经会阴实时三维超声在女性压力性尿失禁患者中的应用

目的 探讨经会阴实时三维超声在女性压力性尿失禁(SUI)患者手术前评估及术后疗效评估中的临床应用价值.方法 收集SUI患者32例(SUI组),同时选取32例年龄匹配的健康女性为对照组,对照组及SUI组术前及术后3个月均行经会阴实时三维超声检查,比较两组在不同状态下(静息、Valsalva动作)膀胱颈位置、尿道、盆膈裂孔、耻骨内脏肌形态等参数,同时比较经阴道尿道中段无张力悬吊手术(TVT-O)手术前后患者膀胱颈、尿道等解剖结构的变化,以及术后吊带在不同状态下的移动情况.结果 与对照组比较,SUI组膀胱颈移动度、膀胱尿道后角、尿道旋转角、肛提肌裂孔面积显著性增大,尿道长度显著性缩短,尿道漏斗形成率也显著增高(P<0.05);SUI组手术前后比较,TVT-O术后患者尿道长度在静息及Valsalva动作下与术前比较有显著性增加,(P<0.05),并接近对照组(P>0.05);TVT-O手术后患者尿道旋转角接尿道口漏斗形成率较术前显著性下降(P>0.05),但未达到正常水平(P>0.05).结论 经会阴实时三维超声影像技术可用于女性SUI患者的术前评估、术后疗效评估及TVT-O吊带位置形态观察和随访.

The Clinical Application of The Real - Time Three - Dimensional Transperineal Ultrasound In Women With Stress Urinary Incontinence

Objective To investigate the clinical application of real - time three - dimensional transperineal in pre - operative and post - operative evaluation for women with stress urinary incontinence (SUI). Methods Thirty - two women with SUI and 32 age - matched female healthy controls were included in our hospital from April 2015 to December 2016. All participants received real - time three - dimensional transperineal ultrasound. The positions of bladder neck,u-rethra,and pubovisceral muscle at rest and during a Valsalva maneuver,respectively,were measured. The parameters were compared between the two groups,as well as compared before and after tension - free vaginal tape obturator proce-dure (TVT - O)in SUI group. Results SUI group had significantly higher bladder neck mobility,larger posterior vesi-courethral angle,larger anteroposterior diameter of the levator hiatus,longer urethra and larger urethral rotation angle com-pared to healthy controls (P < 0. 05). In SUI group,the post - operative urethra was significantly shorter than the pre -operatitve urethra (P < 0. 05),close to healthy controls (P > 0. 05). However,the urethra rotation angle and the forma-tion of the funnel of urethra orifice were dramatically reduced (P < 0. 05),but still not similar with healthy control (P <0. 05). Conclusion The real - time three - dimensional transperineal ultrasound is valuable to make pre - operative eval-uation,monitor the TVT - O tape after surgery and make post - operative assessment.