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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。
Objective To investigate the value of pelvic floor ultrasound in observing the changes of anterior chamber structure in postpartum patients with recent stress urinary incontinence. Methods A total of 182 primiparae women were randomly selected for vaginal delivery at 6 to 8 weeks postpartum for perineal pelvic ultrasonography. There were 72 cases of stress incontinence group (SUI group) and 110 cases of control group. Ultrasound changes in the anterior chamber structure were observed at rest and at maximum Valsalva motion. Ultrasound observations and measurements included bladder neck position at rest, detrusor muscle thickness, posterior bladder angle and bladder neck mobility at maximum Valsalva maneuver, urethral rotation angle, presence or absence of urethral funnel formation, presence or absence of bladder Bulging. Results The detrusor muscle thickness in SUI group was (3.21 ± 0.86) mm at rest and (3.11 ± 0.76) mm in control group, but there was no significant difference between the two groups (t = 0.798, P = 0.426) (23.61 ± 4.57) mm vs. (25.35 ± 4.05) mm] in the SUI group and greater in the bladder ([134.14 ± 21.04] ° vs (114.29 ± 10.53) °], respectively Statistical significance (t values were -2.697, 8.422, P values were 0.008,0.000). The maximal Valsalva motion had a significant effect on bladder neck mobility [(30.39 ± 8.37) mm vs. (21.82 ± 7.65) mm] and urethral rotation angle [(45.21 ± 12.78) ° vs (33.25 ± 14.58) °] (T = 7.115, 5.673, P = 0.000). The incidence of funnel formation in the urethra (55.56% vs. 30.00%) and cystocele (63.89%) were significantly higher in the two groups vs.24.55%) SUI group also increased, the differences were statistically significant (χ2 values were 11.831,28.041, P values were 0.001,0.000). Conclusions Postpartum stress urinary incontinence is associated with bladder neck, urethral support structure and levator ani muscle injury. Using pelvic floor ultrasound dynamic observation of the structure and function of the anterior chamber, early detection of abnormal changes in pelvic floor tissue for clinical and early diagnosis and treatment of postpartum stress urinary incontinence provide an objective basis.