产后压力性尿失禁的腹压漏尿点压及对应的超声参数研究  

Abdominal leak-point pressure and corresponding ultrasonic parameters of postpartum stress urinary incontinence

作　　者：陈惠英[1] 许红雁[1] 钟永红[1] 黄笑英 何剑芬[1] 周新卫[1] CHEN Huiying;XU Hongyan;ZHONG Yonghong;HUANG Xiaoying;HE Jianfen;ZHOU Xinwei(Department of obstetrics and gynecology,Northern Guangdong People's Hospital affiliated to Shantou University,Guangdong Shaoguan 512000,China)

机构地区：[1]汕头大学附属粤北人民医院妇产科,广东韶关512000

出　　处：《中国妇幼健康研究》2020年第1期117-121,共5页Chinese Journal of Woman and Child Health Research

基　　金：广东省韶关市卫生计生科研资助项目(编号:44011120173078K);广东省韶关市科技计划资助项目(编号:2018sn107).

摘　　要：目的探讨产后压力性尿失禁(SUI)女性的前盆腔结构改变及不同腹压漏尿点压(ALPP)对应的前盆腔超声参数特点。方法选取2015年1月至2017年12月于韶关市粤北人民医院就诊的86例产后6周~6个月的女性进行经会阴超声检查,其中产后未合并SUI者为对照组(25例),产后合并SUI者为实验组(61例)。经会阴超声分别于静息期(R)及张力期(V)测量膀胱尿道后角(RA)、尿道倾斜角(UI)、膀胱颈位置(BSD),计算尿道旋转角度(UR)、膀胱尿道后角变化[RA(V-A)]、膀胱颈移动度(BND);测量实验组患者的ALPP,根据测量ALPP的结果分两组,实验组1:ALPP为> 60~<150cm H2O(40例);实验组2:ALPP≤60cmH2O(21例),对测量数据进行分析。结果实验组的V-RA、RA(V-R)、V-UI、UR、BND均高于对照组(t=2.23~7.01,均P <0.05),实验组的BSD较对照组下移(t=-4.77,P <0.05)、漏斗形尿道内口发生率较对照组增加(χ2=10.10,P=0.00)。实验组1的V-UI、UR、V-BSD、BND均低于实验组2(t=-5.58~5.42,均P <0.05),实验组1与实验组2的漏斗形尿道内口发生率比较差异无统计学意义(χ2=1.25,P=0.40)。结论 SUI女性张力期前腔室结构不稳定性增加:膀胱和尿道位置下移、膀胱及尿道过度运动、尿道内口开放呈漏斗形改变导致关闭障碍;ALPP越低提示尿道关闭功能越差,超声下表现为张力期的UR增加及膀胱颈的过度位移。Objective To investigate the changes of anterior pelvic structure in women with postpartum stress urinary incontinence,and the characteristics of the anterior pelvic parameters corresponding to different abdominal leak-point pressure(ALPP).Methods A total of 86 women who were six weeks to six months after the labor underwent perineal ultrasound examination in Shaoguan Northern Guangdong People’s Hospital during the period from January 2015 to December 2017.25 cases of postpartum women without stress incontinence were assigned to the control group,and 61 cases of postpartum women with stress incontinence were assigned to the experimental group(stress urinary incontinence group).Transperinal sonography was used to detect the retrovesical angle(RA),the urethra Inclination(UI),the distance between bladder neck and pubic symphysis(BSD),and then the urethtal rotation(UR),the retrovesical angle variations[RA(V-A)],the bladder neck descent(BND)both at the resting state and the maximal Valsalva were calculated.The abdominal leak-point pressure in the stress urinary incontinence group were measured and they were divided into 2 subgroups(SUI1 and SUI2)according to the ALPP measured.SUI1 included 40 cases(60 cmH2 O<ALPP<150 cmH2 O)and SUI2 included 21 cases(ALPP≤60 cmH2 O).Results Compared with the control group,V-RA、RA(V-R)、V-UI、UR、BND were increased(t=2.23-7.01,P<0.05 for all),the bladder neck moved down(t=-4.77,P<0.05)and the rates of infundibular urethral orifice were increased in the experimental group(χ2=10.10,P=0.00).V-UI,UR,V-BSD,BND in SUI1 group were all lower than in SUI2 group(t=-5.58-5.42,P<0.05 for all),and there was no significant difference in the rates of infundibular urethral orifice between the two groups(χ2=1.245,P=0.4).Conclusion The structural instability of the anterior compartment was increased in women with stress urinary incontinence,including the positions of bladder and urethra being moved downward,the bladder and urethra were of hypermotility,and there was disorder of funnel-shape i

关 键 词：产后压力性尿失禁 腹压漏尿点压 经会阴超声 前腔室结构 

分 类 号：R694.54[医药卫生—泌尿科学] R445.1[医药卫生—外科学]