经会阴三维超声评价压力性尿失禁患者盆底功能及其对手术的指导意义

目的通过经会阴三维超声评价压力性尿失禁患者与正常对照患者在静息状态、缩肛状态和用力状态下盆底功能及其对手术的指导意义。方法选择本院收治的压力尿失禁患者30例为尿失禁组，同期30例健康者为对照组，两组均行经会阴三维超声检查，不同状态下进行盆底容积扫描及多断面成像，比较两组尿道长度、尿道角、膀胱颈与耻骨联合的距离、盆膈裂空孔大小等参数。结果两组患者均能良好配合，顺利完成检查，两组一般资料比较，差异无统计学意义。静息状态下两组膀胱颈到耻骨联合下缘的垂直及水平距离差异均有统计学意义（P〈0．05），用力状态下尿失禁组与对照组膀胱颈到耻骨联合下缘的距离、尿道近端长度、尿道角、尿道膝部到X轴距离、内脏肌厚度比较，差异有统计学意义（P〈0．05），缩肛状态下尿失禁组与对照组膀胱颈到耻骨联合下缘的距离、尿道膝部到X轴距离、内脏肌厚度、盆膈裂孔前后径比较，差异有统计学意义（P〈0．05）。结论盆腔内膀胱颈和尿道支持结构的异常是导致压力性尿失禁发生的主要机制，经会阴三维超声可良好评价不同状态下上述支持结构的改变，可用于治疗术前治疗方案的评估和术后疗效评价。

By perineum three-dimensional ultrasound evaluation of stress urinary incontinence in pelvic floor function and its guiding significance for surgery

Objective To investigate the pelvic floor function of stress urinary incontinence patients and normal control patients in resting state,shrink anal state and force state with three-dimensional ultrasound and its guiding significance for surgery.Methods 30 cases of stress urinary incontinence in our hospital were selected for the urinary incontinence group,30 cases of healthy over the same period as control group,both groups were given three-dimensional ultrasound,took pelvic floor volume scanning and multi-sectional imaging under different states,combined distance of the length of the urethra,urethral angle,bladder neck and pubic basin diaphragm hole size and other parameters of the piercing were compared between the two groups.Results The two groups of patients could be a good coordination,the successful completion of the inspection,two sets of general information,the difference was not statistically significant.Two groups under the resting bladder neck to the lower edge of the pubic symphysis vertical and horizontal distance differences were statistically significant(P < 0.05),bladder neck incontinence group and control group in the hard state to the distance from the edge of pubic symphysis,urethra length of the proximal urethral angle,urethral knee to the X-axis distance,the visceral muscle thickness,the difference was statistically significant(P < 0.05),shrinking the anus state SUI group and control group bladder neck to the pubic symphysis to the lower edge of the distance urethra to the knee X-axis distance,visceral muscle thickness,the anteroposterior diameter of the basin diaphragmatic hiatus comparison,the difference was statistically significant(P < 0.05).Conclusion The bladder neck and urethra within the pelvic support structures exception is the main mechanism leading to stress urinary incontinence by perineum three-dimensional ultrasound a good evaluation of the support structure under different conditions change,can be used regimens in the treatment of preoperative assessment and surgery after efficacy evaluation.