耻骨后途径经阴道尿道中段无张力悬吊术治疗中重度压力性尿失禁的盆底超声指标变化分析  

Clinical significance of changes in related parameters of pelvic floor ultrasound before and after TVT operation

作　　者：丁上书 陈娟[1] 孙羿[1] 刘莉[2] 穆靓[2] 南淑良 张菲 DING Shangshu;CHEN Juan;SUN Yi;LIU Li;MU Liang;NAN Shuliang;ZHANG Fei(Department of Urology,Shaanxi Provincial People's Hospital,Xi'an,710068,China;Ultrasonic Diagnosis Center,Shaanxi Provincial People's Hospital)

机构地区：[1]陕西省人民医院泌尿外科,西安710068 [2]陕西省人民医院超声诊断中心

出　　处：《临床泌尿外科杂志》2024年第2期98-101,106,共5页Journal of Clinical Urology

基　　金：陕西省卫生健康科研基金项目(No:2021D028)。

摘　　要：目的:比较中重度压力性尿失禁(stress urinary incontinence,SUI)患者行耻骨后途径经阴道尿道中段无张力悬吊术(tension-free vaginal tape,TVT)手术前后的盆底超声指标的变化并进行分析。方法:纳入2019年11月—2022年3月在陕西省人民医院女性泌尿门诊就诊并收住院手术的42例中重度SUI女性患者,纳入患者完善入院相关检查,计划在全麻下行TVT,术前在静息和Valsalva动作状态下行经会阴的盆底超声检查,收集并记录尿道倾斜角和膀胱后角,术后收集并记录在静息和Valsalva动作状态下的尿道倾斜角、膀胱颈移动度、膀胱后角和尿道旋转角。结果:42例患者均完成手术治疗,术后临床症状改善。盆底超声检查显示,静息状态下,手术前后患者的膀胱后角显著减少[(124.20±4.50)°vs(110.51±3.20)°,P=0.030],尿道倾斜角变化差异无统计学意义[(23.60±2.97)°vs(23.86±1.89)°,P=0.930];Valsalva动作下,手术前后患者尿道倾斜角[(45.20±3.58)°vs(28.86±2.88)°,P=0.001]、膀胱后角[(159.97±5.96)°vs(134.49±5.76)°,P=0.003]、膀胱颈移动度[(2.77±0.93)cmvs(1.76±0.13)cm,P=0.001]、尿道旋转角[(67.22±4.44)°vs(40.54±4.68)°,P=0.001]均显著减少。结论:盆底超声可以帮助选择适合TVT手术的患者,预测手术效果和并发症风险,并监测术后吊带的状态和功能。盆底超声指标变化可以反映TVT手术对盆底解剖和功能的影响。Objective:To compare the changes of pelvic floor ultrasound parameters before and after TVT in patients with moderate to severe stress urinary incontinence(SUI)and analyze the results.Methods:Forty-two female patients with moderate to severe SUI who visited the female urology clinic and were admitted for surgery in Shaanxi Provincial People's Hospital from November 2019 to March 2022 were included.The patients completed the relevant examinations before admission and planned to undergo TVT under general anesthesia.Before the surgery,transperineal pelvic floor ultrasound examination was performed at rest and during Valsalva maneuver,and the urethral inclination angle and bladder posterior angle were collected.After the surgery,the urethral inclination angle,bladder neck mobility,bladder posterior angle and urethral rotation angle at rest and during Valsalva maneuver were recorded.Results:All 42 patients completed TVT.The clinical symptoms of patients with moderate to severe SUI improved after TVT.Pelvic floor ultrasound showed that the bladder posterior angle of the patients was significantly reduced after the surgery([124.20±4.50]°vs[110.51±3.20]°,P=0.030)at rest,and there was no significant change in the urethral inclination angle([23.60±2.97]°vs[23.86±1.89]°,P=0.930).During Valsalva maneuver,the urethral inclination angle([45.20±3.58]°vs[28.86±2.88]°,P=0.001),bladder posterior angle([159.97±5.96]°vs[134.49±5.76]°,P=0.003),bladder neck mobility([2.77±0.93]cm vs[1.76±0.13]cm,P=0.001),and urethral rotation angle([67.22±4.44]°vs[40.54±4.68]°,P=0.001)of the patients were significantly reduced after the surgery.Conclusion:Pelvic floor ultrasound can help select patients who are candidates for TVT surgery,predict surgical outcomes and risk of complications,and monitor the status and function of the postoperative sling.Changes in pelvic floor ultrasound indicators can reflect the impact of TVT surgery on pelvic floor anatomy and function.

关 键 词：尿道中段无张力悬吊术 压力性尿失禁 盆底超声 

分 类 号：R694.54[医药卫生—泌尿科学]