经会阴盆底超声对子宫全切术后患者盆底功能的评估  

Transperineal pelvic ultrasound in evaluation of pelvic floor function in post-hysterectomy women

作　　者：孙立倩[1] 王宏桥[1] 付青[1] 史锋锋[1] 张云[1] 

机构地区：[1]青岛大学附属医院腹部超声科,266100

出　　处：《中华医学超声杂志（电子版）》2015年第3期50-54,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：山东省科技发展计划项目(2014GGB14120)

摘　　要：目的评估经会阴盆底超声对子宫全切术后患者的盆底功能。方法应用经会阴盆底超声,对子宫全切术后患者的盆腔器官进行观察,并对盆底组织各参数进行测量。以耻骨联合下缘为参考点,分别在静息状态下和最大Valsalva状态下观察膀胱颈及近端尿道的移动情况;测量膀胱颈距耻骨联合下缘的垂直距离(BSD),膀胱尿道后角,计算膀胱颈下降度(BND),尿道旋转角度及膀胱颈旋转角度;通过计算组内相关系数(ICC)评估不同观察者之间测量结果的一致性。结果子宫全切术后患者在静息状态下BSD测值为(-2.73±0.37)cm,膀胱尿道后角测值为(119.00±22.40)°;最大Valsalva状态下BSD测值为(-0.25±0.67)cm,膀胱尿道后角测值为(114.74±21.50)°;BND测值为(2.46±0.59)cm,膀胱颈旋转角度测值为(70.68±19.91)°,尿道旋转角度测值为(60.81±17.34)°。结合临床及盆底超声测量结果诊断子宫全切术后盆底功能障碍29例(58.00%,29/50,压力性尿失禁5例,直肠脱垂8例,膀胱脱垂16例)。研究中不同观察者之间测量静息状态和最大Valsalva状态下BSD、膀胱尿道后角及计算BND的一致性非常好,组内相关系数分别为0.90、0.89、0.91、0.88、0.92;尿道旋转角度及膀胱颈旋转角度的组内相关系数分别为0.79、0.88,表明观察者之间测量结果的一致性较好。结论经会阴盆底超声可动态观察女性盆底器官的运动变化,对子宫全切术后患者盆底功能进行评估,操作简单,可重复性好,值得临床应用。Objective To evaluate the pelvic floor function in post-hysterectomy patients. Methods Transperineal pelvic ultrasound was used to observe the pelvic organs in post- hysterectomy patients, and parameters of pelvic floor were measured. Taking the inferior margin of public symphysis as the reference plane,the shape and motion of the proximal urethra and bladder neck were observed at rest and on maximum Valsalva maneuver. Bladder neck-symphyseal distance（BSD） and retrovesical angle were measured. And the bladder neck descent（BND）,urethral rotation angle and the rotation angle of the bladder neck were also calculated. Interclass correlation coefficients were calculated to evaluate the consistency of data. Results At rest,the BSD and retrovesical angle were （-2.73±0.37）cm and （119.00±22.40）°, while on maximum Valsalva maneuver was （-0.25±0.67）cm and （114.74±21.50）°,respectively. BND was （2.46±0.59）cm,the urethral rotation angle and the rotation angle of the bladder neck was （70.68±19.91）° and （60.81±17.34） °,respectively. Combined with pelvic ultrasound and clinical manifestations,29 cases of pelvic floor dysfunction after hysterectomy were diagnosed （58.00%, 5 cases of stress urinary incontinence, 8 cases of proctoptoma and 16 cases of bladder prolapse）. The consistency was very high in measuring BNS, retrovesical angle at rest and on maximum Valsalva maneuver and BND by different observers. The interclass＆amp;nbsp;coefficient was 0.90,0.89,0.91,0.88,0.92,respectively. And the interclass coefficient of urethral rotation angle and the rotation angle of the bladder neck was 0.79, 0.88,respectively. These results showed a good interobserver agreement. Conclusion Transperineal pelvic ultrasound is a simple,reproducible and noninvasive imaging method, which can reveal the position and function of female pelvic organ dynamically and evaluate postoperative pelvic floor function.

关 键 词：超声检查 盆底功能 子宫切除术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R713.4[医药卫生—诊断学]