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盆底超声联合MRI在浮针治疗压力性尿失禁中的应用

苏进展 徐英姿 杜嘉 黄晓姗 樊树峰 郦妙尔

苏进展, 徐英姿, 杜嘉, 黄晓姗, 樊树峰, 郦妙尔. 盆底超声联合MRI在浮针治疗压力性尿失禁中的应用[J]. 中华全科医学, 2022, 20(11): 1916-1919. doi: 10.16766/j.cnki.issn.1674-4152.002735
引用本文: 苏进展, 徐英姿, 杜嘉, 黄晓姗, 樊树峰, 郦妙尔. 盆底超声联合MRI在浮针治疗压力性尿失禁中的应用[J]. 中华全科医学, 2022, 20(11): 1916-1919. doi: 10.16766/j.cnki.issn.1674-4152.002735
SU Jin-zhan, XU Ying-zi, DU Jia, HUANG Xiao-shan, FAN Shu-feng, LI Miao-er. Application of pelvic floor ultrasound combined with MRI in treating stress urinary incontinence with Fu's subcutaneous needling[J]. Chinese Journal of General Practice, 2022, 20(11): 1916-1919. doi: 10.16766/j.cnki.issn.1674-4152.002735
Citation: SU Jin-zhan, XU Ying-zi, DU Jia, HUANG Xiao-shan, FAN Shu-feng, LI Miao-er. Application of pelvic floor ultrasound combined with MRI in treating stress urinary incontinence with Fu's subcutaneous needling[J]. Chinese Journal of General Practice, 2022, 20(11): 1916-1919. doi: 10.16766/j.cnki.issn.1674-4152.002735

盆底超声联合MRI在浮针治疗压力性尿失禁中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002735
基金项目: 

浙江省中管局青年人才基金资助项目 2018ZQ024

详细信息
    通讯作者:

    徐英姿, E-mail: xyz1180@163.com

  • 中图分类号: R711.59 R445.1

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

  • 摘要:   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。

     

  • 图  1  压力性尿失禁患者治疗前后盆底超声图像

    注:患者,女性,62岁。A示治疗前患者盆底超声检查最大Valsalva状态下膀胱内口扩张,膀胱后角∠1=137°;B示治疗后患者盆底超声检查最大Valsalva状态下膀胱内口未见扩张,膀胱后角∠2=112°;C示治疗前患者盆底超声检查最大Valsalva状态下肛提肌裂孔最大面积为20.45 cm2;D示治疗后患者盆底超声检查最大Valsalva状态下肛提肌裂孔最大面积为13.08 cm2

    Figure  1.  Ultrasound image of pelvic floor before and after treatment of a patient with stress urinary incontinence

    图  2  压力性尿失禁患者治疗前后耻骨直肠肌厚度及T2WI信号值情况

    注:A为治疗前,B为治疗后。

    Figure  2.  Puborectalis thickness and T2WI signal value before and after treatment of patients with pressure urinary incontinence

    图  3  压力性尿失禁患者治疗前后尿道括约肌厚度及T2WI信号值情况

    注:A为治疗前,B为治疗后。

    Figure  3.  Thickness of urethral sphincter and signal value of T2WI before and after treatment of patients with pressure urinary incontinence

    表  1  2组治疗前最大Valsalva状态下超声及静息状态下磁共振观察指标比较

    Table  1.   Comparison of ultrasonic indicators in the maximum Valsalva state and MRI indicators In the resting state before treatment between the two groups

    项目 实验组(45例) 对照组(50例) 统计量 P
    BND(x±s,mm) 30.01±6.40 28.33±5.41 1.391a 0.173
    Av(x±s,°) 139.56±23.49 134.94±22.80 0.973a 0.334
    θv(x±s,°) 50.07±22.66 48.77±22.69 0.280a 0.782
    θ(x±s,°) 50.84±22.00 50.01±22.71 0.181a 0.864
    Sv(x±s,cm2) 22.47±5.25 20.59±6.27 1.574a 0.121
    尿道内口漏斗化[例(%)] 39(86.7) 40(80.0) 0.752b 0.393
    耻骨直肠肌(左,x±s) 3.96±0.32 4.01±0.26 -0.660a 0.514
    耻骨直肠肌(右,x±s) 2.47±0.11 2.46±0.13 0.901a 0.373
    耻骨直肠肌T2WI信号值(左,x±s) 118.72±6.86 119.17±6.17 -0.343a 0.741
    耻骨直肠肌T2WI信号值(右,x±s) 129.28±6.51 128.89±5.87 0.312a 0.760
    髂尾肌(左,x±s) 5.70±0.17 5.71±0.18 -0.061a 0.952
    髂尾肌(右,x±s) 3.07±0.12 3.09±0.12 -0.463a 0.652
    髂尾肌T2WI信号值(左,x±s) 60.27±1.97 60.10±1.66 0.421a 0.673
    髂尾肌T2WI信号值(右,x±s) 61.06±1.43 61.45±1.34 -1.384a 0.171
    耻尾肌(x±s) 4.36±0.12 4.32±0.11 1.552a 0.124
    耻尾肌T2WI信号值(x±s) 74.68±1.43 74.70±1.44 -0.091a 0.932
    尿道括约肌(x±s) 4.15±0.12 4.16±0.12 0.654a 0.521
    尿道括约肌T2WI信号值(x±s) 114.36±5.79 116.68±6.60 -1.810a 0.071
    注:at值, b为χ2值。
    下载: 导出CSV

    表  2  2组治疗后最大Valsalva状态下超声及静息状态下磁共振观察指标比较

    Table  2.   Comparison of ultrasonic indicators in the maximum Valsalva state and MRI indicators In the resting state after treatment between the two groups

    项目 实验组(45例) 对照组(50例) 统计量 P
    BND(x±s,mm) 19.96±7.31 24.71±4.84 -3.763a <0.001
    Av(x±s,°) 131.25±17.43 140.85±16.96 -2.722a 0.008
    θv(x±s,°) 29.94±16.70 40.43±20.01 -2.754a 0.007
    θ(x±s,°) 29.94±16.70 40.58±19.87 -2.811a 0.006
    Sv(x±s,cm2) 17.86±4.37 20.04±4.47 -2.400a 0.020
    尿道内口漏斗化[例(%)] 6(13.3) 22(44.0) 10.712b 0.001
    耻骨直肠肌(左,x±s) 5.16±0.25 5.08±0.33 2.263a 0.030
    耻骨直肠肌(右,x±s) 3.32±0.10 3.19±0.14 4.904a <0.001
    耻骨直肠肌T2WI信号值(左,x±s) 102.41±2.77 105.98±1.97 -7.280a <0.001
    耻骨直肠肌T2WI信号值(右,x±s) 101.45±2.56 109.15±5.12 -9.111a <0.001
    髂尾肌(左,x±s) 5.70±0.16 5.67±0.16 1.102a 0.280
    髂尾肌(右,x±s) 3.01±0.13 3.01±0.12 0.074a 0.940
    髂尾肌T2WI信号值(左,x±s) 60.31±1.59 59.77±1.71 1.622a 0.110
    髂尾肌T2WI信号值(右,x±s) 60.27±2.30 59.66±2.09 1.374a 0.170
    耻尾肌(x±s) 4.32±0.13 4.35±0.14 0.722a 0.470
    耻尾肌T2WI信号值(x±s) 74.92±2.01 74.58±1.78 0.891a 0.380
    尿道括约肌(x±s) 4.41±0.13 4.12±0.17 9.223a <0.001
    尿道括约肌T2WI信号值(x±s) 86.34±6.34 86.34±6.34 -3.024a 0.003
    注:at值, b为χ2值。
    下载: 导出CSV
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  • 收稿日期:  2021-10-28
  • 网络出版日期:  2022-12-30

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