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
计量
- 文章访问数: 99
- HTML全文浏览量: 49
- PDF下载量: 4
- 被引次数: 0
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

HTML全文

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。

下载: 导出CSV

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。

下载: 导出CSV

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。

下载: 导出CSV

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

下载: 导出CSV

参考文献(20)

[1]	杨晓二, 程芳, 王慧, 等. 产后压力性尿失禁危险因素分析[J]. 实用预防医学, 2020, 27(12): 1489-1491. doi: 10.3969/j.issn.1006-3110.2020.12.021 YANG X E, CHENG F, WANG H, et al. Risk factors of postpartum stress urinary incontinence[J]. Practical Preventive Medicine, 2020, 27(12): 1489-1491. doi: 10.3969/j.issn.1006-3110.2020.12.021
[2]	GONZALES A L, BARNES K L, QUALLS C R, et al. Prevalence and treatment of postpartum stress urinary incontinence: A systematic review[J]. Female Pelvic Med Reconstr Surg, 2021, 27(1): e139-e145. doi: 10.1097/SPV.0000000000000866
[3]	张亮. 应用盆底超声诊断产后早期压力性尿失禁的效果[J]. 中国医药指南, 2020, 18(29): 103-104. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK202029049.htm ZHANG L. Application of pelvic floor ultrasound in the diagnosis of early postpartum stress urinary incontinence[J]. Guide of China Medicine, 2020, 18(29): 103-104. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK202029049.htm
[4]	赵祥虎, 马明, 徐亮, 等. 呼吸训练在产后压力性尿失禁中的应用[J]. 中国康复理论与实践, 2018, 24(6): 720-725. doi: 10.3969/j.issn.1006-9771.2018.06.018 ZHAO X H, MA M, XU L, et al. Application of breathing training in postpartum stress urinary incontinence[J]. Chinese Journal of Rehabilitation Theory and Practice, 2018, 24(6): 720-725. doi: 10.3969/j.issn.1006-9771.2018.06.018
[5]	陈红敏, 吴丽琴, 丁花艳. 产后盆底功能障碍性疾病与女性性生活质量相关性的研究[J]. 中国性科学, 2017, 26(12): 113-115. doi: 10.3969/j.issn.1672-1993.2017.12.039 CHEN H M, WU L Q, DING H Y. Study on the relationship between postpartum pelvic floor dysfunction and female sexual life quality[J]. Chinese Journal of Human Sexuality, 2017, 26(12): 113-115. doi: 10.3969/j.issn.1672-1993.2017.12.039
[6]	高伟. 生物反馈电刺激联合盆底肌训练治疗初产后盆底功能障碍的效果观察[J]. 中国妇幼保健, 2019, 34(20): 4829-4831. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201920076.htm GAO W. Effect of biofeedback electrical stimulation combined with pelvic floor muscle training on pelvic floor dysfunction in the first postpartum period[J]. Maternal and Child Health Care of China, 2019, 34(20): 4829-4831. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201920076.htm
[7]	谢贺江. 早期康复训练联合电刺激生物反馈在产后压力性尿失禁患者中的应用效果[J]. 中国民康医学, 2020, 32(19): 73-75. doi: 10.3969/j.issn.1672-0369.2020.19.029 XIE H J. Application effect of early rehabilitation training combined with electrical stimulation biofeedback in postpartum stress urinary incontinence patients[J]. Medical Journal of Chinese People's Health, 2020, 32(19): 73-75. doi: 10.3969/j.issn.1672-0369.2020.19.029
[8]	QI X, SHAN J, PENG L, et al. The effect of a comprehensive care and rehabilitation program on enhancing pelvic floor muscle functions and preventing postpartum stress urinary incontinence[J]. Medicine(Baltimore), 2019, 98(35): e16907.
[9]	白军, 杨斌健, 陈薇玲, 等. 压力性尿失禁病因学研究进展[J]. 中国妇产科临床杂志, 2017, 18(4): 382-384. https://www.cnki.com.cn/Article/CJFDTOTAL-FKLC201704031.htm BAI J, YANG B J, CHEN W L, et al. Advances in the etiology of stress urinary incontinence[J]. Chinese Journal of Clinical Obstetrics and Gynecology, 2017, 18(4): 382-384. https://www.cnki.com.cn/Article/CJFDTOTAL-FKLC201704031.htm
[10]	赵璇, 任志红. 产后压力性尿失禁发病的相关因素及防治对策分析[J]. 中国妇幼保健, 2019, 34(12): 2828-2830. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201912055.htm ZHAO X, REN Z H. Analysis of related factors and prevention strategies of postpartum stress urinary incontinence[J]. Maternal and Child Health Care of China, 2019, 34(12): 2828-2830. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201912055.htm
[11]	单华英, 徐亚芬, 陆艳, 等. 盆底超声在女性压力性尿失禁中的应用及初产妇产后盆底肌肉训练的疗效评估[J]. 中华全科医学, 2019, 17(9): 1557-1560. doi: 10.16766/j.cnki.issn.1674-4152.000997 SHAN H Y, XU Y F, LU Y, et al. Application of pelvic floor ultrasound in female stress incontinence and evaluation of efficacy of postpartum pelvic floor muscle training[J]. Chinese Journal of General Practice, 2019, 17(9): 1557-1560. doi: 10.16766/j.cnki.issn.1674-4152.000997
[12]	韩大芬. 三维超声在诊断女性盆底功能障碍中的应用研究[J]. 中国医疗器械信息, 2021, 27(4): 100-101. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGQX202104050.htm HAN D F. Application of three dimensional ultrasound in the diagnosis of female pelvic floor dysfunction[J]. China Medical Device Information, 2021, 27(4): 100-101. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGQX202104050.htm
[13]	雷凯荣, 李艳平, 张小培, 等. 盆底超声在女性盆底功能障碍性疾病诊断中的应用[J]. 中国实用妇科与产科杂志, 2017, 33(10): 1008-1014. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF201710007.htm LEI K R, LI Y P, ZHANG X P, et al. Application of pelvic floor ultrasonography in the diagnosis of female pelvic floor dysfunction[J]. Chinese Journal of Practical Gynecology and Obstetrics, 2017, 33(10): 1008-1014. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF201710007.htm
[14]	陆敏姣, 姬亚敏, 董爱春, 等. 盆底超声用于产后压力性尿失禁患者康复疗效评价的临床价值[J]. 中国基层医药, 2020, 27(20): 2458-2462. doi: 10.3760/cma.j.issn.1008-6706.2020.20.007 LU M J, JI Y M, DONG A C, et al. Clinical value of pelvic floor ultrasound in the evaluation of rehabilitation of patients with postpartum stress urinary incontinence[J]. Chinese Journal of Primary Medicine and Pharmacy, 2020, 27(20): 2458-2462. doi: 10.3760/cma.j.issn.1008-6706.2020.20.007
[15]	YOUSSEF A, FIORENTINI M, DI DONNA G, et al. The correlation between transperineal ultrasound assessment of the levator ani muscle and postpartum urinary incontinence[J]. Neurourol Urodyn, 2021, 40(7): 1786-1795. doi: 10.1002/nau.24744
[16]	张美琴, 罗红. 初次产后早期盆底形态的三维超声研究[J]. 四川大学学报(医学版), 2016, 47(2): 253-256. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYK201602024.htm ZHANG M Q, LUO H. Three-dimensional ultrasound of the pelvic floor in early postpartum after first delivery[J]. Journal of Sichuan University (Medical Science Edition), 2016, 47(2): 253-256. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYK201602024.htm
[17]	李晓平. 生物反馈电刺激对产后压力性尿失禁患者盆底表面肌电信号及尿动力学的影响[J]. 实用医院临床杂志, 2020, 17(4): 209-211. doi: 10.3969/j.issn.1672-6170.2020.04.063 LI X P. The effect of biofeedback electrical stimulation on the surface electromyography of pelvic floor and urodynamics in patients with postpartum stress urinary incontinence[J]. Practical Journal of Clinical Medicine, 2020, 17(4): 209-211. doi: 10.3969/j.issn.1672-6170.2020.04.063
[18]	刘昵, 尹婵. 盆底肌锻炼联合电刺激对产后压力性尿失禁患者盆底肌力及尿动力学的影响[J]. 现代诊断与治疗, 2020, 31(3): 411-413. https://www.cnki.com.cn/Article/CJFDTOTAL-XDZD202003035.htm LIU N, YIN C. Effect of pelvic floor muscle exercise combined with electrical stimulation on pelvic floor muscle strength and urodynamics in patients with postpartum stress urinary incontinence[J]. Modern Diagnosis & Treatment, 2020, 31(3): 411-413. https://www.cnki.com.cn/Article/CJFDTOTAL-XDZD202003035.htm
[19]	肖玲佳, 吴珠青, 叶芳芬. 盆底超声诊断SUI患者的价值及患者VLPP MUCP的变化研究[J]. 中国妇幼保健, 2020, 35(20): 3897-3900. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202020061.htm XIAO L J, WU Z Q, YE F F. The value of pelvic floor ultrasound in diagnosing SUI patients and the changes of VLPP and MUCP in patients[J]. Maternal and Child Health Care of China, 2020, 35(20): 3897-3900. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202020061.htm
[20]	曾丽娟, 李志林. 女性产后压力性尿失禁患者膀胱颈移动度与超声尿动力学检查研究[J]. 中国数字医学, 2019, 14(7): 15, 31-33. https://www.cnki.com.cn/Article/CJFDTOTAL-YISZ201907011.htm ZENG L J, LI Z L. Bladder neck mobility and ultrasound in patients with stress urinary incontinence in postpartum women[J]. China Digital Medicine, 2019, 14(7): 15, 31-33. https://www.cnki.com.cn/Article/CJFDTOTAL-YISZ201907011.htm