女性压力性尿失禁应用TVT-O治疗术中超声参数分析

发布时间：2019-03-18 19:20

【摘要】：目的：随着诊疗技术的不断更新发展,以及女性患者对疾病本身认识和对生活质量的要求不断提高,在临床上工作中女性压力性尿失禁患者越来越多见,就诊率的提高,更要求我们有比较系统的诊治体系。现在临床上对SUI患者的治疗,轻度主要以药物、锻炼等保守措施进行医治,而对于中重度患者常采取外科手术以达到缓解或治愈。手术治疗,是我们对中重度SUI患者在临床上疗效较为肯定的治疗方式,TVT-O术式的出现,成为我们临床上一个较好的手术方式,此手术较之前的TVT或TOT手术更减小了术中对膀胱或其他腹内脏器的损伤,但是因为无特殊的参数,在术中对患者进行的手术操作大部分是凭借手术医师长期的经验,使用咳嗽-漏尿等实验对吊带放置的松紧程度进行大致的判断,以便对术后的恢复情况进行预测和评估。我们的研究是对SUI患者行经阴道闭孔无张力尿道中段悬吊术(Tension-free vaginal tape-obturator, TVT-O),并应用经会阴超声来观察术中盆腔的膀胱、尿道等情况实时图像,同时对TVT-O手术前后膀胱和尿道超声学参数进行分析并和对照组数据进行比较。方法：本实验设置SUI组21例和对照组17例,SUI组选择在2012年2月——2014年2月在我院因压力性尿失禁行TVT-O术的女性患者,而对照组选择健康的体检人群。根据下文中的详细入组条件,对入组的人群进行严格挑选,在年龄、孕次、产次、体重指数无统计学差异的条件下进行我们的研究。术前对两个研究组的人员分别进行评估,对于入选实验的人员进行一般检查和超声检查。被研究对象取截石位,预设膀胱容量为300ml,在静息和Valsalva状态下用超声对盆腔内器官和解剖结构进行观察,以测量膀胱颈活动度、膀胱尿道后角、吊带角度和尿道角等相关参数。对SUI组的患者还需进行尿动力学、指压实验等,TVT-O术后重复测量以上数值。最后对所得数值分别进行对比分析,即SUI组手术前后、SUI组术前和对照组以及SUI组术后和对照组分别进行对照研究,以判断其对手术效果的影响。结果：对所得到的超声参数使用SPSS应用t检验进行比较,通过实验数据及计算结果可以看出,TVT-O术后的膀胱颈活动度和膀胱尿道后角和术前相比均减小(p0.001),但是和对照组的超声参数相比无统计学差异(p0.05),而尿道角的统计结果和前两个数值相反,术后的超声参数和术前参数相比是增大的。SUI组与对照组的参数是有统计学意义的,而SUI组在术后和对照组的参数是无统计学意义。在术前,SUI组患者的膀胱颈活动度和膀胱尿道后角和对照组相比均较大。结论：中、重度压力性尿失禁的女性患者使用TVT-O手术在临床上有着较好的疗效,且手术操作相对便捷,恢复较快,不良并发症较少。尿道的高活动性是女性压力性尿失禁发病机制之一。超声在术中对膀胱和尿道的参数及TVT-O吊带的定位发挥重要作用。术中的超声参数可作为TVT-O吊带的位置参考。
[Abstract]:Objective: With the continuous development of the diagnosis and treatment technology, as well as the improvement of the requirement of the female patients to the disease itself and the quality of life, the patients with stress urinary incontinence are more and more common in the clinical work, and the rate of the visit is increased. We are more demanding that we have a system of diagnosis and treatment of the system. The treatment of the SUI patients is now clinically indicated, and the mild is mainly treated by conservative measures such as medicine, exercise and the like, and the surgical operation is often taken for moderate and severe patients to achieve the remission or cure. Surgical treatment is a more positive treatment for patients with moderate to severe SUI, and the occurrence of TVT-O operation is a good surgical method in our clinical practice. The previous TVT or TOT procedure has reduced the damage to the bladder or other internal organs in the operation. However, because there is no special parameter, most of the operation performed by the patient during the operation is based on the experience of the surgeon for a long time, and the degree of tightness of the hanging strip is judged by using the experiments such as cough and urine leakage, so as to predict and evaluate the postoperative recovery. Our study was to apply transvaginal closed-cell suspension (TVT-O) to SUI patients without tension-free vaginal tape-obtuator (TVT-O), and to apply transperineal ultrasound to observe real-time images of the bladder, urethra, etc. of the pelvis. At the same time, the parameters of the bladder and the urethra before and after TVT-O operation were analyzed and compared with the control data. Methods: In this experiment,21 cases of SUI group and 17 cases of control group were set. The group of SUI was selected to be a female patient with TVT-O operation in our hospital from February to February,2014. The population of the enrolled group was selected strictly according to the detailed entry conditions set out below, and our study was conducted under the conditions of age, pregnancy, birth, and body mass index without statistical difference. Study. The personnel of the two study groups were evaluated before operation, and the general and ultrasonic tests were performed on the personnel selected for the experiment. The internal organs and the anatomical structure of the pelvic cavity were observed under the condition of resting and Valsalva in order to measure the range of the bladder neck, the posterior angle of the urinary bladder, the angle of the sling and the angle of the urethra. The number of patients in the SUI group should also be subject to urodynamics, finger pressure test, etc., and the above number should be repeated after TVT-O. The results were compared with the control group before and after the operation of the SUI group and the control group after the operation of the SUI group and the control group. Results: The obtained ultrasonic parameters were compared with the t-test of the SPSS. The results of the experimental data and the calculation results showed that the bladder neck motion and the posterior angle of the bladder after TVT-O were all decreased compared with that of the pre-operation (p0.05). 01), but no statistical difference (p0.05) was found in the ultrasound parameters of the control group, whereas the statistical results for the urethral angle and the first two values were opposite, and the postoperative ultrasound parameters were compared to the pre-operative parameters The parameters of the SUI group and the control group were statistically significant and the parameters of the SUI group and the control group were not statistically significant. Study significance. Before the operation, the bladder neck motion of the patients in the SUI group and the posterior angle of the urinary bladder were compared with the control group. Conclusion: The use of TVT-O in female patients with moderate and severe stress urinary incontinence has a good curative effect in clinic, and the operation is relatively convenient, and the recovery is fast and bad. Low complications. The high mobility of the urethra is a female stress urinary incontinence. One of the mechanisms of the disease mechanism. The parameters of the bladder and the urethra and the positioning of the TVT-O sling during the operation The intraoperative ultrasound parameters can be used as TVT-O sling
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699

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