中老年女性盆底功能障碍性疾病的临床研究进展

女性盆底功能障碍(pelvic floor dysfunction,PFD)是一系列由各种原因导致盆底肌功能损伤疾病的统称.该类疾病常见于产后和中老年女性,严重影响了患者的身心健康和生活质量.本文通过系统回顾该领域新近文献,从流行病学、临床诊断、疾病管理等方面对该类疾病的临床研究进展进行综述.     

盆底康复训练治疗中老年妇女压力性尿失禁的效果评价

目的观察盆底康复治疗压力性尿失禁的临床效果。方法选取86例压力性尿失禁的妇女随机分成对照组（n=43）和治疗组（n=43）,治疗组由专人指导进行盆底肌康复治疗,对照组进行一般健康教育。治疗前和治疗结束时评价2组自觉症状、盆底肌收缩力、1 h尿垫试验和尿失禁生活质量问卷评分。结果治疗组在治疗后自觉症状有改善,轻度和中度患者漏尿症状改善率分别为95.65%和81.25%。盆底肌张力强度评分上升,治疗前平均肌力为（2.56±0.42）分,治疗后为（3.29±0.98）分,差异有统计学意义（P〈0.05）。治疗前1 h尿垫试验（1HPTV）平均值为（5.93±2.05）g,治疗后为（4.16±1.84）g,差异有统计学意义（P〈0.05）,治疗后生活质量问卷评分与对照组相比,差异无统计学意义（P〉0.05）。结论盆底康复训练可改善妇女盆底肌功能,治疗压力性尿失禁有效。     

盆底神经肌肉电刺激联合行为训练在老年盆底功能障碍患者康复中的应用价值

目的 探讨老年盆底功能障碍(FPFD)患者采用盆底神经肌肉电刺激联合行为训练的效果。方法 选取120例老年FPFD患者,采用双盲法分为两组各60例。对照组采用盆底肌肉康复(Kegel)训练+行为训练,观察组采用Kegel训练+盆底神经肌肉电刺激联合行为训练,均连续干预1个月。干预前、干预1个月时比较两组盆底功能、肌纤维平均肌电值(Ⅰ类肌纤维肌力、Ⅱ类肌纤维肌力平均肌电值)、尿失禁和脏器脱垂情况、盆底电生理指标(Ⅰ类肌疲劳度、Ⅱ类肌疲劳度)及生活质量[盆底障碍影响简易问卷(PFIQ-7)评分]。结果 观察组干预1个月盆底功能分级显著优于对照组(P<0.05);干预1个月,两组Ⅰ类、Ⅱ类肌纤维肌力平均肌电值均明显高于干预前,且观察组明显高于对照组(P<0.05);干预1个月,观察组尿失禁、脏器脱垂严重程度轻于对照组,差异有统计学意义(P<0.05);干预1个月,观察组Ⅰ类、Ⅱ类肌疲劳度负值显著高于干预前,且观察组显著高于对照组(P<0.05);两组干预1个月PFIQ-7评分显著低于干预前,且观察组显著低于对照组(P<0.05)。结论 盆底神经肌肉电刺激联合行为...     

盆底功能训练联合生物反馈电刺激在经阴分娩产妇盆底功能改善中的作用

目的：观察盆底功能训练联合生物反馈电刺激对经阴分娩后产妇盆底功能的改善情况。方法经阴分娩的产妇376例,随机分为接受单纯盆底功能训练的对照组及接受盆底功能训练联合生物反馈电刺激的观察组,观察比较两组训练后患者的盆底肌肉张力、尿道功能指标及盆底组织器官功能障碍性疾病等差异。结果与对照组相比,观察组产后2个月、产后6个月时的阴道静息压、阴道收缩压高,阴道收缩持续时间长;功能性尿道长度、最大尿道关闭压高;产后各类盆底组织器官功能障碍性疾病发生率低（P均＜0．05）。结论盆底功能训练联合生物反馈电刺激可以有效增强产妇的盆底肌肉张力,提高尿道功能,且能降低盆底组织器官功能障碍性疾病发生率。     

产后盆底超声对孕期不同体重增加值孕妇盆底功能的评估

目的 盆底超声评估不同孕期体重增加值对女性产后盆底功能的近期影响.方法 选取深圳市宝安区妇幼保健院2020年1月至2020年10月190例经阴道分娩的单胎初产妇为本次研究对象,将研究对象根据美国医学研究所(IOM)公布的指南妊娠期体重增长推荐值、建议单胎孕妇孕期总增重范围将其分为体重增长不足、增长适宜、增长过多3个研究...     

女性盆底功能障碍性疾病的发病因素及盆底重建研究进展

<正>女性盆底功能障碍性疾病(PFD)包括盆腔器官脱垂(POP)、尿失禁(UI)和大便失禁(FI),伴随着全社会的老龄化趋势,PFD已演变为中老年妇女的常见病,严重妨碍妇女的日常生活,而且会导致失落和自卑等情绪问题,被称为"社交癌",是影响人类生活质量的五大疾病之一。现针对PFD的发病相关因素及盆底重建治疗方法进展等综述。1 PFD的发生的相关因素PFD的病因及相关因素仍存在争议。     

全子宫切除术后对盆底功能的影响

目的探讨全子宫切除术后对盆底功能的影响。方法选取2014-01～2017-06因非子宫脱垂的良性疾病于该院行全子宫切除术患者400例,术前及术后3个月常规妇科检查、盆底功能评估及完善性生活质量问卷调查。结果术后盆底Ⅰ类肌及Ⅱ类肌肌力、阴道压力及性生活质量较术前均有下降,差异有统计学意义(P 0. 05);盆底Ⅰ类肌及Ⅱ类肌疲劳度、每周平均漏尿次数、阴道前壁膨出、阴道后壁膨出、压力性尿失禁较术前均增加,差异有统计学意义(P 0. 05)。结论全子宫切除术后对患者盆底功能有显著的影响,术后3个月应常规行妇科检查及盆底筛查评估,以期早期开展盆底功能康复干预治疗,改善盆底功能。     

盆底康复技术对产后女性盆底功能障碍效果研究

目的 探讨盆底康复技术对产后女性盆底功能障碍的效果观察.方法 选取2018年7月-2019年7月我院盆底功能障碍的产妇140例,应用数字随机表对患者进行分组为对照组与观察组.对照组采用常规盆底肌肉康复训练模式进行康复治疗,观察组采用盆底康复技术进行治疗.结果 两组治疗后进行效果比较,观察组在盆底收缩压、盆底静息压等指标方面的表现更佳(P<0.05).结论 在女性盆底功能障碍的产后康复治疗中,采用盆底康复技术进行治疗能够有效缓解患者的自觉症状,对产妇产后盆底功能的恢复具有良好的效果,提高女性的生活质量.     

不同分娩方式对产后妇女盆底功能影响的临床分析

目的通过盆底功能评估了解产后妇女盆底功能障碍状况,分析比较剖宫产与阴道产两种分娩方式对产后盆底功能的影响,为盆底功能障碍性疾病(PFD)的防治提供理论依据。方法选取2014-01~2014-06间在该院分娩并于产后6~8周来产后门诊复查的800例产妇,根据分娩方式的不同分为剖宫产组288例和阴道产组512例做盆底功能常规评估,对其评估所获得的指标进行回顾性分析比较。结果手法检查辅以盆底肌评估筛查800例患者中,剖宫产组Ⅰ类肌纤维受损185例,Ⅱ类肌纤维受损168例;阴道产组Ⅰ类肌纤维受损504例,Ⅱ类肌纤维受损502例,两组比较差异有统计学意义(P0.01);阴道产组肌力收缩失调、肛提肌损伤、疲劳度异常、阴道动态压力值80 cm H2O均高于剖宫产组(P0.01)。结论相对于阴道分娩,剖宫产可在一定程度上降低对产妇盆底功能的影响,但盆底功能可通过进行产后康复锻炼来促进恢复,因此不应以此为依据进行分娩方式的选择。     

盆底超声评价女性盆底结构及功能障碍性疾病的应用及进展

盆底超声目前已成为诊断女性盆底功能障碍性疾病的重要影像学检查方法。该文对盆底的解剖结构、盆底功能障碍性疾病,以及盆底超声的应用及研究新进展进行综述。     

产后盆底肌电刺激对哺乳期妇女盆底肌力及卵巢功能的影响

目的探讨产后盆底肌电刺激对哺乳期妇女盆底肌力及卵巢功能的影响。方法选取该院2013-01~2014-12分娩后的300例哺乳妇女为研究对象,按随机数字表法随机分为观察组和对照组各150例,观察组产后42 d开始给予盆底肌电刺激治疗,对照组给予Kegel运动指导,比较两组干预前后盆底肌力及卵巢功能情况。结果观察组干预后盆底肌力改善程度明显优于对照组,差异有统计学意义(P0.01)。观察组干预后子宫内膜厚度较干预前明显增厚,FSH水平较干预前明显下降,E2水平较干预前明显上升,差异有统计学意义(P0.05);观察组干预后各项指标均优于对照组(P0.05);对照组干预前后各项指标差异无统计学意义(P0.05)。结论产后行盆底肌电刺激治疗,能明显改善盆底肌力,促进卵巢功能恢复,值得临床推广。     

Evaluation of acupuncture treatments of postpartum female pelvic floor dysfunction by four-dimensional transperineal pelvic floor ultrasound

Introduction:In the present investigation, a systematic evaluation of the clinical treatment performance of diagnosed with pelvic floor dysfunction is explored. By comparing the 4Dtransperineal pelvic floor ultrasound images with the acupuncture treatment performance of the patients, an evaluation system with various parameters is established to provide critical information to guide the clinical treatment fpostpartum female pelvic floor dysfunction (FPFD).Methods:Eighty patients diagnosed with FPFD are divided into 2 groups. After the designated treatment to the patients, they are carefully examined using transperineal pelvic floor ultrasound. The shape and activity of bladder neck, cervix and rectum anal canal under resting, anal sphincter and Valsalva movements are observed and recorded. The morphology and continuous shape of levator ani muscle in different states after 4D image reconstruction are obtained.Results:After the acupuncture treatment, the bladder neck descent is decreased by 3.8 cm and the anal levator muscle area is decreased by 3.4 cm² comparing with the control group. The anal levator muscle hole diameter is decreased by 0.3 cm, while the anterior and posterior diameter is reduced by 0.5 cm. Reduced possibility of cystocele and uterine prolapse is demonstrated by X² test. These changes upon acupuncture therapy are in line with the improved conditions of the patients, indicating these parameters can help evaluate the therapy performance.Conclusion:4D pelvic floor ultrasound imaging provides objective and quantified information for the clinical diagnosis and treatment of FPFD and the assessment of therapy efficacy, making it a promising novel method in practical applications.     

Botulinum toxin A injection in the treatment of chronic pelvic pain with hypertonic pelvic floor in women: Treatment techniques and results

Chronic pelvic pain (CPP) is an extremely bothersome condition which leads to major effects in women's everyday life. In addition to visceral sources of pain, pelvic floor dysfunction including myofascial pain and spasm on the pelvic floor muscles causing hypertonicity are causes often overlooked. Injecting botulinum toxin type A (BoNT-A) into hypertonic pelvic floor muscles may aid the relaxation of pelvic floor musculature. The muscles that are injected in CPP treatment include the obturator internus, levator ani (pubococcygeus, iliococcygeus, and puborectalis), and coccygeus. Generally, injections can be performed tolerably with safety under conscious sedation combined with local anesthesia. Most practitioners perform BoNT-A injection of pelvic floor muscles using anatomical landmarks identified by manual palpation only. For the precise location of injection sites, some needle guidance techniques were proposed, including electromyography, electrical stimulation, ultrasound, fluoroscopy, and/or computed tomography. Side effects of BoNT-A injection in CPP are rare and self-limiting. Because of the reversible nature of BoNT-A, reinjection appears to be necessary. Increasing proof points out that BoNT-A is a promising treatment option for CPP in women. We conducted a review of published literature in Pubmed, using chronic pelvic pain in women, hypertonic pelvic floor, and botulinum toxin as the keywords. This article aims to summarize the treatment techniques and results of BoNT-A injection for hypertonic pelvic floor in women with chronic pelvic pain.     

应用全盆底重建术治疗老年女性重度盆腔器官脱垂临床分析

目的 评价全盆底重建术治疗老年女性重度盆腔器官脱垂的疗效.方法 回顾性分析34例POP-QⅢ～Ⅳ期盆腔器官脱垂行全盆底重建术的老年患者临床资料,评价该手术疗效及对患者生活质量的影响.结果 所有手术均安全顺利进行,未见膀胱、直肠等损伤;手术时间（105±31.2） min,出血（185.4±65.9） mL;所有患者术后4～5d后均自主排尿.随访2年,复发率为0（0/34）;PFIQ评分由术前的（84.3±22.6）分降至术后2年的（11.2±6.5）分,PFDI评分由术前的（75.8±19.4）分降至术后2年的（12.4±5.3）分.结论 全盆底重建术用于纠正老年女性重度盆腔器官脱垂,手术安全,术后生活质量改善明显,值得临床推广应用.     

Acupoint injection combined with pelvic floor rehabilitation in the treatment of postpartum pelvic floor disorders: A protocol of randomized controlled trial

Background:Female pelvic floor dysfunction is one of the common chronic diseases affecting women''s physical and mental health. Pregnancy and delivery are one of the main causes. Pelvic floor rehabilitation is a common method for the treatment of postpartum pelvic floor dysfunction, but it has some defects. Acupoint injection has advantages in the treatment of postpartum pelvic floor dysfunction, but there is a lack of standard clinical research to verify it. Therefore, the purpose of this randomized controlled trial is to evaluate the efficacy and safety of acupoint injection combined with pelvic floor rehabilitation in the treatment of postpartum pelvic floor disorders.Methods:This is a prospective randomized controlled trial to study the efficacy and safety of acupoints injection combined with pelvic floor rehabilitation. And it is approved by the Ethics Committee of Clinical Research of our hospital. Patients were randomly divided into observation group (acupoint injection combined with pelvic floor rehabilitation group) or control group (pelvic floor rehabilitation group alone). The patients were followed up for 8 weeks after 12 weeks of treatment. The observation indexes included: pelvic organ prolapse degree, pelvic floor muscle strength, urinary incontinence score, adverse reactions, among others. Data were analyzed using the statistical software package SPSS version 18.0.Conclusions:This study will evaluate the efficacy and safety of acupoint injection combined with pelvic floor rehabilitation in the treatment of postpartum pelvic floor dysfunction, and provide reliable reference for the clinical application of this project.Trial registration:OSF Registration number: DOI 10.17605/OSF.IO/VC65Z     

Prolift全盆底修补系统在老年女性全盆底重建术中的应用

目的通过对Prolift全盆底修补系统在老年女性盆腔器官脱垂治疗中的应用及近期疗效的评估,探讨治疗盆腔器官脱垂的手术方式。方法选取2009年1月至2010年12月间南京市妇幼保健院妇科收治的因盆腔器官脱垂行盆底修复重建手术的老年女性患者共43例。其中采用Prolift全盆底修补系统行全盆底重建手术24例（A组）,传统的阴道前后壁修补手术19例（B组）。比较2组患者的一般资料、围手术期和随访情况,并进行统计学分析。结果 2组患者的年龄、体质量、孕产次、阴道壁脱垂程度差异无显著性（P〉0.05）。2组患者的手术时间、术中出血量、尿管留置天数、术后残余尿和住院时间比较,差异无显著性（P〉0.05）。2组术后随访率均为100%。A、B组术后复发各为0和3例,A组复发率明显低于B组（P〈0.05）;A组发生性生活不适者3例,略高于B组的1例,但无显著性差异（P〉0.05）;A组补片侵蚀2例（8.33%）,2组均未发生直肠、输尿管等周围脏器及明显血管神经损伤。结论 Prolift用于阴道前后壁脱垂患者的全盆底重建手术,手术安全可行,近期疗效明显优于传统的阴道前后壁修补术。     

Treatment of the spastic pelvic floor syndrome with biofeedback

The spastic pelvic floor syndrome is a functional disorder based on contraction instead of relaxation of the pelvic floor muscle during straining, which inhibits defecation and gives rise to constipation. Until now no adequate treatment has been found for this condition. The treatment described here is aimed at teaching patients to relax their pelvic floor muscle during straining. Treatment consists of a training program with EMG feedback, followed by simulation of the defecation process, using oatmeal porridge. Patients are then given instructions to generalize the relaxation response in their daily lives. Treatment was completely successful in seven of ten patients. The three remaining patients learned to strain in the correct manner, but could not achieve generalization. Two of them underwent subtotal colectomy because of delayed colonic transit times, which subsequently resulted in normal evacuation. In the third patient, the generalization was most likely hampered by psychologic problems, for which she now receives psychotherapy.