The trajectory and morphology,and position of tape operation in the resting and Valsalva states were compared between the 2 groups.Results In all patients,the tape was placed behind the urethra when they were resting.In the Valsalva state,28 instances in the effective group had symmetrical tape arms on both sides,3 cases had tape folding,2 cases had the tape securely linked to the urethra,and the tape running trajectory was congruent with the urethral position change.The tape was distant from the urethra in 7 cases in the unsuccessful group.2 cases had asymmetrical tape arms on both sides,1 case had tape folding,and the trajectory of the tape running was discordant with the urethral position change.The tape's trajectory did not correspond to the shift in urethral position.In the resting and Valsalva states,there were statistically significant differences in the distance between the tape and the posterior inferior border of the pubic symphysis,the distance between the tape and the midpoint of the urethra,and the tape angle between the effective and the ineffective groups(P<0.05).However,there was no statistically significant difference in the distance between the tape and the bladder neck and the urethral length between the effective and ineffective groups(P>0.05).Conclusion Trans perineal ultrasound can dynamically observe the postoperative regression of TVT-O in patients with SUI and help analyze the causes of different clinical symptoms.