女性慢性盆腔疼痛综合征患者盆底超声影像学改变特征的分析

发布时间：2018-01-19 11:02

  本文关键词： 慢性盆腔痛 慢性盆腔疼痛综合征 盆底解剖学 盆底超声 肌筋膜肛提肌痉挛　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:慢性盆腔痛(Chronic Pelvic Pain,CPP)是一种非常普遍的疾病,对女性的生活产生巨大的负面影响。慢性盆腔痛起病隐匿,涉及多因素、多系统的共同作用,诊断较难明确病因而针对性进行治疗。目前能够明确病因的慢性盆腔痛已经逐渐被人们攻克,而未能明确病因的慢性盆腔疼痛综合征(Chronic Pelvic Pain Syndrome,CPPS)患者仍遭受痛苦的折磨。近年来,随着人们对于高品质健康生活的追求,人们已经越来越意识到慢性盆腔痛的重要性,更加意识到慢性盆腔疼痛综合征诊疗的重要性,并积极投身于相关的研究中。本文通过采用盆底二维、三维超声影像学检查,比较女性慢性盆腔疼痛综合征患者与正常女性的盆底解剖结构,探讨女性CPPS患者的盆底超声影像学改变特征,为慢性盆腔疼痛综合征的诊治提供依据,以期给临床预防及诊治慢性盆腔痛提供一定参考,促进患者恢复,解除患者疼痛,从而缓解患者的疼痛症状,提高其生活质量。方法:随机选取2015年1月-2016年12月就诊于大连市妇女儿童医疗中心女性盆底泌尿整复中心的66例女性CPPS患者为研究组,同期选取81例非CPPS健康人群作为对照组。两组研究对象均如实填写相关的调查表格,采集人口信息资料和病历资料。采用经会阴盆底二维超声及经阴道盆底三维超声(360°旋转以产生3D图像的线性阵列探头)进行盆底二维及三维超声检查,同时进行专科的盆底疼痛检查。比较两组患者在静息状态下和Valsalva状态下二维超声图像上膀胱颈和耻骨联合后下缘水平线之间的距离(BND)、膀胱底和耻骨联合后下缘水平线之间的距离(BSD)、尿道的长度、生殖道裂孔的前后径、肛直肠角度等参数的变化。比较两组患者静息状态下三维超声图像上肛提肌裂孔的前后径、横径及面积,阴道旁间隙的面积,肛提肌的面积,肛提肌的厚度等参数的变化特征。采用SPSS21.0统计软件进行数据分析。结果:1.研究组静息状态下生殖道裂孔前后径(53.23±7.70mmvs 56.72±10.19mm)小于对照组(P0.05),肛直肠角度(115.69° ±13.28° vs 109.22° ±13.03°)大于对照组(P0.05);Vals3lva状态下BSD(6.70±14.91mm vs-0.67±20.23mm)大于对照组(P0.05)。2.研究组肛提肌裂孔前后径(51.25±6.14mmvs 59.36±7.52mm)、肛提肌裂孔横径(39.44±6.07mm vs 48.15±8.10mm)、肛提肌裂孔面积(13.74±2.51mm2 vs 18.54±3.58 mm2)、阴道旁间隙左右侧面积(2.07±0.71mm2 vs 2.96±1.2mm2;2.02±0.52mm2vs2.87±0.90mm2)均明显小于对照组(P0.0001),肛提肌中间厚度(5.59±1.99mm vs 4.54±1.94mm)大于对照组(P0.05)。结论:1.女性CPPS盆底超声影像学显示为肛提肌痉挛性特征,结果提示可能通过肛提肌解痉疗法治疗此类患者。2.采用随机、多中心、大样本的前瞻性研究,对慢性盆腔疼痛综合征的病因及发病机制进行深入研究是十分必要的。
[Abstract]:Objective: chronic pelvic pain (chronic Pelvic PainP) is a very common disease, which has a great negative impact on the life of women. Involving multi-factors, multi-system interaction, diagnosis is difficult to identify the etiology and targeted treatment. At present, chronic pelvic pain which can identify the etiology has been gradually overcome. Patients with chronic pelvic pain syndrome (chronic Pelvic Pain Syndromes) who do not have a definite etiology are still suffering from the disease in recent years. With the pursuit of high-quality healthy life, people have become increasingly aware of the importance of chronic pelvic pain, more aware of the importance of diagnosis and treatment of chronic pelvic pain syndrome. The pelvic floor anatomy of female patients with chronic pelvic pain syndrome was compared with that of normal women by using two-dimensional and three-dimensional ultrasound imaging of pelvic floor. To explore the characteristics of pelvic floor ultrasound imaging in female patients with CPPS, to provide evidence for the diagnosis and treatment of chronic pelvic pain syndrome, to provide a reference for clinical prevention and treatment of chronic pelvic pain, and to promote the recovery of patients. Relieve the patient's pain, thereby relieving the patient's pain symptoms. Improving their quality of life. Methods:. From January 2015 to December 2016, 66 female patients with CPPS in female pelvic floor uroplasty center of Dalian Women and Children Medical Center were randomly selected as the study group. In the same period, 81 non-#en0# healthy people were selected as the control group. The two groups of subjects truthfully filled out the relevant investigation forms. Collection of demographic information and medical records. Linear array probe with two-dimensional transperineal pelvic floor ultrasound and transvaginal pelvic floor 360 掳rotation to generate 3D images). The pelvic floor was examined by two-dimensional and three-dimensional ultrasound. The distance between bladder neck and posterior inferior margin of pubic syndesmosis was compared between two groups of patients in resting state and Valsalva state. The distance between the bottom of the bladder and the horizontal line of the posterior lower margin of the symphysis pubis, the length of the urethra, and the anterior and posterior diameter of the genital fissure. To compare the anterior and posterior diameter, transverse diameter and area of levator ani muscle hiatus, the area of paravaginal space, and the area of levator ani muscle in the resting state of the two groups. The variation of the thickness of levator ani muscle and other parameters. The data were analyzed by SPSS21.0 software. Results: 1. 53.23 卤7.70 mm vs 56.72 卤10.19 mm) was lower than that of the control group (P 0.05). The anorectal angle was 115.69 掳卤13.28 掳vs 109.22 掳卤13.03 掳), which was higher than that of the control group (P 0.05). BSD(6.70 卤14.91 mm vs-0.67 卤20.23 mm in Vals3lva was higher than that in control group (P 0.05). The anterior and posterior diameters of the sphincter fissure in the study group were 51.25 卤6.14mm vs 59.36 卤7.52mm). The transverse diameter of the hiatus of levator ani muscle was 39.44 卤6.07mm vs 48.15 卤8.10mm). The area of the hiatus of levator ani muscle was 13.74 卤2.51 mm ~ 2 vs 18.54 卤3.58 mm ~ 2). The area of paravaginal space was 2.07 卤0.71 mm ~ 2 vs 2.96 卤1.2 mm ~ 2; 2.02 卤0.52 mm 2 vs 2.87 卤0.90 mm 2) was significantly lower than that of the control group (P 0.0001). The median thickness of levator ani muscle was 5.59 卤1.99 mm vs 4.54 卤1.94 mm, which was higher than that of the control group (P 0.05). Conclusions\\\. The results suggest that spasmolysis therapy of levator ani muscle may be used to treat this kind of patients. 2. A randomized, multicenter, large sample prospective study was carried out. It is necessary to study the etiology and pathogenesis of chronic pelvic pain syndrome.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.5;R445.1
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