盆底超声对产后压力性尿失禁康复疗效的评估作用

Assessment value of the pelvic floor ultrasound for the rehabilitation efficacy of patients with postpartum stress urinary incontinence

目的:分析盆底超声对产后压力性尿失禁康复疗效的评估作用。方法:选择2023年3-11月北京大学民航临床医学院诊治的产后6周患压力性尿失禁患者90例,将采用盆底肌训练产妇45例纳入治疗1组、接受电刺激治疗产妇45例纳入治疗2组,两组均治疗12周,同期正常产妇45例作为对照组。运用盆底超声技术,检测对照组及治疗组治疗前后的Valsalva状态时肛提肌裂孔面积、尿道旋转角、膀胱颈移动度、肛提肌应变率。结果:治疗前,两个治疗组Valsalva状态时肛提肌裂孔面积、尿道旋转角、膀胱颈移动度均大于对照组,肛提肌应变率小于对照组(均P<0.05);治疗12周后,两个治疗组Valsalva状态时肛提肌裂孔面积(21.3±2.1、2.4±0.2)cm^(2)、尿道旋转角(46.7±9.8、48.6±10.4)°、膀胱颈移动度(2.3±0.2、2.4±0.2)cm均小于治疗前(均P<0.05),肛提肌应变率(19.0±3.0、17.5±3.3)%与治疗前未见差异(P>0.05)。结论:盆底肌训练与电刺激均是产后压力性尿失禁的有效康复治疗方法,盆底超声技术能判断盆底形态结构变化,对康复疗效有评估作用。

Objective:To analyze the evaluation value of the pelvic floor ultrasound for the rehabilitation efficacy of patients with postpartum stress urinary incontinence(PSUI).Methods:90 patients with PSUI in the 6th weeks after delivery were selected in this study from March to November 2023.45 patients who had accepted the pelvic floor muscle training were included in group A and 45 patients who had received the electrical stimulation therapy were included in group B.Another 45women without PSUI were randomly selected in group C.The pelvic floor ultrasonography was used to compare the hiatus area of the levator ani muscle,the urethral rotation angle,the bladder neck mobility and the strain rate of the levator ani muscle of the patients at Valsalva maneuver before and after treatment were compared among the three groups.Results:Before the treatment,the hiatus area of the levator ani muscle,the urethral rotation angle and the bladder neck mobility of the patients in group A and in group B at Valsalva maneuver were significantly higher than those of the patients in group C,and the strain rate of the levator ani muscle of the patients in group A and in group B at Valsalva maneuver was significantly lower(all P<0.05).After 12weeks of treatment,the hiatus area of the levator ani muscle(21.3±2.1 and 2.4±0.2),the urethral rotation angle(46.7±9.8°and 48.6±10.4°)and the bladder neck mobility(19.0±3.0% and 17.5±3.3%)of the patients in group A and in group B at Valsalva maneuver had decreased significantly.The strain rate of the levator ani muscle of the patients in group A and in group B at Valsalva maneuver after treatment were 19.0±3.0 and 17.5±3.3,which had no change significantly(P>0.05).Conclusion:Both the pelvic floor muscle training and the electrical stimulation are the effective rehabilitation methods for the patients with PSUI.The pelvic floor ultrasound can determine the changes of the pelvic floor morphology and structure of the patients,and which has the role for evaluating the efficacy of the rehabilitation of PSUI of the patients.