经会阴三维盆底超声在女性压力性尿失禁(SUI)诊断及病情评估中的应用价值

目的 探讨经会阴三维盆底超声在女性压力性尿失禁(SUI)诊断及对病情评估的应用价值。方法 以2021年7月-2022年5月收治女性180例SUI患者作为病例组,根据绝经与否分为绝经组76例,非绝经组104例;另选取同时期进行常规体检的健康女性160例作为对照组,根据绝经与否分为绝经组58例和非绝经组102例。对比分析病例组与对照组组间超声参数,比较不同病情阶段各项超声参数。结果 病例组绝经期组URA、BND均显著大于病例组非绝经期组,静息状态UIA和最大Valsalva状态PUVA则均显著小于病例组非绝经期组(P<0.05);对照组绝经期组最大Valsalva状态PUVA显著大于对照组非绝经期组(P<0.05);病例组绝经期组URA、BND均显著大于对照组绝经期组(P<0.05);病例组非绝经期组URA、BND均显著大于对照组非绝经期组(P<0.05)。病例组轻、中、重度组三组间超声参数两两比较,重度组静息状态UIA、最大Valsalva状态PUVA、URA、BND均显著大于轻、中度组,中度组静息状态UIA、最大Valsalva状态PUVA、URA、BND均显著...     

经会阴超声评估肌电刺激盆底治疗压力性尿失禁的疗效

目的:采用经会阴超声评价肌电刺激盆底治疗的疗效,为产后压力性尿失禁的康复提供指导.方法:选择进行产后SUI盆底康复的40例产妇作为病例组,同时选择30例产后非SUI和非妊娠年轻女性作为对照组,研究组进行盆底肌电治疗,并于治疗前、治疗5次后及治疗10次后,采用经会阴超声于安静状态及压力状态下(Valsalva动作时)分别测量患者的盆膈裂孔面积(Sr、Ss),耻骨直肠肌厚度(dr、ds),膀胱颈至耻骨联合下缘的距离(Lr、Ls)、膀胱颈角度(θr、θs)、膀胱颈旋转角度(θ),并进行组间比较.结果:SUI组治疗前Sr、Ss、dr、ds和θr、θs及θ均大于产后非USI组和未孕组(P＜0.05);Lr及Is均小于对照组(P＜0.05);SUI组经盆底肌电激治疗5次后及10次后,与治疗前相比,Sr、Ss、dr、ds和θr、θs及θ均逐渐缩小,而Lr、Is逐渐增大(P＜0.05),并逐渐接近产后非USI组;产后非USI组Sr、Ss、dr、ds和θr、θs及θ均大于未孕组(P＜0.05);Lr及Ls均小于未孕组(P＜0.05).结论:经会阴超声检查能对骨盆功能损伤和康复提供客观准确评价指标.     

盆底三维超声判断压力性尿失禁患者盆底功能损伤和疗效的价值

目的 探讨盆底三维超声在压力性尿失禁患者盆底功能损伤和疗效判断中的应用价值.方法 选取40例产后压力性尿失禁患者纳入本次实验作为观察组,另选择同期产后40例正常产妇纳入本次实验作为对照组,观察组产后接受盆底康复治疗,2组均接受盆底三维超声检查,统计并比较2组盆底功能(盆底裂孔面积、膀胱尿道后角以及膀胱颈至耻骨联合下缘的...     

经会阴超声检查在足月初产妇分娩方式预测中的临床价值

目的 探讨经会阴超声检查预测足月初产妇分娩方式临床价值。方法 选取我院接收的分娩孕妇156例,分析经会阴超声检查预测足月初产妇分娩方式各项临床数据。结果 胎头方向角及其下降距离和内诊检查胎先露最低点位置存在线性关系;自然分娩组胎头方向角显著高于非自然分娩组(P <0.05),自然分娩组胎头下降距离显著低于非自然分娩组(P <0.05),胎头方向角>120°及胎头下降距离> 40 mm时可选择阴道分娩。结论 对足月初产妇采取经会阴超声检查,通过胎头方向角和胎头下降距离可预测分娩方式。     

经腹和经会阴超声联合诊断前置胎盘的临床价值

前置胎盘是指胎盘附着于子宫下段,下缘达到或覆盖子宫颈内口处,位置低于胎儿的先露部。前置胎盘常因产后大量出血、感染等症状危及母亲生命,同时也会引起胎儿缺氧缺血,导致新生儿窒息或死亡[1]。早期明确诊断并判断其类型有利于临床医生正确选择分娩方式,降低母子死亡率和剖宫产率。     

应用盆底康复疗法治疗女性压力性尿失禁的临床效果研究

目的：探究盆底康复疗法治疗女性压力性尿失禁的临床效果。方法选取诊治的62例压力性尿失禁女性患者,随机分为实验组和对照组,实验组患者应用盆底疗法进行治疗,对照组患者应用主动式训练治疗,对比两组患者的治疗效果。结果实验组治疗总有效率（96.8％）高于对照组（64.5％）,差异有统计学意义（P＜0.01）。结论盆底康复疗法治疗女性压力性尿失禁具有更好的治疗效果。     

经会阴超声诊断晚期妊娠前置胎盘的价值

前置胎盘是引起晚期妊娠出血的主要原因之一,发生率0.83%～1.8%,可危及母子生命.本研究采用经腹超声和经会阴超声对照,比较两种检查方法对诊断前置胎盘的临床意义.     

经会阴超声对女性盆底功能障碍性疾病的观察及评估分析

目的探讨经会阴超声对女性盆底功能障碍性疾病诊断价值。方法对在本院接受自然分娩、剖宫产术及未孕女性采用三维容积或腔内探头进行检查,经会阴对盆底肌肉及盆腔器官位置、结构进行观察和评估,对比三组受检者的检查结果,并进行统计学比较。结果三组受检者之间比较,在尿道旋转、静息状态膀胱颈到耻骨联合下缘、Valsalva膀胱下降、肛提肌Valsalva最大面积、静息宫颈到耻骨联合下缘、Valsalva宫颈下降、尿道漏斗、直肠膨出等指标方面均存在明显差异,且差异具有统计学意义。进行两组间比较发现自然分娩组的尿道旋转明显高于未孕组和剖宫产组。自然分娩组、剖宫产组在静息状态下膀胱颈到耻骨联合下缘距离明显低于未孕组,Valsalva动作时,未孕组膀胱下降均明显低于自然分娩组和剖宫产组,自然分娩组的肛提肌Valsalva最大面积明显高于未孕组和剖宫产组,未孕组静息宫颈到耻骨联合下缘距离明显高于自然分娩组和剖宫产组,未孕组Valsalva宫颈下降数明显低于自然分娩组和剖宫产组;Valsalva动作时,自然分娩组的尿道漏斗发生率明显高于未孕组和剖宫产组,而自然分娩组的直肠膨出发生率明显高于未孕组和剖宫产组(P<0.05)。结论不同分娩方式对盆底器官结构及功能引起不同程度的损伤,经会阴超声能有效诊断盆底功能功能性障碍性疾病,反应出患者的损伤情况,是一种较好的检查方法。     

肌电图检查在子宫脱垂伴压力性尿失禁诊治中的价值研究

目的:探讨肌电图检查在子宫脱垂伴压力性尿失禁诊断及疗效监测中的价值。方法:选择子宫脱垂伴压力性尿失禁20例,动态观察治疗前后肛提肌肌电图检查数据变化。结果:(1)单纯肛提肌损伤8例,术前运动单位平均时限为8.6ms,术后1个月为7.0ms,术后6个月为6.9ms;均未检测到自发电位。(2)神经损伤伴肛提肌损伤12例,术前运动单位平均时限为8.8ms,术后1个月为7.6ms,术后6个月为7.4ms;术前自发电位为正相(■或■),术后1个月及6个月均为(+)。结论:肌电图检查对子宫脱垂伴压力性尿失禁具有较高的诊断及疗效监测价值。     

Urinary incontinence and disordered eating in female elite athletes

Objectives

To evaluate the association between urinary incontinence and disordered eating, in elite female athletes.

盆底MRI在女性压力性尿失禁诊疗中的应用价值

目的 探讨盆底MRI在女性压力性尿失禁(SUI)诊疗中的应用价值。方法 前瞻性收集2017年1月至2019年1月首都医科大学附属北京朝阳医院的SUI组和对照组受试者,部分SUI患者行尿道中段悬吊带术(TVT)治疗。受试者均行盆底动态MRI检查(静息相及力排相),对SUI组尿道、膀胱颈功能及盆腔器官脱垂进行定性、定量诊断,分析SUI组TVT术后尿道移动角度、膀胱颈及尿道开放、盆底器官脱垂程度变化。采用独立样本t检验(正态分布)或秩和检验(偏态分布)比较对照组和SUI组患者计量资料的差异,采用χ2检验比较计数资料的差异。结果 对照组25例,SUI组33例,31例行TVT治疗,其中12例于术后3~ 6个月复查盆底MRI,纳入术后观察。力排相下,SUI组较对照组,功能尿道长度、尿道移动角度、H线、M线、膀胱漏斗征、尿道开放和膀胱脱垂的差异有统计学意义(P<0.05)。膀胱漏斗征及尿道开放征术前、后的差异有统计学意义(P<0.05)。TVT术后SUI患者的膀胱脱垂程度减小,子宫脱垂程度增大,但差异无统计学意义(P>0.05);TVT术后SUI患者的尿道长度增加,尿道移动角度减小,但差异无统计学意义(P>0.05)。结论 盆底MRI能准确评估SUI盆底功能;TVT术后对尿道支持结构薄弱及盆底器官脱垂无明显改善。     

MRI role in morphological and functional assessment of the levator ani muscle: Use in patients affected by stress urinary incontinence (SUI) before and after pelvic floor rehabilitation

Objective

Pelvic floor dysfunctions affect a very high proportion of female population. Magnetic resonance imaging is the only technique able to provide a multiplanar overview of pelvic organs and muscles without the use of ionizing radiation. The aim of our prospective study is to objectively evaluate the effectiveness of perineal re-education applying MR technique.

Materials and methods

22 patients affected by stress urinary incontinence were enrolled in our prospective study. They underwent urogynaecological, urodynamic examinations, and a questionnaire about symptoms (ICIQ-UI) to investigate the degree of their interference with daily activities. Then they underwent a morphological and dynamic MR exam.

Results

The pre-perineal rehabilitation MR examinations showed an asymmetry of the levator ani muscle in 87% of patients; the remaining 13% showed a muscular bilateral volume reduction. In the group with unilateral defect, the muscle total volume had values between 15 and 21 cm³. Its overall volume was 34.2% smaller on the defective side (9.28 ± 0.26 cm³) compared to the normal side (12.64 ± 12.31 cm³, P < 0.001).In patients with a bilateral impairment, the muscle was replaced by fibro-fatty tissue, without a significant asymmetry between the two sides. The post-perineal rehabilitation MR tests showed three different degrees of response to therapy, with a “complete response” found in 67% of patients and no response in 13%.

Conclusions

MR is an useful tool in the management of patients affected by stress urinary incontinence with indication for perineal rehabilitation. Its objective data allow to distinguish different types of response to therapy and, consequently, different outcomes in terms of additional treatments.     

MRI对盆底康复治疗前后压力性尿失禁患者肛门提肌的形态学评价

目的:探讨MRI在肛门提肌形态学和功能学评估中的应用价值,以期为压力性尿失禁(SUI)患者骨盆康复治疗的疗效评价提供依据.方法:25例SUI患者骨盆康复治疗前后均进行了泌尿妇科尿动力学检测和MRI检查,记录肌肉缺损程度,评估康复治疗疗效.结果:康复治疗前MRI显示82％的患者肛门提肌不对称,其余患者两侧肛门提肌萎缩.在单侧肛门提肌缺损病例中,肌肉总体积为15～22 cm3,其中肌肉缺损侧的总体积[(9.06±0.31) cm3]为正常侧[(14.54±4.32) cm3]的62.3％.在双侧肛门提肌缺损病例中,肌肉两侧较为对称,缺损部位形成纤维脂质斑块.康复治疗后MRI检查结果表明64％的患者治疗完全有效,20％的患者治疗部分有效,16％的患者治疗完全无效.结论:MRI是SUI患者诊断和评估康复治疗疗效的重要检查方法.     

Current applications of transperineal ultrasound in gastroenterology

Transperineal ultrasound is an inexpensive,safe and painless technique that dynamically and non-invasively evaluates the anorectal area.It has multiple indications,mainly in urology,gynaecology,surgery and gastroenterology,with increased use in the last decade.It is performed with conventional probes,positioned directly above the anus,and may capture images of the anal canal,rectum,puborectalis muscle(posterior compartment),vagina,uterus,(central compartment),urethra and urinary bladder(anterior compartment).Evacuatory disorders and pelvic floor dysfunction,like rectoceles,enteroceles,rectoanal intussusception,pelvic floor dyssynergy can be diagnosed using this technique.It makes a dynamic evaluation of the interaction between pelvic viscera and pelvic floor musculature,with images obtained at rest,straining and sustained squeezing.This technique is an accurate examination for detecting,classifying and following of perianal inflammatory disease.It can also be used to sonographically guide drainage of deep pelvic abscesses,mainly in patients who cannot undergo conventional drainage.Transperineal ultrasound correctly evaluates sphincters in patients with fecal incontinence,postpartum and also following surgical repair of obstetric tears.There are also some studies referring to its role in anal stenosis,for the measurement of the anal cushions in haemorrhoids and in chronic anal pain.     

四维盆底超声在电刺激联合生物反馈结合盆底肌锻炼治疗压力性尿失禁疗效评估中的价值

目的:探讨四维盆底超声在电刺激联合生物反馈盆底肌锻炼治疗压力性尿失禁(SUI)疗效评估中的价值.方法:选择60例SUI患者,电刺激联合生物反馈盆底肌锻炼3个月后分析治疗效果;并于治疗前后采用经会阴四维盆底超声记录患者肛提肌裂孔面积、裂孔左右径、肛提肌厚度、膀胱颈移动度、膀胱尿道后角及尿道内口漏斗形成率.结果:治疗后,肛...     

High-resolution endovaginal MR imaging in stress urinary incontinence

The causes of stress urinary incontinence are not completely known. Recent papers have stressed the importance of more anatomical information, which may help to elucidate the mechanism of stress urinary incontinence. The purpose of this study was to evaluate the prevalence of lesions of the urethral support mechanism and lesions (defects and scars, thinning) of levator ani muscle with endovaginal MRI in a case-control study. Forty women (median age 52 years, age range 40–65 years)—20 patients with stress urinary incontinence (cases) and 20 age-matched healthy volunteers (controls)—underwent endovaginal MRI: axial, coronal, and sagittal T2-weighted turbo spin echo. The examinations were evaluated for the presence of lesions of urethral supporting structures and levator ani and scar tissue of the levator ani. The thickness of the levator ani muscle was measured. Lesions of the urethral support system and levator ani were significantly more prevalent in cases than in controls (p<0.01). Median levator ani thickness in patients was significantly lower than in healthy controls [2.5 mm (range 0.9–4.1 mm) vs 3.9 mm (range 1.4–7 mm)] (p<0.01). This study indicates a relationship between stress urine incontinence and the presence of lesions of the urethral support and levator ani and levator ani thinning.