经会阴盆底超声评估Kegel训练对妊娠中晚期压力性尿失禁患者盆腔器官脱垂的治疗效果

Efficacy of Kegel training in the treatment of pelvic organ prolapse in stress urinary incontinence patients with second-and third-trimester pregnancy by transperineal pelvic floor ultrasound

目的应用Kegel训练对妊娠中晚期压力性尿失禁患者盆腔器官脱垂进行治疗,探讨经会阴盆底超声评估其治疗效果的临床价值。方法选取于我院就诊的妊娠中晚期孕妇85例,根据是否存在压力性尿失禁分为阳性组46例和阴性组39例,按照随机数字表法进一步将阳性组患者分为对照组(未进行任何治疗)和治疗组(采用Kegel训练),每组各23例;比较阳性组与阴性组、对照组与治疗组治疗前及治疗3个月、6个月尿道旋转角度(Δα)、膀胱颈活动度(BND)、膀胱颈旋转角度(Δβ)及静息状态与Valsalva状态下膀胱尿道后角(θr、θs)、膀胱颈角度(βr、βs)的差异。分析超声测量指标与孕周的关系。结果阳性组BND、Δβ、θr、θs、βs均大于阴性组,差异均有统计学意义(均P<0.05)。治疗组治疗3个月、6个月Δα、BND、θr与治疗前比较差异均有统计学意义(均P<0.05),治疗6个月θs与治疗前比较差异有统计学意义(P<0.05);对照组6个月后Δα和θr与基线水平比较差异均有统计学意义(均P<0.05)。相关性分析显示,阳性组Δα与孕周呈正相关(r=0.387,P=0.039)。结论Kegel训练可改善妊娠中晚期压力性尿失禁患者膀胱尿道周围支持结构,经会阴盆底超声可准确评估其治疗效果,具有较好的临床应用价值。

Objective To treat pelvic organ prolapse in stress urinary incontinence patients with second-and thirdtrimester pregnancy by Kegel training,and to explore the clinical value of the efficacy evaluated by transperineal pelvic floor ultrasound.Methods Totally 85 pregnant women in the second-and third-trimester pregnancy in our hospital were selected,and 46 cases were set in the positive group and 39 cases in the negative group according to whether there was stress urinary incontinence.The patients in the positive group were further divided into control group(without any treatment)and treatment group(using Kegel training)according to the random number table method,with 23 cases in each group.The differences between the positive group and the negative group,the control group and the treatment group before treatment and at 3 months and 6 months of treatment were compared with the differences in urethral rotation angle(Δα),bladder neck range(BND),bladder neck rotation angle(Δβ),resting state and Valsalva state of bladder urethral posterior angle(θr,θs)and bladder neck angle(βr,βs).The relationship between ultrasonic index and gestational age was analyzed.Results BND,Δβ,θr,θs andβs in the positive group were higher than those in the negative group,the differences were statistically significant(all P<0.05).The differences inΔα,BND andθr at 3 months and 6 months in the treatment group were statistically significant compared with those before treatment(all P<0.05),and the difference inθs in the treatment group was statistically significant between 6 months after treatment and before treatment(all P<0.05).There were significant differences inθr andΔαin the control group between 6 months after treatment and baseline levels(both P<0.05).Correlation analysis showed thatΔαin the positive group was positively correlated with gestational age(r=0.387,P=0.039).Conclusion Kegel training can improve the periurethral support structure of the bladder in patients with stress urinary incontinence in the second-and third-trimester pregnancy,and its therapeutic effect can be accurately evaluated by transperineal pelvic floor ultrasound,which has good clinical application value.