盆底四维超声评估全子宫切除术对前盆腔功能的影响

摘要

目的 运用经会阴盆底四维超声评估全子宫切除术对女性前盆腔功能的影响.方法 选取盆腔良性及癌前病变患者57例,排除压力性尿失禁(SUI)、排除生殖器官脱垂(POP)而有子宫切除指征者,年龄35 ～ 50岁,所有患者术前、术后3、6、12个月行经会阴盆底四维超声检查,在静息和最大Valsalva动作下,测量膀胱颈距耻骨联合后下缘水平线的垂直距离(BSD),最大瓦时动作下观察有无尿道漏斗形成、有无膀胱膨出,测量尿道旋转角、盆膈裂孔面积等相关参数,计算膀胱颈下降度(BND),统计膀胱膨出的例数并进行自身对照研究.评估全子宫切除术对前盆腔功能的影响.结果 手术后3、6、12个月与术前比较,在最大瓦时动作下BSD明显低于手术前,差异有统计学意义(均P＜0.05);BND、尿道旋转度、盆膈裂孔面积明显大于手术前,差异有统计学意义(均P＜ 0.05).术后3、6、12个月,膀胱膨出数分别为7例、9例、13例,差异均有统计学意义(均P＜ 0.05).结论 全子宫切除术可以导致女性前盆腔功能不同程度改变.经会阴盆底四维超声可以较好地评估前盆腔功能障碍性疾病(PFD),值得推广.%Objective To evaluate the effect of total hysterectomy on women's anterior pelvic function with transperineal pelvic floor ultrasonography.Methods 57 30-50 years old patients with uterine benign diseases or precancerous lesions were selected.All the patients did not have stress urinary incontinence(SUI) and reproductive organ prolapse(POP) and needed hysterectomy.All the patients were examined by 4D ultrasound before and 3,6 and 12 months after the operaion.During rest and under maximum Valsalva action,the vertical distance from the bladder neck to the edge of the pubic symphysis (BSD) was measured.Under maximum Valsalva action,whether having urethral funnel formation or cystocele was observed,the urethral rotation angle,pelvic diaphragm hiatal area,etc.were measured,and the bladder neck drop (BND) was calculated.The cases of BND were calculated and self-comparatively studied.The effect of total hysterectomy on women's anterior pelvic function was evaluated.Results Under maximum Valsalva action,the BSD was lower and the BND,urethral rotation angle,and pelvic diaphragm hiatal area were larger 3,6,and 12 months after than before the operation,with statistical differences (all P ＜ 0.05).3,6,and 12 months after operation,7,9,and 12 cases got cystocele,with statistical differences (all P ＜ 0.05).Conclusion Total hysterectomy can lead to different changes of female anterior pelvic function.Transperineal sonography is preferable for evaluating anterior pelvic dysfunction,so it is worth being generalized.