女性产后压力性尿失禁诊断及预后评估的定量诊断方法研究

严静; 钱陈凤; 周一波

doi:10.16766/j.cnki.issn.1674-4152.002376

女性产后压力性尿失禁诊断及预后评估的定量诊断方法研究

doi: 10.16766/j.cnki.issn.1674-4152.002376

金华市中心医院超声医学科，浙江金华 321000

基金项目:

浙江省自然科学基金项目 LSY19H180006

详细信息

通讯作者:
严静, E-mail: 624936749@qq.com

中图分类号: R694.54 R445.1
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出版历程
- 收稿日期: 2021-10-13
- 网络出版日期: 2022-08-13

Quantitative detection method for diagnosis and prognosis evaluation of postpartum stress urinary incontinence in women

Department of Ultrasound Medicine, Jinhua Central Hospital, Jinhua, Zhejiang 321000, China

摘要

摘要: 目的观察盆底超声及尿动力学检测用于女性产后压力性尿失禁诊断及预后评价的临床效果。方法选择2019年2月—2021年2月于金华市中心医院就诊并接受产后康复治疗的100例产后压力性尿失禁患者和同期300例产后正常女性为研究对象，所有研究对象均进行盆底超声检查及尿动力学检测，产后压力性尿失禁患者均进行盆底肌康复训练及生物反馈电刺激治疗，评价疗效水平，比较盆底超声相关参数及尿动力学指标差异情况。结果产后压力性尿失禁患者膀胱颈移动距离和尿道旋转角超声检测数值均显著高于产后正常女性(t=32.768、28.960，均P＜0.001)，产后压力性尿失禁患者尿道内漏斗形成率(88.00%)显著高于产后正常女性水平(11.33%，χ²=207.965，P＜0.001)，且产后压力性尿失禁患者尿道最大闭合压力、功能性尿道长度和尿道最大压力等尿动力学检测参数均显著低于产后正常女性水平(均P＜0.001)；盆底肌康复训练及生物反馈电刺激治疗对于产后压力性尿失禁患者的总体治疗有效率为83.00%；康复治疗有效的产后压力性尿失禁患者膀胱颈移动距离和尿道旋转角超声检测数值均显著低于治疗无效患者(t=5.760、8.323，均P＜0.001)，且尿道内漏斗形成率(18.07%)显著低于治疗无效患者(76.47%，χ²=21.060，P＜0.001)，各尿动力学指标均显著高于治疗无效患者(均P＜0.001)。结论盆底超声及尿动力学检测可有效识别产后压力性尿失禁患者盆底组织结构和尿道生理功能变化，对产后压力性尿失禁的早期诊断和预后评估具有较高临床应用价值。
- 产后压力性尿失禁 /
- 盆底超声 /
- 尿动力学检测 /
- 早期诊断 /
- 预后评价
Abstract: Objective To observe the clinical effect of pelvic floor ultrasound and urodynamic test in the diagnosis and prognosis evaluation of female postpartum stress urinary incontinence. Methods One hundred cases of postpartum stress urinary incontinence patients and 300 cases of normal postpartum women were studied. All subjects were tested by pelvic floor ultrasound and urodynamics. The patients with postpartum stress incontinence were trained with pelvic floor muscle rehabilitation and biofeedback electrical stimulation to evaluate the efficacy level. The changes in pelvic floor ultrasound and urodynamic indexes between patients with postpartum stress incontinence and normal postpartum women and patients with different therapeutic levels were compared. Results The ultrasonic detection values of bladder neck movement distance and urethral rotation angle in patients with postpartum stress urinary incontinence were significantly higher than those in normal postpartum women (t=32.768, 28.960; all P < 0.001), the rate of intraurethral funnel formation in patients with postpartum stress urinary incontinence (88.00%) was significantly higher than that in normal postpartum women (11.33%, χ²=207.965, P < 0.001), and the urodynamic parameters such as maximum urethral closure pressure, functional urethral length and maximum urethral pressure in patients with postpartum stress urinary incontinence were significantly lower than those of normal postpartum women (all P < 0.001). The total effective rate of floor muscle rehabilitation training and biofeedback electrical stimulation for patients with postpartum stress urinary incontinence was 83.00%. The pelvic floor ultrasound indexes of patients with postpartum stress urinary incontinence after effective rehabilitation treatment were significantly lower than those of patients with ineffective treatment (t=5.760, 8.323; all P < 0.001), the rate of intraurethral funnel formation (18.07%) was significantly lower than that of patients with ineffective treatment (76.47%, χ²=21.060, P < 0.001), and the urodynamic indexes were significantly higher than those in patients with ineffective treatment (all P < 0.001). Conclusion Pelvic floor ultrasound and urodynamic detection can effectively identify the changes of pelvic floor tissue structure and urethral physiological function in patients with postpartum stress urinary incontinence, which has high clinical application value for early diagnosis and prognosis evaluation of postpartum stress urinary incontinence.
- Postpartum stress urinary incontinence /
- Pelvic floor ultrasound /
- Urodynamic test /
- Early diagnosis /
- Prognosis evaluation

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表 1 产后压力性尿失禁患者与产后正常女性盆底超声检测参数比较

Table 1. Comparison of pelvic floor ultrasonic testing parameters between postpartum stress urinary incontinence patients and postpartum normal women

组别	例数	膀胱颈移动距离(x±s，mm)	尿道旋转角(x±s，°)	尿道内漏斗形成[例(%)]	静息状态膀胱尿道后夹角(x±s，°)	Valsalva状态膀胱尿道后夹角(x±s，°)
产后压力性尿失禁患者组	100	17.03±2.14	39.16±4.49	88(88.00)	147.17±14.48	136.26±13.41
产后正常组	300	10.64±1.51	27.53±3.07	34(11.33)	144.93±14.62	134.43±12.65
统计量		32.768^a	28.960^a	207.965^b	1.340^a	1.234^a
P值		＜0.001	＜0.001	＜0.001	0.181	0.218
注：^a为t值，^b为χ²值。

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表 2 产后压力性尿失禁患者与产后正常女性尿动力学检测参数比较(x±s)

Table 2. Comparison of urodynamic parameters between postpartum stress urinary incontinence patients and postpartum normal women

组别	例数	尿道最大闭合压力 (cm H₂O)	功能性尿道长度 (mm)	尿道最大压力 (cm H₂O)
产后压力性尿失禁患者组	100	59.12±6.73	26.31±2.84	68.03±7.21
产后正常组	300	78.34±8.19	35.17±3.29	96.24±9.05
t值		21.200	24.090	28.291
P值		＜0.001	＜0.001	＜0.001
注：1 cm H₂O=0.098 kPa。

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表 3 不同疗效产后压力性尿失禁患者盆底超声检测参数比较

Table 3. Comparison of pelvic floor ultrasound parameters in postpartum stress urinary incontinence patients with different therapeutic effects

组别	例数	膀胱颈移动距离(x±s，mm)	尿道旋转角(x±s，°)	尿道内漏斗形成[例(%)]	静息状态膀胱尿道后夹角(x±s，°)	Valsalva状态膀胱尿道后夹角(x±s，°)
治疗无效产后压力性尿失禁患者组	17	15.29±3.07	37.35±4.59	13(76.47)	146.29±15.63	135.21±13.36
治疗有效产后压力性尿失禁患者组	83	11.35±2.46	29.74±3.16	15(18.07)	143.46±14.27	132.03±13.54
统计量		5.760^a	8.323^a	21.060^b	0.722^a	0.886^a
P值		＜0.001	＜0.001	＜0.001	0.472	0.378
注：^a为t值，^b为χ²值。

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表 4 不同疗效产后压力性尿失禁患者尿动力学检测参数比较(x±s)

Table 4. Comparison of urodynamic parameters in postpartum stress urinary incontinence patients with different therapeutic effects (x±s)

组别	例数	尿道最大闭合压力(cm H₂O)	功能性尿道长度(mm)	尿道最大压力(cm H₂O)
治疗无效产后压力性尿失禁患者组	17	64.57±6.71	28.59±2.86	73.62±7.79
治疗有效产后压力性尿失禁患者组	83	76.34±7.95	34.37±3.17	94.57±8.91
t值		5.737	7.026	8.918
P值		＜0.001	＜0.001	＜0.001

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