经会阴超声评估不同子宫全切术对女性盆底功能障碍性疾病的影响  

The effect of different surgical methods of total hysterectomy of women on their pelvic floor dysfunction by transperineal ultrasound examination

作　　者：陈微微[1] 陈晓龙 王磊[1] 严映波 陈梅[3] CHEN Weiwei;CHEN Xiaolong;WANG Lei;YAN Yingbo;CHEN Mei(The People's Hospital of Yuyao, Zhejiang Province, 315400;Haining County People's Hospital of Zhejiang Province;The First Hospital of Ningbo)

机构地区：[1]浙江省余姚市人民医院,315400 [2]浙江省宁海县人民医院 [3]宁波市第一医院

出　　处：《中国计划生育学杂志》2021年第10期2224-2227,2231,共5页Chinese Journal of Family Planning

摘　　要：目的:利用经会阴超声评估不同方式子宫全切术对患者术后盆底功能的影响。方法:回顾性收集2016年2月—2019年10月在本院妇科行子宫全切除术患者180例临床资料,按照手术路径的不同分为经腹子宫切除术组(TAH组)、经阴道子宫切除术组(TVH组)、腹腔镜下子宫切除术(LTH组);按照手术范围的不同分为筋膜内子宫切除术(IH组)、筋膜外子宫切除术(EH组)。于术后6个月及12个月随访,妇科检查、盆腔器官脱垂定量(POP-Q)分度、压力性尿失禁(SUI)评估、经会阴超声盆底肌检查。结果:TAH组、TVH组、LTH组术后6、12个月压力性尿失禁(SUI)及盆腔器官脱垂(POP)发生率无差异,盆底超声ΔA、ΔC、ΔL、ε逐渐增大(P<0.05)但3组间无差异(P>0.05);IH组与EH组,术后6个月SUI及POP发生率无差异(P>0.05),术后12个月SUI发生率EH组高于IH组(P<0.05),POP发生率无差异(P>0.05),术后6、12个月盆底超声ΔA、ΔC、ΔL、ε逐渐增大(P<0.05)。术后6个月IH组与EH组盆底超声ΔA、ΔC、ΔL有差异(P<0.05),ε无差异(P>0.05);术后12个月EH组盆底超声ΔA、ΔC、ΔL、ε均高于IH组(P<0.05)。结论:经腹、经阴或经腹腔镜子宫全切术对盆底肌功能的影响未见差异,而筋膜内子宫全切术可能更有利于盆底肌功能的保护。Objective:To evaluate the effect of different surgical methods of total hysterectomy of women on their pelvic floor dysfunction by transperineal ultrasound examination.Methods:The clinical data of 180 women who underwent total hysterectomy from February 2016 to October 2019 were collected retrospectively.According to the different surgical paths,these women were divided into three groups,which included women with transabdominal hysterectomy group in group A,women with transvaginal hysterectomy in group B,and women with laparoscopic hysterectomy in group C.According to the different scope of operation,these women were also divided into group D(women with intrafascial hysterectomy)and group E(women with extrafascial hysterectomy).Gynecological examination,pelvic organ prolapse quantitative(POP-Q)grading,stress urinary incontinence(SUI)assessment,and transperineal ultrasonographic pelvic floor muscle examination were performed for the women in the three groups 6 and 12 months after surgery.Results:There was no significant differences in the incidences of SUI and POP of the women in 6 months and 12 months after surgery among group A,group B,and group C(P>0.05).The values ofΔA,ΔC,ΔL,andεmeasured by pelvic ultrasound of the women in group A,group B,and group C had increase gradually(P<0.05),but which had no significant differences among group A,group B,and group C(P>0.05).The incidences of postoperative SUI and POP of the women 6 months after operation had no significant differences between group D and group E(P>0.05),but the incidence of SUI in 12 months after operation of the women in group E was significant higher than that of the women in group D(P<0.05),and the incidence of POP of the women in 12 months after operation had no significant difference between group D and group E(P>0.05).The values ofΔA,ΔC,ΔL,andεmeasured by pelvic ultrasound of the women in group D and group E had increased gradually in 6 and 12 months after operation(P<0.05).The values ofΔA,ΔC,andΔL measured by pelvic ultrasound of the wo

关 键 词：子宫切除术 不同术式 不同手术范围 超声指标评估 盆腔器官脱垂 压力性尿失禁 盆底肌功能 

分 类 号：R713.42[医药卫生—妇产科学] R445.1[医药卫生—临床医学]