经会阴三维超声对子宫全切术后盆膈裂孔形态的临床研究

发布时间：2018-06-05 06:47

本文选题：经会阴三维超声 + 盆膈裂孔　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:采用经会阴三维超声观察子宫全切术后患者盆膈裂孔的形态,探讨经会阴盆底三维超声对子宫全切术后患者盆底功能评估的临床应用价值;对比子宫全切术后患者与正常生育后女性盆底结构的静态及动态学变化,探讨子宫全切手术对盆底功能的影响。方法:选取2015年1月到2016年12月子宫全切术后1年来济宁医学院附属医院救诊的患者50例作为研究对象,选取因月经不调、阴道炎等症状来我院妇科就诊的50例未行子宫切除术的产后妇女作为对照组。采用美国GE VOLUSON E8彩色多普勒诊断仪,配置RIC5-9-D三维容积经腹部3D/4D凸阵探头(RAB6-D),频率5-9Mhz,最大扫描角度120°。病例组与对照组在同一盆底超声检查条件下完成图像采集,以耻骨联合下缘作为参考点,分别测量患者在静息状态、Valsalva动作和缩肛状态下盆膈裂孔的前后径、横径、面积及耻骨直肠肌厚度等相关参数。对比分析研究组与对照组不同参数的统计学差异。结果:1.经会阴三维超声可清晰显示所有患者盆膈裂孔并测量其前后径、横径及面积;2.研究组与对照组相比较:缩肛状态下,两组盆膈裂孔横径比较无明显统计学意义(p0.05),在静息状态、Valsalva状态及缩肛状态下盆膈裂孔的前后径、面积大小以及耻骨直肠肌的厚度两组比较有统计学差异(p0.05),且研究组盆膈裂孔前后径、面积及耻骨直肠肌的厚度均高于对照组,其中Valsalva状态下盆膈裂孔面积变化两组比较有显著的统计学差异;3.子宫切除组在Valsalva动作中,出现了膀胱颈位置低下,膀胱颈、膀胱最低点降至耻骨联合下缘水平参考线足侧以及盆膈裂孔面积的增大,结合临床及盆底超声测量结果诊断子宫全切术后盆底功能障碍(28)例。结论:1.经会阴三维超声可以动态观察女性盆膈裂孔平面的解剖结构、位置及运动。2.子宫全切组与正常未切除组在三种不同状态下,均能够对盆膈裂孔的大小、形态进行有效评估,对盆膈裂孔的形态改变具有较好的诊断价值;3.子宫全切除组与正常未切除组在三种不同状态下盆膈裂孔各参数变化,可间接提示女性盆底功能不全性疾病的发生;4.通过子宫全切除组与正常未切除组盆膈裂孔参数的比较,提示子宫全切手术对女性盆底支持结构存在影响,希望为临床改良手术方式、减少女性盆底功能不全性疾病的发生提供理论支持。
[Abstract]:Objective: to observe the shape of pelvic and phrenic hiatus after hysterectomy by transperineal three-dimensional ultrasound, and to explore the clinical application value of transperineal pelvic floor three-dimensional ultrasound in the evaluation of pelvic floor function after hysterectomy. To investigate the effect of total hysterectomy on pelvic floor function, the static and dynamic changes of pelvic floor structure in women after hysterectomy and normal birth were compared. Methods: from January 2015 to December 2016, 50 patients who had been rescued from the affiliated Hospital of Jining Medical College were selected as the subjects of the study. Vaginitis and other symptoms came to our hospital gynecological treatment of 50 postpartum women without hysterectomy as the control group. A GE VOLUSON E8 color Doppler diagnostic instrument was used in this study. The RIC5-9-D 3D volume was transabdominal 3D/4D convex array probe with a frequency of 5-9 MHz and a maximum scanning angle of 120 掳. The patients in the case group and the control group completed the image collection under the same pelvic floor ultrasound condition. The lower margin of pubic symphysis was used as the reference point to measure the anteroposterior and transverse diameters of the pelvic and phrenic fissure in the resting state of Valsalva and the contraction of the anus. Area and thickness of pubic rectum muscle. The statistical differences of different parameters between the study group and the control group were compared and analyzed. The result is 1: 1. Transperineal 3D ultrasound could clearly display the pelvic diaphragm hiatus and measure the anteroposterior diameter, transverse diameter and area of all patients. Compared with the control group, the transverse diameter of the pelvic diaphragm hiatus in the two groups was not significantly different from that in the control group (P < 0.05), but the anteroposterior diameter of the pelvic diaphragm fissure in the resting state and in the anus contraction state. The area size and the thickness of puborectum muscle were significantly different between the two groups (p 0.05), and the anterior and posterior diameter, area and thickness of the puborectum muscle in the study group were higher than those in the control group. There was significant statistical difference between the two groups in the area change of the pelvic diaphragm hiatus under Valsalva. In the hysterectomy group, the position of the bladder neck was low, the lowest point of the bladder decreased to the horizontal reference line of the lower margin of the pubic symphysis and the area of the pelvic and phrenic fissure increased in the Valsalva group. 28 cases of pelvic floor dysfunction were diagnosed after hysterectomy combined with clinical and pelvic floor ultrasonography. Conclusion 1. The transperineal three-dimensional ultrasound can dynamically observe the anatomical structure, position and movement of the pelvic phrenic hiatus in women. The total hysterectomy group and the normal unresectable group could effectively evaluate the size and shape of the pelvic diaphragm hiatus in three different states, and had a better diagnostic value for the morphological changes of the pelvic diaphragm hole. The changes of the parameters of pelvic and phrenic hole in total hysterectomy group and normal unresectable group under three different conditions may indirectly indicate the occurrence of pelvic floor insufficiency disease in female. By comparing the parameters of pelvic and phrenic hiatus between the total hysterectomy group and the normal unresectable group, it is suggested that the total hysterectomy has an effect on the pelvic floor supporting structure of the female. To reduce the incidence of pelvic floor dysfunction in women provides theoretical support.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R713.42

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