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目的探讨经腹子宫全切除术(TAH)后经会阴盆底超声评价患者早期盆底功能改变的价值。方法预行TAH 40例未绝经患者,均在术前1周内及术后3个月行经会阴盆底超声检查,分别观察其在静息、收缩及Valsalva状态的盆底情况,记录Valsalva状态的膀胱颈旋转角度(△v BA),膀胱尿道后角(v UJV),膀胱颈、阴道穹窿及肛管直肠连接部移动度(v BND、v FND、v AND),Valsalva状态及收缩期肛提肌裂隙的变化度(△v M、△c M)等超声参数16项。对比术前和术后3个月各超声参数,分析盆底功能的变化。结果根据盆底超声各参数测量结果,诊断TAH术后出现膀胱脱垂、直肠脱垂、压力性尿失禁等盆底功能障碍性疾病共7例,其中压力性尿失禁2例,直肠脱垂3例,压力性尿失禁合并膀胱脱垂1例,压力性尿失禁合并膀胱脱垂、直肠脱垂1例;术后3个月△v BA、v UJV、△v UIA、v BND、v FND、v AND、vs B、vs F、vs A、△v M较术前比较有所增大,术后盆腔器官的活动度增加,盆底组织抗腹压功能减低;术后3个月v Dx B、vx F、vx A、△cx B、△cy B、△c M较术前比较有所减小,术后盆底肌肉及韧带的支持能力减弱,肛提肌的收缩功能降低。上述参数差异均有统计学意义(P<0.05)。结论 TAH后早期即可出现盆底功能降低,术后经会阴盆底超声检查能在患者出现临床症状之前发现盆底功能减退,为临床早期干预,延缓或预防盆底功能障碍性疾病的发生提供量化依据。
Objective To investigate the clinical value of perineal pelvic ultrasonography in evaluating pelvic floor function after total hysterectomy (TAH). Methods 40 cases of patients with non-menopausal TAH were enrolled in this study. All cases underwent pelvic ultrasonography in 1 week before operation and 3 months after operation. The pelvic floor of the patients with resting, contracted and Valsalva state were observed. The Valsalva state (V BND, v FND, v AND), Valsalva status, and systolic anorexia (AVBV), bladder UTI (v UJV), bladder neck, vaginal vault and anorectal junction Muscle fissure changes (△ v M, △ c M) and other ultrasonic parameters 16 items. The changes of pelvic floor function were analyzed by comparing the ultrasound parameters before and 3 months after operation. Results According to the results of pelvic floor ultrasound, there were 7 cases of pelvic floor dysfunction such as bladder prolapse, rectal prolapse and stress urinary incontinence diagnosed after TAH, including 2 cases of stress urinary incontinence, 3 cases of rectal prolapse One case of stress urinary incontinence complicated with bladder prolapse and one case of stress urinary incontinence complicated with prolapse of the bladder and rectum prolapse. The levels of △ v BA, v UJV, △ v UIA, v BND, v FND, V AND, vs B, vs F, vs A, △ v M increased compared with the preoperative, postoperative pelvic organ mobility increased, anti-abdominal pelvic floor anti-abdominal function decreased; 3 months after surgery v Dx B , Vx F, vx A, △ cx B, △ cy B, △ c M decreased compared with that before operation, the pelvic floor muscles and ligaments support ability weakened, the levator ani muscle contraction decreased. The above parameters were statistically significant (P <0.05). Conclusions The pelvic floor function may be reduced in the early stage after TAH. The pelvic floor dysfunction may be found before the clinical symptoms of the patients through the perineal pelvic ultrasonography after the operation, which provides the clinical early intervention to delay or prevent pelvic floor dysfunction. Quantitative basis.