Observation of anterior compartment in primipara with postpartum stress urinary incontinence by pelvic floor ultrasound
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摘要: 目的 探讨盆底超声在观察产后近期压力性尿失禁患者前腔室结构变化的应用价值。 方法 随机选取经阴道自然分娩、并在产后6~8周接受产后复查的初产妇182例进行经会阴盆底超声检查,其中压力性尿失禁组(SUI组)72例,对照组110例。观察静息状态下及最大Valsalva动作时前腔室结构的超声改变。超声观察及测量的参数包括:静息状态下膀胱颈位置、逼尿肌厚度、膀胱后角以及最大Valsalva动作时膀胱颈的移动度、尿道旋转角、有无尿道内口漏斗形成、有无膀胱膨出。 结果 静息状态下SUI组的逼尿肌厚度为(3.21±0.86) mm,对照组为(3.11±0.76) mm,2组差异无统计学意义(t=0.798,P=0.426),但静息状态下SUI组膀胱颈位置更低[(23.61±4.57) mm vs.(25.35±4.05) mm]、膀胱后角更大[(134.14±21.04)° vs.(114.29±10.53)°],差异有统计学意义(t值分别为-2.697、8.422,P值分别为0.008、0.000)。最大Valsalva动作时膀胱颈移动度[(30.39±8.37) mm vs.(21.82±7.65) mm]和尿道旋转角[(45.21±12.78)° vs.(33.25±14.58)°]SUI组均较对照组明显增大,2组比较差异有统计学意义(t值分别为7.115、5.673,P值均为0.000),尿道内口漏斗形成率(55.56% vs.30.00%)、膀胱膨出率(63.89% vs.24.55%) SUI组亦增高,差异均有统计学意义(χ2值分别为11.831、28.041,P值分别为0.001、0.000)。 结论 产后压力性尿失禁的发生与膀胱颈、尿道支持结构及肛提肌的损伤有关。利用盆底超声动态观察前腔室结构和功能状态,可早期发现盆底组织异常改变,为临床及早诊治产后压力性尿失禁提供客观依据。Abstract: Objective To investigate the application value of pelvic floor ultrasound to observe the structure changes of anterior compartment in primipara with postpartum stress urinary incontinence. Methods Transperineal pelvic floor ultrasound was performed on a random sample of 182 primiparas in 6 to 8 weeks after vaginal delivery,who were divided into SUI group(72 cases) and control group(110 cases). The structure changes of ultrasonic images of anterior compartment were observed at rest state and on maximal Valsalva maneuver. The observation and measurement parameters include:bladder neck-symphysis pubis distance(BSD),detrusor wall thickness(DWT),retrovesical angle(RA) at rest state and bladder neck descent(BND),urethral rotation,urethral mouth funnel formation,bladder prolapse on maximal Valsalva maneuver. Results The detrusor wall thickness of SUI group was(3. 21 ±0. 86) mm,and that of control group was(3. 11 ±0. 76) mm. It showed no statistical difference at rest state(t=0. 798,P=0. 426). The position of bladder neck of SUI group was lower[(23. 61 ±4. 57) mm vs.(25. 35 ±4. 05) mm],and RA was greater than control group[(134. 14 ±21. 04) ° vs.(114. 29 ±10. 53) °]. There was a statistically significant change(t value was- 2. 697 and8. 422,P value was 0. 008 and 0. 000 respectively). BND[(30. 39 ±8. 37) mm vs.(21. 82 ±7. 65) mm] and urethral rotation[(45. 21 ±12. 78) ° vs.(33. 25 ±14. 58) °]of SUI group was also greater than that of control group on maximal Valsalva maneuver. There was significant difference(t value was 7. 115 and 5. 673 respectively,P value was 0. 000). The urethral mouth funnel formation rate(55. 56% vs. 27. 27%) and bladder prolapse formation rate(63. 89% vs.24. 55%) of SUI group were significantly higher than that of control group(χ2value was 11. 831 and 28. 041,P value was0. 001 and 0. 000 respectively). Conclusion The occurrence of postpartum stress urinary incontinence has a significant relation to the impairment of supporting structure of bladder neck,urethra and levatorani. The changes of structure and function of anterior compartment can be observed by pelvic floor ultrasound. Abnormal changes of pelvic floor can be detected early. It can provide the objective basis for the clinical diagnosis and treatment of postpartum stress urinary incontinence.
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Key words:
- Pelvic floor ultrasound /
- Stress urinary incontinence /
- Rest state /
- Vaginal delivery
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