盆底超声在女性压力性尿失禁与膀胱脱垂中的应用研究

发布时间：2018-02-22 11:25

本文关键词： 盆底超声女性压力性尿失禁膀胱脱垂分型尿道括约肌缺陷　出处：《兰州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的本研究主要探讨经会阴盆底二维超声、实时三维超声在女性压力性尿失禁(stress urinary incontinence,SUI)中的表现,研究盆底超声关于膀胱、尿道的各参数测量值在SUI中的临床意义,尤其是膀胱颈部“漏斗”形成及尿道括约肌厚度评估尿道括约肌缺陷在女性SUI患者中的意义;同时经会阴盆底超声评估前盆腔膀胱脱垂不同分型的表现,并进一步分析不同膀胱脱垂分型与女性SUI之间的相关性。资料与方法首先对经临床或尿动力学证实的女性SUI或前盆腔膀胱脱垂患者进行基本信息采集,包括年龄、身高、体重、生育史、绝经史、产后康复训练史、重体力劳动史、临床症状进行对比分析;将其分为压力性尿失禁组(SUI组)、膀胱脱垂组,回顾性分析每组患者的盆底超声测量参数,包括在静息状态下膀胱逼尿肌的厚度、膀胱颈及膀胱后壁最低点位置距耻骨联合(Symphysis Pubis,SP)的距离、尿道倾斜角、膀胱尿道后角(posterior urethrovesical angle,PUA)及膀胱颈漏斗形成等,最大Valsalva状态膀胱颈及膀胱后壁最低点位置距SP的距离、尿道倾斜角、PUA及膀胱颈“漏斗”形成等,分析计算膀胱颈及膀胱后壁最低点的移动度、尿道旋转角,评估膀胱脱垂的不同分型;同时在静息状态下测量尿道中段括约肌的厚度,对比尿动力学评估尿道括约肌缺陷(Intrinsic Urethral Sphincter Deficiency,ISD)。实时三维超声及断层成像模式下,观察静息状态及Valsalva状态下双侧肛提肌的对称性、完整性及最大Valsalva状态下肛提肌裂孔的面积大小。正常体检女性为对照组。结果(1)最大Valsalva状态下,SUI组中患者的膀胱颈“漏斗”形成率66%明显高于对照组患者5%,有统计学差异(P0.05);(2)SUI组患者的膀胱颈部下降值及PUA明显大于对照组,差异均有统计学意义(P0.05);(3)SUI组经尿动力学证实有ISD 9例,均出现膀胱颈“漏斗”形成,其尿道中段括约肌厚度与无尿道括约肌缺陷及正常对照组的尿道括约肌厚度对比,差异无明显统计学意义(P0.05);(4)经会阴超声诊断SUI组膀胱尿道膨出73例,孤立性膀胱膨出10例,脱垂组膀胱尿道膨出37例,孤立性膀胱膨出41例,SUI组与脱垂组的膀胱脱垂分型有统计学差异(P0.05);(5)不论SUI组或脱垂组,膀胱尿道膨出与孤立性膀胱膨出的膀胱颈部下降值无明显差异(P0.05),而两种不同膀胱膨出类型的膀胱后壁最低点下降值、PUA及尿道旋转角有明显统计学差异(P0.05);(6)Valsalva动作后,SUI组、脱垂组与对照组相互比较,膀胱颈及膀胱后壁下降值、PUA、尿道旋转角等均有统计学差异(P0.05)。结论(1)经会阴盆底超声可动态评估SUI和膀胱脱垂患者的盆底解剖结构,可为临床诊断及治疗盆底功能障碍疾病提供一种经济、简便、实用的影像学方法;(2)膀胱颈及膀胱后壁最低点下降值、PUA、尿道旋转角等超声指标在评估SUI及膀胱脱垂患者中有一定的指导意义;(3)膀胱颈“漏斗”形成是SUI的重要指征,与盆底支持组织结构功能受损、ISD密切相关,但通过尿道括约肌的厚度评估ISD还需要进一步研究;(4)经会阴盆底超声能够根据超声各测量指标诊断不同膀胱脱垂类型,不同膀胱脱垂类型的盆底解剖结构改变不同,其病理解剖及形成的原因也不同,其中膀胱尿道膨出与SUI关系密切。
[Abstract]:The purpose of this research is to investigate the transperineal pelvic two-dimensional echocardiography, real-time three-dimensional echocardiography in female stress urinary incontinence (stress urinary, incontinence, SUI) in the performance of the pelvic floor ultrasound on bladder, urethral measured the parameters value of clinical significance in SUI, especially the bladder neck funnel formation and urethral sphincter thickness assessment the significance of urethral sphincter defects in female patients with SUI; at the same time the transperineal ultrasound assessment of pelvic anterior pelvic prolapse of bladder in different types of performance, and further analysis of the different points the relationship between bladder prolapse and female SUI. Materials and methods firstly confirmed by clinical or urodynamics female SUI or anterior pelvic prolapse of bladder basic information collection, including age, height, weight, family history, menopause, postpartum rehabilitation training history, heavy labor history, to analysis the clinical symptoms; Stress urinary incontinence group (SUI group), bladder prolapse group, retrospective analysis of pelvic ultrasound measurement parameters of patients in each group, including in the resting state of the detrusor thickness, bladder neck and bladder wall after the lowest position from the pubic symphysis (Symphysis Pubis SP) distance, urethral angle, posterior urethra vesical angle (posterior urethrovesical angle, PUA) and bladder neck funnel formation, the largest Valsalva state of bladder neck and bladder wall after the lowest point of distance from SP, the urethra and bladder neck angle, PUA "funnel" formation, analysis and calculation of bladder neck and bladder wall after low mobility, urethral rotation angle and different types of assessment of bladder prolapse; mid urethral sphincter and measured in the resting state of the thickness, comparison of urodynamic evaluation of urethral sphincter defects (Intrinsic Urethral Sphincter Deficiency, ISD) by real-time three-dimensional echocardiography and fault. The imaging mode, observe the symmetry of the levator muscle of the resting state and the Valsalva state of the integrity of the bilateral anal, Valsalva state and the maximum size of levator ani muscle hiatus. Normal healthy women as control group. Results (1) the maximum under the condition of Valsalva, patients in the SUI group of bladder neck "funnel" formation rate 66% of 5% patients was significantly higher than the control group, there was significant difference (P0.05); (2) SUI patients with bladder neck drop value and PUA significantly higher than the control group, the differences were statistically significant (P0.05); (3) SUI group by urodynamics confirmed 9 cases of ISD were bladder neck "funnel" formation. The thickness of the urethral sphincter mid urethral sphincter thickness contrast and urethral sphincter defects and the normal control group, the difference was not statistically significant (P0.05); (4) the transperineal ultrasound diagnosis of SUI group bladder urethral prolapse in 73 cases, 10 cases of solitary bladder prolapse, bladder and urethral prolapse group. Out of 37 cases, 41 cases of isolated cystocele, SUI group and the group of prolapse of bladder prolapse type had significant difference (P0.05); (5) either group SUI or group prolapse, cystourethrocele and isolated cystocele decreased bladder neck had no significant difference (P0.05), and the lowest value decline wall two different types of bladder after cystocele, PUA and urethral rotation angle has significant difference (P0.05); (6) after the action of Valsalva, SUI group, prolapse group and control group comparison, bladder neck and bladder wall decrease, PUA, urethral rotation angle were statistically different (P0.05) conclusion. (1) dynamic transperineal pelvic floor ultrasound assessment of SUI and bladder prolapse pelvic structure, can provide an economic, clinical diagnosis and treatment of pelvic floor dysfunction is simple and practical method of imaging; (2) bladder neck and bladder wall after the lowest point decline in the value of PUA, urethral rotation angle super The sound index has certain guiding significance in the assessment of SUI and bladder prolapse; (3) bladder neck "funnel" formation is the important indication of SUI, and the pelvic floor structure function damaged, closely related to the ISD, but through the thickness evaluation of ISD urethral sphincter is also the need for further research; (4) the transperineal pelvic floor according to the measurements of ultrasound ultrasound in diagnosis of bladder prolapse of different types, different types of pelvic floor prolapse of bladder anatomical changes, the pathological anatomy and the causes are different, the bladder urethrocele has close relationship with SUI.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.59;R445.1

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