盆底超声评估女性混合性尿失禁疗效的临床研究

刘闪闪; 方悦; 周一波

doi:10.16766/j.cnki.issn.1674-4152.003846

盆底超声评估女性混合性尿失禁疗效的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.003846

浙江大学医学院附属金华医院金华市中心医院超声科，浙江金华 321000

基金项目:

浙江省自然科学基金项目 LSY19H180006

详细信息

通讯作者:
周一波，E-mail: 1046455948@qq.com

中图分类号: R694.54 R445.1
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- 文章访问数: 32
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- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-02-28
- 网络出版日期: 2025-02-13

Study on the pelvic floor ultrasound for evaluating the therapeutic effect level of mixed urinary incontinence in women

Department of Ultrasound, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang 321000, China

摘要

摘要: 目的为提高混合性尿失禁(MUI)临床治疗水平，丰富MUI病情监测途径，探讨盆底超声用于MUI病情诊断及疗效监测的可行性。方法纳入2020年6月—2023年9月浙江大学医学院附属金华医院收治的170例MUI女性患者，采用随机数字表法分为对照组(85例)和观察组(85例)。对照组患者采用抗尿失禁药物结合盆底肌康复训练治疗，观察组患者予以神经电刺激治疗，分别于治疗前至治疗12周监测患者MUI临床症状指标、尿动力学指标和盆底超声指标变化。结果治疗4周和治疗8周后，观察组72 h尿失禁次数[(3.64±1.45)次、(1.36±0.48)次]和1 h尿垫试验漏尿量[(19.15±2.24)g、(5.13±1.18)g]均显著低于对照组[(6.25±1.74)次、(4.83±1.46)次和(24.73±3.16)g、(12.64±1.59)g，P＜0.001]；观察组最大尿流率显著高于对照组，而最大尿流率时逼尿肌压力显著低于对照组(P＜0.001)；观察组Valsalva状态下膀胱颈移动距离、尿道旋转角和膀胱尿道后夹角均显著低于对照组(P＜0.001)。而治疗12周后，2组各项临床症状、尿动力学及盆底超声指标差异均无统计学意义(P＞0.05)。结论盆底超声与尿动力学指标均可有效反映MUI治疗时程延长的疗效变化情况，且盆底超声具有无创、便捷、低成本、易重复检测等特点，在MUI病情监测及疗效评估方面更具优势。
- 混合性尿失禁 /
- 盆底肌康复训练 /
- 神经电刺激 /
- 盆底超声 /
- 尿动力学 /
- 病情监测 /
- 疗效评价
Abstract: Objective To improve the clinical treatment level of mixed urinary incontinence (MUI) and enrich the monitoring pathways of MUI condition, the feasibility of using pelvic floor ultrasound for the diagnosis and efficacy monitoring of MUI is explored. Methods A total of 170 female patients with MUI admitted to Jinhua Hospital Affiliated to Zhejiang University from June 2020 to September 2023 were randomly divided into a control group (85 cases) and an observation group (85 cases). Patients in the control group were treated with anti-urinary incontinence drugs combined with pelvic floor muscle rehabilitation training, while patients in the observation group were treated with nerve electrical stimulation. The changes in MUI clinical symptom indicators, urodynamic indicators, and pelvic floor ultrasound indicators of patients from before treatment to 12 weeks of treatment were monitored. Results After 4 weeks and 8 weeks of treatment, the observation group had significantly lower urinary incontinence frequency [(3.64±1.45) times, (1.36±0.48) times] and 1-hour urinary pad test leakage [(19.15±2.24) g, (5.13±1.18) g] compared to the control group [(6.25±1.74) times, (4.83±1.46) times and (24.73±3.16) g, (12.64±1.59) g, P < 0.001]. In terms of urodynamic indicators, the maximum urine flow rate in the observation group were significantly higher than those in the control group, while the detrusor muscle pressure at maximum urine flow rate were significantly lower than those in the control group (P < 0.001). In terms of pelvic floor ultrasound indicators, the bladder neck movement distance, urethral rotation angle, urethral infundibulum formation rate, and bladder urethral posterior angle in the Valsalva state of the observation group were significantly lower than those in the control group. However, after 12 weeks of treatment, there was no statistically significant difference in various urodynamic and pelvic floor ultrasound indicators between the two groups (P>0.05). Conclusion Pelvic floor ultrasound and urodynamic indicators can effectively reflect the changes in the therapeutic effect of prolonged MUI treatment duration. Pelvic floor ultrasound has the characteristics of non-invasive, convenient, low-cost, and easy to repeat detection, making it more advantageous in monitoring the condition and evaluating the therapeutic effect of MUI.
- Mixed urinary incontinence /
- Pelvic floor muscle rehabilitation training /
- Nervous electrical stimulation /
- Pelvic floor ultrasound /
- Urodynamic /
- Disease monitoring /
- Efficacy evaluation

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表 1 2组MUI患者一般情况比较

Table 1. Comparison of the general information between two groups of MUI patients

组别	例数	年龄(x±s，岁)	BMI(x±s)	产次(x±s，次)	病程(x±s，年)	尿失禁严重指数评分(x±s，分)	分娩方式(例)
组别	例数	年龄(x±s，岁)	BMI(x±s)	产次(x±s，次)	病程(x±s，年)	尿失禁严重指数评分(x±s，分)	经阴道分娩	剖宫产
对照组	85	52.43±6.27	22.54±1.93	1.19±0.59	3.59±1.14	5.36±1.08	71	14
观察组	85	53.18±6.65	22.32±1.86	1.25±0.64	3.41±1.07	5.47±1.15	66	19
统计量		0.756^a	0.757^a	0.635^a	1.061^a	0.643^a	0.934^b
P值		0.450	0.451	0.581	0.290	0.521	0.334
注：^a为t值，^b为χ²值。

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表 2 2组MUI患者不同治疗时程尿失禁次数和漏尿量比较(x±s)

Table 2. Comparison of urinary incontinence frequency and urine leakage between two groups of MUI patients with different treatment durations(x±s)

组别	例数	72 h尿失禁次数(次)				1 h尿垫试验漏尿量(g)
组别	例数	治疗前	治疗4周	治疗8周	治疗12周	治疗前	治疗4周	治疗8周	治疗12周
对照组	85	10.42±2.13	6.25±1.74^a	4.83±1.46^ab	1.14±0.42^abc	47.31±5.26	24.73±3.16^a	12.64±1.59^ab	4.95±1.13^abc
观察组	85	10.83±2.25	3.64±1.45^a	1.36±0.48^ab	1.05±0.35^ab	47.85±5.31	19.15±2.24^a	5.13±1.18^ab	4.88±1.05^ab
F值		1.213	10.895	19.573	1.521	0.622	16.536	24.641	1.074
P值		0.227	＜0.001	＜0.001	0.149	0.535	＜0.001	＜0.001	0.306
注：与治疗前比较，^aP＜0.05；与治疗4周比较，^bP＜0.05；与治疗8周比较，^cP＜0.05。

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表 3 2组MUI患者不同治疗时程尿动力学指标比较(x±s)

Table 3. Comparison of urodynamic indicators between two groups of MUI patients with different treatment durations(x±s)

组别	例数	Qmax(mL/s)				Pdet-Qmax(cmH₂O)
组别	例数	治疗前	治疗4周	治疗8周	治疗12周	治疗前	治疗4周	治疗8周	治疗12周
对照组	85	14.31±1.86	17.18±2.05^a	19.94±2.21^ab	23.25±2.36^abc	35.62±3.71	26.92±2.84^a	19.36±2.18^ab	14.06±1.69^abc
观察组	85	14.52±1.71	20.24±2.12^a	23.06±2.38^ab	23.54±2.47^ab	36.05±3.82	21.84±2.53^a	14.23±1.62^ab	13.84±1.45^ab
F值		0.725	8.861	9.528	1.156	0.839	12.416	17.549	1.743
P值		0.471	＜0.001	＜0.001	0.249	0.361	＜0.001	＜0.001	0.121
注：与治疗前比较，^aP＜0.05；与治疗4周比较，^bP＜0.05；与治疗8周比较，^cP＜0.05。1 cmH₂O=0.098 kPa。

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表 4 2组MUI患者不同治疗时程盆底超声指标比较(x±s)

Table 4. Comparison of pelvic floor ultrasound indicators between two groups of MUI patients with different treatment durations(x±s)

组别	例数	膀胱颈移动距离(mm)				尿道旋转角(°)				膀胱尿道后夹角(°)
组别	例数	治疗前	治疗4周	治疗8周	治疗12周	治疗前	治疗4周	治疗8周	治疗12周	治疗前	治疗4周	治疗8周	治疗12周
对照组	85	31.53±4.17	25.74±3.76^a	20.57±3.15^ab	16.23±2.54^abc	43.21±4.84	37.35±4.27^a	32.87±3.26^ab	29.26±2.91^abc	145.26±8.61	137.61±7.84^a	129.47±7.51^ab	120.92±7.31^abc
观察组	85	31.82±4.36	22.08±3.49^a	16.35±2.61^ab	15.94±2.13^ab	42.93±4.36	33.49±3.41^a	29.61±3.07^ab	28.95±2.86^ab	146.39±8.45	130.85±7.46^a	121.56±7.23^ab	119.73±7.15^ab
F值		0.562	5.947	9.184	1.623	0.543	8.163	6.283	1.437	0.506	7.235	8.562	0.906
P值		0.634	＜0.001	＜0.001	0.132	0.652	＜0.001	＜0.001	0.158	0.691	＜0.001	＜0.001	0.336
注：与治疗前比较，^aP＜0.05。与治疗4周比较，^bP＜0.05；与治疗8周比较，^cP＜0.05。

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