盆底超声联合MRI在浮针治疗压力性尿失禁中的应用

  目的  采用经会阴盆底超声联合盆底MRI观察浮针治疗轻中度压力性尿失禁前后的不同指标的变化，为浮针治疗压力性尿失禁疗效判断提供客观依据。  方法  纳入2017年1月—2020年4月就诊于浙江中医药大学附属第二医院临床诊断为轻中度压力性尿失禁的患者100例，采用随机数字表法分为对照组(50例)和实验组(50例)，对照组进行凯格尔运动，实验组进行浮针治疗和凯格尔运动。研究对象治疗前后均行盆底超声及盆底MRI检查，比较2组治疗前后膀胱颈移动度(BND)、膀胱后角(Av)、尿道倾斜角(θv)、尿道旋转角(θ)、肛提肌裂孔面积(Sv)和尿道内口开放情况、肛提肌、尿道括约肌的连续性及厚度、尿道周围韧带、尿道旁韧带、耻骨尿道韧带和尿道下韧带形态及肌肉的T₂WI信号值的差异。  结果  治疗前，2组所有超声和MRI指标比较差异无统计学意义(均P＞0.05)；2组治疗后比较，BND对照组(24.71±4.84)mm, 实验组(30.01±6.40)mm]、Av、θv、θ、Sv、耻骨直肠肌厚度对照组(3.19±0.14)mm, 实验组(3.32±0.10)mm]、耻骨直肠肌T₂WI信号值、尿道括约肌T₂WI信号值差异有统计学意义(P＜0.05)。静息状态下，2组尿道内口漏斗化差异有统计学意义对照组22例(44.0%), 实验组6例(13.3%)，P＜0.05]。  结论  轻中度压力性尿失禁患者经浮针治疗后，部分膀胱、尿道及盆底肌的参数和功能发生了改变。盆底超声联合MRI检查能辅助评估浮针治疗的疗效。 

Application of pelvic floor ultrasound combined with MRI in treating stress urinary incontinence with Fu's subcutaneous needling

  Objective  To observe the changes of different indicators before and after the treatment of mild to moderate stress urinary incontinence with Fu's subcutaneous needling using transperineal pelvic floor ultrasound combined with pelvic floor MRI, and provide an objective basis for judging the efficacy of Fu's subcutaneous needling in treating stress urinary incontinence.  Methods  A total of 100 patients with mild to moderate stress urinary incontinence that were diagnosed in the Second Affiliated Hospital of Zhejiang Chinese Medical University from January 2017 to April 2020 were randomly divided into control group (n=50) and experimental group (n=50). The control group received the Kegel exercise, meanwhile, the experimental group received Fu's subcutaneous needling and Kegel exercise. Patients were examined by pelvic floor ultrasound and MRI before and after treatment. The bladder neck descent (BND), posterior angle of the bladder (Av), the tilt angle of the urethra (θv), rotation angle of the urethra (θ), area of the levator hiatus (Sv) and the opening of the urethral orifice, the continuity and thickness of levator anus and urethral sphincter, the morphology and muscle T₂WI signal values of peri-urethral ligament, para-urethral ligament, pubic urethral ligament, hypospadias ligament of the two groups were compared before and after the treatment.  Results  Before the treatment, there was no significant difference found in ultrasound and MRI indicators between the two groups (all P > 0.05). Compare the two groups after treatment, there were significant differences in BND control group (24.71±4.84) mm; experimental group (30.01±6.40) mm], Av, θv, θ, Sv, pubic sphincter thickness control group (3.19±0.14) mm; experimental group (3.32±0.10) mm], the thickness of urethral sphincter T₂WI signal value and urethral sphincter T₂WI signal value (P < 0.05). Meanwhile, in the resting state, there were statistically significant differences in funnelization of the internal urethral orifice between the two groups control group 22 cases (44.0%), experimental group 6 cases (13.3%), P < 0.05].  Conclusion  After Fu's subcutaneous needling treatment, some parameters and functions of the bladder, urethra and pelvic floor muscle are changed in patients with mild to moderate stress urinary incontinence. Therefore, pelvic floor ultrasound combined with MRI can be used to evaluate the efficacy of Fu's subcutaneous needling therapy.