超声对子宫切除术后下尿路形态学改变的观察研究

目的：利用超声观察子宫切除术后女性膀胱和尿道静态及动态的形态变化，从而评估其解剖结构的改变。方法：收集2012年6月-2013年3月于广东省人民医院进行检查的、因子宫病变行全子宫切除术的术后患者136例，根据手术方式及切除范围将其分为3组：A组为腹腔镜辅助的阴式子宫切除术者29例，B组为开腹子宫切除术者41例，C组为开腹广泛子宫切除术者66例。另将无盆腔或腹部手术史者50例设为对照组。4组均行经腹及经会阴超声检查，测量参数包括静止期及压力期（Valsalva呼吸时）膀胱颈移动度（UVJ-M）、膀胱尿道后角（PUVA）及膀胱残余尿量。结果：C组患者术后膀胱及尿道等下尿路解剖结构发生明显改变，UVJ-M、PUVA-r、PUVA-s等参数与对照组比较差异均有统计学意义（均P＜0.01）。 B组患者术后膀胱及尿道等下尿路解剖结构也发生变化，改变程度较C组小，UVJ-M参数与对照组、C组相比差异有统计学意义（均P＜0.01），PUVA-r、PUVA-s等参数与对照组相比差异无统计学意义（均P＞0.05）。 A组患者术后膀胱及尿道等下尿路解剖结构无明显改变，UVJ-M、PUVA-r、PUVA-s等参数与对照组比较差异均无统计学意义（均P＞0.05）。结论：①超声可对子宫全切术后女性膀胱及尿道形态学变化进行实时观察、客观评价解剖结构的改变。②子宫切除的3种手术方式中以开腹广泛子宫切除术对女性膀胱及尿道解剖结构改变最大，腹腔镜辅助的阴式子宫切除术则几乎没有影响。

Study of Lower Urinary Tract Morphological Changes after Hysterectomy by Ultrasound

Objective： To investigate the static and dynamic morphological changes of bladder and urethral after hysterectomy by ultrasound,and evaluate the anatomical changes. Methods：Grouping 136 cases of hysterectomy patients according to surgical mode and scope of removal,Group A：29 cases of laparoscopic-assisted vaginal hysterectomy;Group B：41 cases of abdominal hysterectomy;Group C：66 cases of abdominal radical hysterectomy. Control group：50 cases of no pelvic or abdomen surgical operation experience. Apply abdominal and perineal ultrasound inspection to the groups ,measuring parameters include UVJ-M,PUVA and bladder post-void residual volume. Results：There were significant changes in the anatomical structure of urinary tract like bladder and urethra in group C cases after surgery, UVJ-M, PUVA-r and PUVA-s had significant differences between group C and control group（P〈0.01）. There were changes in the anatomical structure of urinary tract like bladder and urethra in group B cases after surgery, but the degree of change is small compared with group C, UVJ-M had significant changes between group B and control group or group B and group C （P〈0.01）, PUVA-r, PUVA-s had no significant changes between group B and control group （P〉0.05）. There were no significant changes in the anatomical structure of urinary tract like bladder and urethra in group A cases after surgery, UVJ-M, PUVA-r and PUVA-s had no significant changes between group A and control group （P〉0.05）. Conclusions： ①Ultrasound can provide a real time observation for the morphological changes of bladder and urethral after hysterectomy and provide an objective evaluation for the anatomical changes. ②Abdominal radical hysterectomy brings the most significant morphological changes of bladder and urethral compared with the other 2 types of hysterectomy,and there are almost no changes by laparoscopic-assisted vaginal hysterectomy.