经会阴盆底超声观察40例患者经腹子宫全切除术后早期盆底功能的变化

doi:10.6040/j.issn.1671-7554.0.2016.1253

摘要/Abstract

摘要： 目的探讨经腹子宫全切除术(TAH)后经会阴盆底超声评价患者早期盆底功能改变的价值。方法预行TAH 40例未绝经患者,均在术前1周内及术后3个月行经会阴盆底超声检查,分别观察其在静息、收缩及Valsalva状态的盆底情况,记录Valsalva状态的膀胱颈旋转角度(△vBA),膀胱尿道后角(vUJV),膀胱颈、阴道穹窿及肛管直肠连接部移动度(vBND、vFND、vAND),Valsalva状态及收缩期肛提肌裂隙的变化度(△vM、△cM)等超声参数16项。对比术前和术后3个月各超声参数,分析盆底功能的变化。结果根据盆底超声各参数测量结果,诊断TAH术后出现膀胱脱垂、直肠脱垂、压力性尿失禁等盆底功能障碍性疾病共7 例,其中压力性尿失禁2例,直肠脱垂3例,压力性尿失禁合并膀胱脱垂1例,压力性尿失禁合并膀胱脱垂、直肠脱垂1例;术后3个月△vBA、vUJV、△vUIA、vBND、vFND、vAND、vsB、vsF、vsA、△vM较术前比较有所增大,术后盆腔器官的活动度增加,盆底组织抗腹压功能减低;术后3个月vDxB、vxF、vxA、△cxB、△cyB、△cM较术前比较有所减小,术后盆底肌肉及韧带的支持能力减弱,肛提肌的收缩功能降低。上述参数差异均有统计学意义(P<0.05)。结论 TAH后早期即可出现盆底功能降低,术后经会阴盆底超声检查能在患者出现临床症状之前发现盆底功能减退,为临床早期干预,延缓或预防盆底功能障碍性疾病的发生提供量化依据。

关键词: 经腹子宫全切除术, 盆腔脏器脱垂, 盆底功能障碍, 经会阴盆底超声, 压力性尿失禁

Abstract: Objective To observe the early changes of pelvic floor function after transabdominal hysterectomy(TAH). Methods A total of 40 patients received transperineal pelvic ultrasound examination 1 week before and 3 months after TAH. The ultrasonic parameters of the resting state, contracting state and maximum Valsalva maneuver were recorded, including the rotation angle of the bladder neck(△vBA), posterior urethrovesical angle on the maximum Valsalva condition(vUJV), bladder neck, vaginal fornix and anorectal junction descent on the maximum Valsalva condition(vBND, vFND, vAND), decrease of levator hiatus on the maximum Valsalva maneuver and on the anal sphincter contraction(△vM, △cM), and so on. The parameters were compared to analyze the changes of pelvic floor function. Results According to the results of pelvic ultrasound, pelvic floor dysfunction after TAH was diagnosed in 7 cases, including stress urinary incontinence in 2 cases, proctoptoma in 3 cases, stress urinary incontinence complicated with bladder prolapse in 1 case, stress urinary incontinence complicated with bladder prolapse and proctoptoma in 1 case. The postoperative ultrasonic parameters such as △vBA, vUJV, △vUIA, vBND, vFND, vAND, vsB, vsF, vsA, and △vM were increased, indicating that the activity of pelvic organs increased, and the abdominal pressure resistant 山东大学学报 (医学版)55卷8期 -孟健,等.经会阴盆底超声观察40例患者经腹子宫全切除术后早期盆底功能的变化 \=-function of pelvic floor reduced. In addition, the postoperative ultrasonic parameters including vxB, vDxB, vxF, vxA, △cxB, △cyB, and △cM decreased, showing that pelvic floor muscles and ligaments support ability abated, and the contraction of levator ani decreased. There were significant differences in all of the above parameters(P<0.05). Conclusion After TAH, the pelvic floor function weakened at the early stage. Transperineal pelvic ultrasound might monitor the pelvic floor function dynamically to detect the impairment before clinical symptoms appear, and to provide quantitative basis for early intervention, delay or prevention of pelvic floor functional disorder.

Key words: Pelvic floor dysfunction, Stress urinary incontinence, Pelvic organ prolapse, Transperineal pelvic ultrasound examination, Transabdominal hysterectomy

中图分类号:

R445.1

孟健,马琳,阚艳敏,王远. 经会阴盆底超声观察40例患者经腹子宫全切除术后早期盆底功能的变化[J]. 山东大学学报（医学版）, 2017, 55(8): 76-81.

MENG Jian, MA Lin, KAN Yanmin, WANG Yuan. Early changes of pelvic floor function after transabdominal hysterectomy observed with transperineal pelvic ultrasound[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(8): 76-81.

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