文章摘要
杨硕,李旭红.女性压力性尿失禁患者盆底整体功能分析[J].中华物理医学与康复杂志,2018,40(11):834-839
女性压力性尿失禁患者盆底整体功能分析
  
DOI:
中文关键词: 女性压力性尿失禁  盆底超声检查  盆底电生理检查  肛肠动力学检查
英文关键词: Stress  Urinary incontinence  Pelvic floor  Ultrasonography  Anorectal manometry
基金项目:湖南省科学技术厅项目(2015WK3008)
作者单位
杨硕,李旭红 410013 长沙中南大学湘雅三医院康复医学科 
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中文摘要:
      目的 采用盆底器官脱垂分度(POP-Q)、盆底电生理、盆底超声、肛肠动力检查对女性压力性尿失禁(SUI)患者进行功能评估,探讨各指标与女性SUI的相关性及女性SUI患者盆底整体功能的变化。 方法 共选取SUI女性患者25例作为SUI组,另选取健康女性23例作为对照组。采用POP-Q对2组受试者POP的严重程度进行评估;采用盆底超声测量2组受检者在静息状态、Valsalva动作以及从静息状态到Valsalva动作时的膀胱颈位置、膀胱尿道后角、尿道倾斜角、盆膈裂孔大小;采用盆底电生理检查评估2组受试者盆底肌Ⅰ类、Ⅱ类肌纤维肌力和疲劳度;并对2组受检者进行肛肠动力学检查。对2组受试者各项检查结果进行分析和比较,并采用多因素logistic回归方法分析各指标与女性SUI发生风险的相关性。 结果 SUI组盆腔器官脱垂严重程度(其中POP-QⅠ期,POP-QⅡ期,POP-QⅢ期的例数分别为11例、12例、2例)与对照组比较,差异有统计学意义(P<0.05)。Valsava动作时,SUI组的膀胱颈位置、尿道倾斜角、膀胱尿道后角、膀胱颈下降距离、尿道旋转角度与对照组比较,差异有统计学意义(P<0.05)。从静息状态到Valsalva动作时,SUI组的膀胱颈下降距离、尿道旋转角度与对照组比较,差异均有统计学意义(P<0.05)。盆腔器官脱垂严重程度、膀胱颈下降距离、尿道旋转角度、Valsava动作时膀胱颈位置、尿道倾斜角是女性SUI发生的危险因素,与SUI的发生有显著相关性(P<0.05),且盆腔器官脱垂、膀胱颈及尿道支撑功能改变影响了SUI患者盆底整体功能。 结论 女性SUI患者的膀胱颈移动度和尿道活动度越大则POP越严重;POP、膀胱颈和尿道支撑功能的改变会影响女性SUI患者盆底整体功能。
英文摘要:
      Objective To evaluate any changes in overall pelvic floor function among women with stress urinary incontinence (SUI). Methods Twenty-five female SUI patients were recruited as the SUI group and twenty-three healthy female counterparts were selected as the control group. Pelvic organ prolapse quantification (POP-Q) was performed with both groups. Ultrasonography was used to measure the position of the bladder neck, the posterior angle of the urethra, the urethra′s inclination angle and the size of the diaphragmatic hiatus for both groups at rest, during the Valsalva maneuver, as well as during the transition from resting to the Valsalva maneuver. The strength and fatigue of type I and type II fibers in the pelvic muscles were evaluated electrophysiologically, and anorectal manometry was also performed with both groups. The significance of any relationship between these measurements and SUI was determined using multivariate logistic regression analysis. Results Eleven members of the SUI group showed phase I pelvic organ prolapse. Twelve were in phase II and 2 were in phase III. All of those incidences were significantly different from the control group. There were significant differences between the two groups in the average bladder neck position, urethral inclination angle, posterior urethra angle, descending distance of the bladder neck, and urethral rotation angle during the Valsalva maneuver. In the transition from resting to the Valsalva maneuver, significant differences were found only in the distance of the bladder neck′s descent and the rotation angle of the urethra. The severity of pelvic organ prolapse, the descending distance of the bladder neck and the urethral rotation angle, as well as the bladder neck position and urethral angle during the Valsalva maneuver were the major risk factors associated with female SUI, and the correlation was statistically significant. Conclusion The greater the mobility of the bladder neck and urethra in female SUI patients, the more serious the prolapse. Prolapse, bladder neck mobility and urethral support all affect the overall functionality of the pelvic floor.
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