经会阴盆底超声观察40例患者经腹子宫全切除术后早期盆底功能的变化

发布时间：2018-01-19 11:34

本文关键词： 经腹子宫全切除术盆底功能障碍经会阴盆底超声压力性尿失禁盆腔脏器脱垂　出处：《山东大学学报(医学版)》2017年08期 　论文类型：期刊论文

【摘要】：目的探讨经腹子宫全切除术(TAH)后经会阴盆底超声评价患者早期盆底功能改变的价值。方法预行TAH 40例未绝经患者,均在术前1周内及术后3个月行经会阴盆底超声检查,分别观察其在静息、收缩及Valsalva状态的盆底情况,记录Valsalva状态的膀胱颈旋转角度(△v BA),膀胱尿道后角(v UJV),膀胱颈、阴道穹窿及肛管直肠连接部移动度(v BND、v FND、v AND),Valsalva状态及收缩期肛提肌裂隙的变化度(△v M、△c M)等超声参数16项。对比术前和术后3个月各超声参数,分析盆底功能的变化。结果根据盆底超声各参数测量结果,诊断TAH术后出现膀胱脱垂、直肠脱垂、压力性尿失禁等盆底功能障碍性疾病共7例,其中压力性尿失禁2例,直肠脱垂3例,压力性尿失禁合并膀胱脱垂1例,压力性尿失禁合并膀胱脱垂、直肠脱垂1例;术后3个月△v BA、v UJV、△v UIA、v BND、v FND、v AND、vs B、vs F、vs A、△v M较术前比较有所增大,术后盆腔器官的活动度增加,盆底组织抗腹压功能减低;术后3个月v Dx B、vx F、vx A、△cx B、△cy B、△c M较术前比较有所减小,术后盆底肌肉及韧带的支持能力减弱,肛提肌的收缩功能降低。上述参数差异均有统计学意义(P0.05)。结论 TAH后早期即可出现盆底功能降低,术后经会阴盆底超声检查能在患者出现临床症状之前发现盆底功能减退,为临床早期干预,延缓或预防盆底功能障碍性疾病的发生提供量化依据。
[Abstract]:Objective to evaluate the value of transperineal pelvic floor ultrasound in evaluating early pelvic floor function changes after total abdominal hysterectomy (TAH). Methods TAH was performed in 40 premenopausal patients. The pelvic floor was examined by transperineal pelvic floor ultrasound within 1 week before operation and 3 months after operation. The pelvic floor was observed in resting, contractile and Valsalva state. The rotation angle of bladder neck (v BAN), posterior horn of bladder urethra (v UJV), bladder neck, vagina fornix and anorectal junction were recorded in Valsalva. V FNDV ANDU Valsalva state and the change degree of the fissures of the levator ani muscle during systolic period (VM). The changes of pelvic floor function were analyzed by comparing the ultrasonic parameters before and 3 months after operation. Results according to the results of pelvic floor ultrasound parameters, bladder prolapse was diagnosed after TAH. There were 7 cases of pelvic floor dysfunction such as rectal prolapse and stress urinary incontinence, including 2 cases of stress urinary incontinence, 3 cases of rectal prolapse and 1 case of stress urinary incontinence with bladder prolapse. Stress urinary incontinence combined with bladder prolapse, rectal prolapse in 1 case; Three months after operation, v BAVV, v UIAA v BNDV ANDV vs BND v ANDV vs BN vs FN vs A. Compared with the pre-operation, VM increased, the pelvic organ activity increased, and the pelvic floor tissue anti-abdominal pressure function decreased. At 3 months after operation, vDX BX VX VX VX, CX B, CY B, CM decreased compared with those before operation, and the supporting ability of pelvic floor muscles and ligaments decreased after operation. The contractile function of levator ani muscle was decreased, and the difference of the above parameters was statistically significant (P 0.05). Conclusion the pelvic floor function can be decreased early after TAH. Transperineal pelvic floor ultrasound examination can find pelvic floor dysfunction before clinical symptoms, which provides quantitative basis for clinical early intervention, delay or prevention of pelvic floor dysfunction disease.
【作者单位】：华北理工大学附属医院超声科;华北理工大学临床医学院;
【分类号】：R445.1;R713.42
【正文快照】： 子宫全切除术是妇科常见的手术之一,根据手术途径的不同一般分为开腹、阴式及腹腔镜3种方式。美国每年行子宫全切除术者达60余万人次[1-2]。由于子宫全切除术破坏盆底组织结构,已经成为盆底功能障碍性疾病发生的重要影响因素之一[3-4],因此,患者术后盆底功能变化情况逐渐受到

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