Clinical Value of Transperineal 3D Volume Ultrasound Combined with 2D High Frequency Ultrasound in Anal Fistula

Objective: To explore the clinical diagnostic value of transperineal volume ultrasound combined with two-dimensional high-frequency ultrasound for anal fistula. Methods: A total of 52 patients with anal fistula admitted to the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from December 2017 to July 2018 were selected. They were all undergoing transperineal 3D volume ultrasound combined with 2D high-frequency ultrasound examination, and the diagnosis results were analyzed. The results of ultrasonography and surgical pathology were compared. Results: Among 52 patients, 3D volume ultrasound combined with 2D high-frequency ultrasound were used to diagnose 32 cases of anal fistula intersphincteric type, 14 cases of transsphincter type, 5 cases of supra-sphincter type, and 1 case of extra-sphincter type. T supervisor classification accuracy rate is 90%. The detection rate of branch pipes was 92%, and the compliance rate of internal fistula was 95%. Two-dimensional high-frequency ultrasound was used to diagnose 34 cases of anal fistula intersphincteric type, 14 cases of transsphincter type, 4 cases of supra-sphincter type, and 0 cases of extra-sphincter type. The detection rate of branch canals was 42%, and the accuracy of type classification was 90%. The coincidence rate was 95%. There was a statistically significant difference in the detection rate of the anal fistula branch and the coincidence rate of the internal fistula between the two methods (both P Conclusion: 1) The overall coincidence rate of three-dimensional volumetric ultrasound combined with two-dimensional high-frequency ultrasound in the diagnosis of anal fistula is high;2) Three-dimensional volumetric ultrasound technology has great application prospects in infants and anal fistulas.

Clinical efficacy of ultrasound-guided pulsed radiofrequency combined with ganglion impar block for treatment of perineal pain

BACKGROUND Ganglion impar block alone or pulsed radiofrequency alone are effective options for treating perineal pain.However,ganglion impar block combined with pulsed radiofrequency(GIB-PRF)for treating perineal pain is rare and the puncture is usually performed with X-ray or computed tomography guidance.AIM To evaluate the safety and clinical efficacy of real-time ultrasound-guided GIBPRF in treating perineal pain.METHODS Thirty patients with perineal pain were included and were treated by GIB-PRF guided by real-time ultrasound imaging between January 2015 and December 2016.Complications were recorded to observe the safety of the ultrasound-guided GIB-PRF procedure,and visual analogue scale(VAS)scores at 24 h before and after treatment and 1,3,and 6 mo later were analyzed to evaluate clinical efficacy.RESULTS Ultrasound-guided GIB-PRF was performed successfully in all patients,and no complications occurred.Compared with pretreatment scores,the VAS scores were significantly lower(P<0.05)at the four time points after treatment.The VAS scores at 1 and 3 mo were slightly lower than those at 24 h(P>0.05)and were significantly lower at 6 mo after treatment(P<0.05).There was a tendency toward lower VAS scores at 6 mo after treatment compared with those at 1 and 3 mo(P>0.05).CONCLUSION Ultrasound-guided GIB-PRF was a safe and effective way to treat perineal pain.The 6-mo short-term clinical efficacy was favorable,but the long-term outcomes need future study.

Can We Predict De Novo Urge Incontinence by Perineal Ultrasound?

Introduction: Urinary incontinence affects over 200 million people worldwide [1]. Tension free vaginal tape is the standard surgical treatment for stress urinary incontinence. De novo urge urinary incontinence is a long-term complication of this treatment with a significant impact in the quality of life of these patients. Objective: The major aim of this study is to assess the correlation between perineal ultrasonography findings and the incidence of de novo urge urinary incontinence. Material and Methods: A prospective observational study was designed. Patients with stress urinary incontinence diagnosed by clinical and urodynamic findings submitted to a tension-free vaginal tape surgery were included. International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and introital perineal ultrasound were performed before surgical intervention (I-STOP&copy). Clinical and ultrasound re-evaluation were executed six months after surgery. Stress urinary incontinence was defined according to the ICS-IUGA. Data were recorded using a Microsoft Access database and statistical analysis using SAS&copy. Results: Bladder thickness equal to or below 6 mm has a low positive predictive value (PPV, 0.55), but a negative predictive power (NPP) of 0.72. Following surgery, a slight increase in postvoid residue is observed. Considering demographic data, an increase of 5 points in body mass index (BMI) resulted in an odds ratio (OR) of 1.74 of presenting de novo urge urinary in continence. Conclusions: In patients submitted to a tension-free vaginal tape surgery, high BMI seems to be associated with a higher rate of de novo urge urinary incontinence. Preoperative bladder wall thickness below 6 mm seems predict absence of this complication.

Value of myocardial function in children with Kawasaki disease by two-dimensional and three-dimensional ultrasound speckle tracking

Objective:To investigate the value of two-dimensional ultrasound speckle tracking(2D-STI)and three-dimensional ultrasound speckle tracking(3D-STI)in evaluating myocardial function in children with Kawasaki disease.Methods 92 children with Kawasaki disease admitted to our hospital from February 2017 to February 2019 were retrospectively analyzed.50 children who underwent 3D-STI examination were taken as observation group and 42 children who underwent 2D-STI examination were taken as control group.The left ventricular systolic function index,storage time and analysis time of the image,the diameter of coronary artery,the strain difference of left ventricular basal segment,middle segment,apical segment and whole segment were observed.Results The levels of left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular myocardial mass(LVMI)in the observation group were higher than those in the control group(P<0.05),but there was no statistical difference in left ventricular ejection fraction(LVEF)between the two groups(P>0.05).The storage time and analysis time of the image in the observation group were significantly lower than those in the control group(P<0.05).The left coronary artery(LCA)and right coronary artery(RCA)in the observation group were higher than those in the control group(P<0.05).There was no statistical difference between left anterior descending(LAD)in the two groups(P>0.05).The longitudinal peak systolic strain(LS),circumferential peak systolic strain(CS)and radial peak systolic strain(RS)in the observation group were higher than those in the control group(P<0.05).The global longitudinal peak strain(GLS),global circumferential peak strain(GCS)and global radial peak strain(GRS)in the observation group were higher than those in the control group(P<0.05).LS and CS in the middle segment of the observation group were higher than those in the control group(P<0.05).Conclusions Compared with 2D-STI,3D-STI can objectively and accurately reflect the myocardial function of children with Kawasaki disease.

Differential diagnosis of different types of solid focal liver lesions using two-dimensional shear wave elastography

BACKGROUND The clinical management and prognosis differ between benign and malignant solid focal liver lesions(FLLs),as well as among different pathological types of malignant FLLs.Accurate diagnosis of the possible types of solid FLLs is important.Our previous study confirmed the value of shear wave elastography(SWE)using maximal elasticity(Emax)as the parameter in the differential diagnosis between benign and malignant FLLs.However,the value of SWE in the differential diagnosis among different pathological types of malignant FLLs has not been proved.AIM To explore the value of two-dimensional SWE(2D-SWE)using Emax in the differential diagnosis of FLLs,especially among different pathological types of malignant FLLs.METHODS All the patients enrolled in this study were diagnosed as benign,malignant or undetermined FLLs by conventional ultrasound.Emax of FLLs and the periphery of FLLs was measured using 2D-SWE and compared between benign and malignant FLLs or among different pathological types of malignant FLLs.RESULTS The study included 32 benign FLLs in 31 patients and 100 malignant FLLs in 96 patients,including 16 cholangiocellular carcinomas(CCCs),72 hepatocellular carcinomas(HCCs)and 12 liver metastases.Thirty-five FLLs were diagnosed as undetermined by conventional ultrasound.There were significant differences between Emax of malignant(2.21±0.57 m/s)and benign(1.59±0.37 m/s)FLLs(P=0.000),and between Emax of the periphery of malignant(1.52±0.39 m/s)and benign(1.36±0.44 m/s)FLLs(P=0.040).Emax of liver metastases(2.73±0.99 m/s)was significantly higher than that of CCCs(2.14±0.34 m/s)and HCCs(2.14±0.46 m/s)(P=0.002).The sensitivity,specificity and accuracy were 71.00%,84.38%and 74.24%respectively,using Emax>1.905 m/s(AUC 0.843)to diagnose as malignant and 23 of 35(65.74%)FLLs with undetermined diagnosis by conventional ultrasound were diagnosed correctly.CONCLUSION Malignant FLLs were stiffer than benign ones and liver metastases were stiffer than primary liver carcinomas.2D-SWE with Emax was a useful complement to conventional ultrasound for the differential diagnosis of FLLs.

Diagnostic problems in two-dimensional shear wave elastography of the liver

Two-dimensional shear wave elastography(2D-SWE)is used in the clinical setting for observation of the liver.Unfortunately,a wide spectrum of artifactual images are frequently encountered in 2D-SWE,the precise mechanisms of which remain incompletely understood.This review was designed to present many of the artifactual images seen in 2D-SWE of the liver and to analyze them by computer simulation models that support clinical observations.Our computer simulations yielded the following suggestions:(1)When performing 2D-SWE in patients with chronic hepatic disease,especially liver cirrhosis,it is recommended to measure shear wave values through the least irregular hepatic surface;(2)The most useful 2D-SWE in patients with focal lesion will detect lesions that are poorly visible on B-mode ultrasound and will differentiate true tumors from pseudo-tumors(e.g.,irregular fatty change);and(3)Measurement of shear wave values in the area posterior to a focal lesion must be avoided.

Role of ultrasound in colorectal diseases

Ultrasound is an undervalued non-invasive examination in the diagnosis of colonic diseases. It has been replaced by the considerably more expensive magnetic resonance imaging and computed tomography, despite the fact that, as first examination, it can usefully supplement the diagnostic process. Transabdominal ultrasound can provide quick information about bowel status and help in the choice of adequate further examinations and treatment. Ultrasonography,as a screening imaging modality in asymptomatic patients can identify several colonic diseases such as diverticulosis, inflammatory bowel disease or cancer. In addition, it is widely available, cheap, non-invasive technique without the use of ionizing radiation, therefore it is safe to use in childhood or during pregnancy, and can be repeated at any time. New ultrasound techniques such as elastography, contrast enhanced and Doppler ultrasound, miniprobes rectal and transperineal ultrasonography have broadened the indication. It gives an overview of the methodology of various ultrasound examinations, presents the morphology of normal bowel wall and the typical changes in different colonic diseases. We will pay particular attention to rectal and transperineal ultrasound because of their outstanding significance in the diagnosis of rectal and perineal disorders. This article seeks to overview the diagnostic impact and correct indications of bowel ultrasound.

经会阴二维超声参数评估初产妇分娩方式及产程

目的探讨经会阴二维超声参数对初产妇分娩方式及产程的评估价值。方法回顾性分析2021年2月至2023年8月在郑州市妇幼保健院经阴道试产的162例初产妇资料,根据分娩结局分为自然分娩组和剖宫产组。比较两组宫口扩张6 cm时的经会阴二维超声参数[产程进展角(AOP)、胎头-会阴距离(HPD)],绘制受试者工作特征(ROC)曲线检验AOP、HPD对初产妇分娩方式的预测价值。以AOP、HPD中位数进行分组,比较不同AOP、HPD的初产妇分娩方式及产程时间的差异,采用Pearson相关性分析,检验AOP、HPD与自然分娩初产妇产程时间的关系。结果162例初产妇中127例为自然分娩,35例为剖宫产。自然分娩组初产妇AOP、HPD大于剖宫产组(P<0.05)。ROC曲线结果显示,AOP、HPD预测初产妇自然分娩的曲线下面积(AUC)均>0.7,有一定预测价值,且以二者联合预测价值最高。162例初产妇AOP、HPD中位数分别为132°、4.1 cm,AOP≥132°、HPD≥4.1 cm组初产妇的自然分娩率分别高于AOP<132°组、HPD<4.1 cm组(P<0.05)。127例自然分娩初产妇的AOP、HPD中位数分别为133°、4.3 cm,AOP≥133°组、HPD≥4.3 cm组自然分娩初产妇的第一产程、第二产程及总产程时间均分别短于AOP<133°组、HPD<4.3 cm组(P<0.05)。经Pearson相关性检验,AOP、HPD与自然分娩初产妇第一产程、第二产程、总产程均呈负相关(r<0,P<0.05)。结论经会阴二维超声参数AOP、HPD可用于指导初产妇分娩方式的合理选择,二者与产程有关,能够为分娩管理提供参考。

第一产程经会阴二、三维超声检测对初产妇阴道分娩及分娩时长的预测价值

目的:探究第一产程经会阴二、三维超声检测指标对初产妇阴道分娩及分娩时长的预测价值。方法:回顾性分析2022年1月至2024年1月在暨南大学附属顺德医院首次分娩的单胎孕妇共119例。于宫颈口扩张3~4 cm时行经会阴二维超声测量产程进展角(AOP)、会阴与胎头距离(HPD),三维超声测量耻骨弓角度(PAA)。根据初产妇是否阴道分娩分为阴道分娩组(85例)和非阴道分娩组(34例),比较两组一般临床资料及超声参数指标;采用多因素Logistic回归分析AOP、HPD及PAA与初产妇阴道分娩的关系。绘制受试者工作特征曲线评估参数对阴道分娩的预测价值。根据AOP、HPD及PAA的中位数进行分组,比较各组分娩时长的差异。结果:与非阴道分娩组相比,阴道分娩组孕妇AOP、PAA水平较高,HPD水平较低(P<0.05)。多因素分析显示AOP、HPD及PAA均为阴道分娩独立影响因素(P<0.05),三者联合预测阴道分娩的曲线下面积分别为0.896(P<0.05)。AOP>136°、HPD≤4 cm、PAA>99°组孕妇分娩时长较短(P<0.05)。结论:第一产程经会阴二、三维超声检测指标AOP、HPD及PAA对初产妇阴道分娩及分娩时长具有较高的预测价值,可协助分娩管理。

超声成像在前列腺癌图像引导放疗中的应用

超声成像(Ultrasonography,USG)技术基于其优势已广泛应用于前列腺癌(Prostate Cancer,PCa)图像引导放疗(Image Guided Radiotherapy,IGRT)中,包括引导黄金基准标志物置入和靶区位置校准。已成熟应用的USG技术包括经腹超声(Trans-Abdominal Ultrasound,TAUS)、经直肠超声(Trans-Rectal Ultrasound,TRUS)和经会阴超声(Trans-Perineal Ultrasound,TPUS)。本文对上述3种USG技术在PCa IGRT中的应用进行了综述,其中TAUS应用过程最为简易,优势不明显且局限较多;TRUS应用过程较为复杂,优势明显但局限较多;TPUS应用过程最为复杂,优势明显且局限最少。TRUS和TPUS将成为PCa IGRT中的应用和研究热点,并进一步提高其治疗增益。

分析经会阴超声检查与经腹部超声检查在宫颈机能不全诊断中的临床价值

目的探析对宫颈机能不全患者应用经会阴超声检查与经腹部超声检查的临床诊断意义。方法纳入2020年1月至2022年1月河南科技大学第一附属医院收治的80例疑似宫颈机能不全患者,对患者同时进行经会阴超声检查、经腹部超声检查,进行术后活检确诊并作为本研究的“金标准”,比较经会阴超声、经腹部超声检查下对宫颈机能不全患者的检出率、诊断效能以及图像满意度。结果术后病理活检对患者确诊为宫颈机能不全患者46例,经会阴超声检查对收治患者宫颈机能不全检出率[73.91%(34/43)]高于经腹部超声检出率[60.87%(28/46)],差异有统计学意义(P<0.05)。诊断效能方面,经会阴超声检查的敏感性、准确性高于经腹部超声检查,差异有统计学意义(P<0.05)。经会阴超声检查的宫颈内口图像、外口图像满意度均高于经腹部超声检查,差异有统计学意义(P<0.05)。结论对宫颈机能不全患者应用经会阴超声检查在诊断疾病上有令人满意的效果,且对收治患者的健康和预后方案调整均有良好的指导价值。

多参数磁共振—超声认知融合经会阴超声引导下前列腺穿刺活检的临床研究

目的:探讨多参数磁共振-超声认知融合经会阴超声引导下前列腺穿刺活检的价值。方法:2021年10月至2023年9月,我院行前列腺穿刺活检患者106例,其中30例在超声引导下经直肠前列腺穿刺活检,为超声组;其中76例在多参数磁共振-超声认知融合经会阴进行超声引导下病灶靶向穿刺+标准经会阴前列腺穿刺活检,为融合组。结果:融合组、超声组的穿刺活检结果、不同总前列腺特异性抗原下的阳性检出结果、不同Gleason评分下的阳性检出结果比较有差异(P<0.05)。结论:多参数磁共振—超声认知融合经会阴超声引导下前列腺穿刺活检临床价值显著。

正常阴道分娩及选择性剖宫产对女性下尿路解剖和控尿功能的影响

目的研究正常阴道分娩和选择性剖宫产对女性下尿路解剖和控尿功能的近期影响.方法选择2003年1～12月在我院作产前检查的24例孕妇为研究组,再进一步均分为正常阴道分娩亚组和选择性剖宫产亚组,以20名非妊娠健康女性为对照组.研究组于孕38～40周和产后6～8周、对照组于排卵期分别进行前庭超声和尿动力检查,分析尿道膀胱连接部移动度(UVJ-M)、静态最大尿道关闭压(MUCP)、功能性尿道长度(FL)和腹压漏尿点压(VLPP)在分娩前、后的变化以及与非妊娠女性的差异.结果各组VLPP均＞90 cm H2O.分娩前、后的UVI-M均较非妊娠女性明显增加(P＜0.01),分娩后均较分娩前轻度下降(P＞0.05),两种分娩方式分娩后UVJ-M的差异无显著性(P＞0.05).分娩后MUCP均较分娩前及非妊娠女性显著增加(P＜0.01),两种分娩方式分娩后MUCP的差异无显著性(P＞0.05).分娩前FL较非妊娠女性明显增加(P＜0.01),两种分娩方式分娩后FL的差异无显著性(P＞0.05),且与非妊娠女性的差异亦无显著性(P＞0.05).结论正常阴道分娩和选择性剖宫产近期内不降低女性下尿路的控尿功能,但是妊娠末期膀胱颈活动度明显增加,并持续到分娩后,是压力性尿失禁的危险因素之一,这种改变是否会随着时间而加重有待长期随访.

正常阴道分娩和选择性剖宫产对初产妇下尿路解剖位置的影响

目的探讨正常阴道分娩和选择性剖宫产对初产妇下尿路解剖位置的影响，以及选择性剖宫产是否对产后压力性尿失禁有预防作用。方法正常阴道分娩组孕妇（16例）和选择性剖宫产组孕妇（15例）于孕38～40周、产后6～8周、产后2年分别进行会阴超声及尿动力检查，分析尿道膀胱连接部移动度（UVJ—M）的变化，及其在两种分娩方式间的差异。无分娩史的非妊娠女性20名为对照组，于排卵期行会阴超声及尿动力检查。结果妊娠晚期的UVJ—M较对照组明显增加（P〈0．01），并持续到产后2年。两种方式分娩后6～8周的UVJ—M均较妊娠晚期轻度下降，但差异均无统计学意义（P〉0．05）；仅选择性剖宫产组的UVJ-M在产后2年较妊娠晚期下降明显（P〈0．05）。两种分娩方式相比，UVJ-M在产后6～8周和产后2年的差异均无统计学意义（P〉0．05）。结论初产妇在妊娠晚期膀胱颈活动度明显增加，并持续到产后2年，选择性剖宫产对其并无明显的保护作用；妊娠本身可能是产后压力性尿失禁的主要致病因素。

慢性前列腺炎外治法治疗进展

目前慢性前列腺炎的治疗已经进入中西结合、内外兼施的综合治疗时代,外治法以其使用方便,临床疗效满意等优势在综合治疗中占有重要的地位,常用的外治法有坐浴、直肠给药、脐疗、物理疗法、前列腺注射、尿道灌注、经会阴超声等。但是,临床中外治法在前列腺炎的治疗中尚有很多误区及不规范的地方,为进一步规范外治法在慢性前列腺炎治疗中的使用,特将常用的外治方法进行详细综述,并对不同的外治方法进行综合评价。

超声评价子宫切除术后患者盆底结构变化与压力性尿失禁的关系

文章探讨了经会阴盆底超声在评价压力性尿失禁患者子宫全切术后盆底结构变化。收集既往行子宫全切手术治疗的91例患者为病例组、100例健康女性作为对照组;采用会阴盆底超声分别对两组研究对象在静息状态、Valsalva状态下的盆底结构特征及变化参数进行检测;并根据病例组患者是否发生压力性尿失禁将患者进行分层分析。病例组患者静息状态、Valsalva状态下的膀胱尿道后角(β)测定值、尿道旋转角(Rα)值、膀胱颈下降距离(BND)值均大于对照组,且差异具有统计学意义(P<0.05);病例组患者静息状态、Valsalva状态下的膀胱颈到耻骨联合下缘的距离(X)、直肠壶腹最低点距离耻骨联合下缘的距离(D)测定值低于对照组,差异具有统计学意义(P<0.05);压力性尿失禁患者静息状态、Valsalva状态下的β测定值、Rα值、BND值均大于未发生压力性尿失禁的患者且两组之间差异具有统计学意义(P<0.05);压力性尿失禁患者静息状态、Valsalva状态下的X、D测定值均小于未发生压力性尿失禁的患者且两组之间差异具有统计学意义(P<0.05);Valsalva状态下尿道倾斜角(α)值,发生压力性尿失禁的患者大于未发生压力性尿失禁的患者,差异具有统计学意义(P<0.05)。与健康女性比较,子宫全切术女性盆底结构参数发生明显改变,发生压力性尿失禁的手术患者盆底结构改变更加显著,采用经会阴盆底超声能够较为准确地对盆底结构改变进行评估。

分析经腹部及会阴部超声联合诊断前置胎盘的诊断价值

目的:分析经腹部及会阴部超声联合诊断前置胎盘的诊断价值。方法:回顾2012年5月-2014年6月在本院治疗的86例前置胎盘产妇,均行单纯经腹部超声和经腹部联合会阴部超声两种诊断方式进行检测。记录两种超声诊断下产妇前置胎盘的类型以及诊断的符合率,并对研究结果进行分析比较。结果:单纯经腹超声诊断结果显示,低置胎盘16例,漏诊3例,边缘性前置胎盘23例,漏诊4例,部分性前置胎盘4例,漏诊7例,中央性前置胎盘24例,漏诊5例,合计前置胎盘符合率77.9%;经腹部联合会阴部超声诊断结果显示,低置胎盘19例,边缘性前置胎盘26例,漏诊1例,部分性前置胎盘9例,漏诊2例,中央性前置胎盘28例,漏诊1例,合计前置胎盘符合率95.3%。经腹部联合会阴部超声的部分性前置胎盘诊断符合率高于单纯经腹超声(P<0.05);经腹部联合会阴部超声方案的低置胎盘、边缘性前置胎盘、中央性前置胎盘符合率与单纯经腹超声比较差异不明显(P>0.05);经腹部联合会阴部超声的前置胎盘诊断准确率(95.3%)明显高于单纯经腹超声(77.9%),差异有统计学意义(字2=11.2927,P=0.0008)。68例胎盘前置产妇经腹部联合会阴部超声检测显示,25例产妇胎盘增厚,其中完全前置胎盘19例,其中胎盘植入15例,子宫切除术4例;边缘性前置胎盘6例,血管表现粗大,血管分支减少,新生儿体重较低。结论:经腹部及会阴部超声联合诊断方案具有较高的诊断价值,可以提高前置胎盘的诊断符合率,适合临床长期推广应用。

超声引导下经会阴前列腺穿刺1044例

目的探讨超声引导下经会阴部前列腺穿刺活检术的临床应用价值,及其一些与前列腺癌发病有关的因素。方法回顾性总结1044例超声引导下经会阴部前列腺穿刺活检患者,计算前列腺癌的检出率,观察其与PSA和前列腺体积的相关性,分析其与前列腺上皮肉瘤(PIN)和不典型增生的关系。结果1044例穿刺活检结果显示:前列腺癌363例(34.8%),前列腺增生554例(53.1%),各级PIN71例(6.8%),不典型增生53例(5.1%),慢性肉芽肿性炎3例(0.3%)。血清PSA增高水平与前列腺癌呈明显正相关,前列腺癌的检出率随前列腺体积增大而降低。结论超声引导下经会阴部前列腺穿刺活检前列腺癌检出率较高,有其自身临床应用的优势。

产后压力性尿失禁的腹压漏尿点压及对应的超声参数研究

目的探讨产后压力性尿失禁(SUI)女性的前盆腔结构改变及不同腹压漏尿点压(ALPP)对应的前盆腔超声参数特点。方法选取2015年1月至2017年12月于韶关市粤北人民医院就诊的86例产后6周~6个月的女性进行经会阴超声检查,其中产后未合并SUI者为对照组(25例),产后合并SUI者为实验组(61例)。经会阴超声分别于静息期(R)及张力期(V)测量膀胱尿道后角(RA)、尿道倾斜角(UI)、膀胱颈位置(BSD),计算尿道旋转角度(UR)、膀胱尿道后角变化[RA(V-A)]、膀胱颈移动度(BND);测量实验组患者的ALPP,根据测量ALPP的结果分两组,实验组1:ALPP为> 60~<150cm H2O(40例);实验组2:ALPP≤60cmH2O(21例),对测量数据进行分析。结果实验组的V-RA、RA(V-R)、V-UI、UR、BND均高于对照组(t=2.23~7.01,均P <0.05),实验组的BSD较对照组下移(t=-4.77,P <0.05)、漏斗形尿道内口发生率较对照组增加(χ2=10.10,P=0.00)。实验组1的V-UI、UR、V-BSD、BND均低于实验组2(t=-5.58~5.42,均P <0.05),实验组1与实验组2的漏斗形尿道内口发生率比较差异无统计学意义(χ2=1.25,P=0.40)。结论 SUI女性张力期前腔室结构不稳定性增加:膀胱和尿道位置下移、膀胱及尿道过度运动、尿道内口开放呈漏斗形改变导致关闭障碍;ALPP越低提示尿道关闭功能越差,超声下表现为张力期的UR增加及膀胱颈的过度位移。

经会阴超声评估对产后女性盆底功能康复治疗的分析

目的探讨会阴超声观察康复治疗对产后女性盆底结构的影响。方法选取丽水市中心医院妇产科2014年6月至2016年6月收治的85例女性盆底功能障碍性疾病患者分为两组,康复组给予康复治疗,常规组给予常规健康教育和产后保健操,运用会阴超声检测两组患者治疗前后,分别在静息、缩肛时、瓦氏动作时盆膈裂孔前后径、周长、面积和耻骨直肠肌宽度的变化;检测静息到瓦氏动作患者膀胱颈位置变化。结果康复组治疗后静息时盆膈裂孔前后径、周长、面积均显著低于治疗前(t值分别为3.189、4.024、4.385,均P<0.05),而常规组上述指标均无显著性差异(t值分别为0.075、0.816、0.139,均P>0.05)。两组患者治疗后盆膈裂孔前后径、周长、面积均显著低于治疗前(t=3.001~4.365,均P<0.05),康复组耻骨直肠肌宽度显著高于治疗前(t=3.257,P<0.05),而常规组治疗前后耻骨直肠肌宽度无显著性差异(t=0.012,P>0.05)。治疗后康复组瓦氏动作时盆膈裂孔前后径、周长、面积和BND均显著低于治疗前(t值分别为3.871、4.582、5.347、3.562,均P<0.05),而常规组治疗前后上述指标无显著性差异(t值分别为0.871、0.492、0.323、0.435,均P>0.05),且康复组治疗后瓦氏动作时盆膈裂孔前后径、周长、面积和BND均显著低于常规组治疗后(t值分别为3.281、4.134、4.762、3.511,均P<0.05)。结论女性盆底功能障碍性疾病经康复治疗能有效地改善盆底结构和功能,会阴超声能有效地评估康复治疗的疗效情况。