盆底超声在尿道中段吊带术治疗混合性尿失禁中的应用  

Mixed urinary incontinence:can pelvic floor ultrasonography predict the success of retropubic midurethral synthetic sling?

作　　者：徐汶鑫 李佳怡[1] 宋奇翔 徐蕾 顾懿元 郭韵悦 孙小伟 薛蔚[1] XU Wenxin;LI Jiayi;SONG Qixiang;XU Lei;GU Yiyuan;GUO Yunyue;SUN Xiaowei;XUE Wei(Department of Urology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Clinical Research Center,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院泌尿科,上海200127 [2]上海交通大学医学院附属仁济医院临床研究中心,上海200127

出　　处：《现代泌尿外科杂志》2024年第12期1069-1073,1080,共6页Journal of Modern Urology

摘　　要：目的探索盆底超声在经阴道经耻骨后无张力尿道中段吊带(RMUS)术治疗混合性尿失禁(MUI)中的应用,以了解RMUS手术前后盆底相关结构形态学变化和疗效之间的关系。方法回顾性分析2018年1月—2020年12月于上海交通大学医学院附属仁济医院采用RMUS术治疗的44例女性MUI患者的资料。44例患者中,9例(20.5%)出现逼尿肌过度活动(DO);RMUS术中所有患者均通过解剖定位调整吊带张力。分析手术前后盆底超声参数变化情况,手术前后盆底超声结果与手术疗效及尿动力学检查结果之间的关系。结果患者年龄(58.59±9.08)岁,身体质量指数24.71±2.77。患者术后3个月主观治愈率为91.3%(21/23),术后2年主观治愈率为85.0%(34/40)。患者术前与术后3个月盆底超声提示,静息时膀胱尿道后角角度、Valsalva时膀胱尿道后角角度、膀胱颈下降距离及尿道内口漏斗形成率比较差异均有统计学意义(P<0.05)。根据术前盆底超声结果进行分组分析,Valsalva时尿道内口漏斗形成组/未形成组、Valsalva时膀胱颈无下移组/轻度下移组/中度下移组/重度下移组,术后3个月和术后2年各组间的主观治愈率比较差异均无统计学意义(P>0.05)。此外,术前尿动力学检查提示无DO者,术后3个月盆底超声Valsalva时尿道内口漏斗均消失;而存在DO者,术后3个月盆底超声Valsalva时尿道内口漏斗未能全部消失(50.0%,3/6),且存在DO患者术后2年复查治愈率较低,仅为55.6%(5/9)。结论通过解剖定位调整吊带张力的RMUS术可以减少MUI患者静息状态下和应力状态下的膀胱尿道后角角度、减少应力状态下膀胱颈下降距离和尿道内口漏斗形成发生率,从而改善患者的控尿功能。下尿路功能学异常指标DO和解剖学异常指标Valsalva时尿道内口漏斗形成之间似乎存在一定的关联,RMUS可能可以部分逆转该两项指标。Objective To explore the application of pelvic floor ultrasonography in the treatment of mixed urinary incontinence(MUI)by transvaginal retropubic midurethral synthetic sling(RMUS),in order to understand the relationship between the morphological changes of pelvic floor structures and the efficacy of RMUS.Methods Clinical data of 44 female MUI patients undergoing RMUS during Jan.2018 and Dec.2020 were retrospectively analyzed.Urodynamics detected detrusor overactivity(DO)in 9 cases(20.5%).During RMUS procedure,the tension of the sling was adjusted based on the anatomical landmarks.The changes of ultrasonic parameters before and after operation,the relationship between the ultrasonic results,surgical efficacy and urodynamic results were analyzed.Results The patients averaged(58.59±9.08)years,with the body mass index being 24.71±2.77.The subjective cure rate was 91.3%(21/23)3 months after surgery,and 85.0%(34/40)2 years after surgery.Pelvic floor ultrasonography showed significant differences in posterior urethravesical angel at rest and during Valsalva,bladder neck descent distance and the rate of urethral funneling during Valsalva(P<0.05).According to the group analysis of the preoperative ultrasonic results,there was no statistical significance in the subjective cure rate between the funneling group and the non-funneling group during Valsalva,and the bladder neck non downward group/mild downward group/moderate downward group/severe downward group during Valsalva 3 months and 2 years after surgery(P>0.05).At 3-month follow-up,all pre-RMUS urethral funneling during Valsalva disappeared in patients without preoperative DO.Comparatively,50.0%(3/6)urethral funneling still presented in DO patients,who had a lower cure rate(55.6%,5/9)at the 2-year follow-up.Conclusion RMUS can reduce the posterior urethravesical angel at rest and during Valsalva,reduce bladder neck descent distance and the rate of urethral funneling during Valsalva in MUI patients,which can enhance urinary continence.There seems to be a correlation b

关 键 词：混合性尿失禁 盆底超声 尿道中段吊带术 尿动力学检查 

分 类 号：R691.5[医药卫生—泌尿科学]