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目的经会阴三维超声检测女性重度盆腔脏器脱垂(POP)合并隐匿性压力性尿失禁(OSUI)以及单纯性重度POP的相关参数,结合盆腔器官脱垂定量分度(POP-Q)评分的相关分析,客观了解隐匿性尿失禁盆底组织改变变化,进而为重度POP合并OSUI的术前评估及手术方案的选择提供新的思路及方法。方法选取2014年9月至2016年6月就诊于郑大三附院盆底重建病区79例重度POP患者,尿动力学将其分为POP合并OSUI组和POP组,记录患者术前POP-Q评分、年龄、孕产次等相关信息,三维彩超分别测量患者静息期和Valsalva动作后尿道口形态、尿道倾斜角(UI)、膀胱颈与耻骨联合的垂直距离(BN-S)及肛提肌裂孔面积(LHA)。计算尿道旋转角度(UR)、膀胱颈移动度(BND)。结果两组患者POP-Q评分中只有Aa、Ba比较有统计学差异(P<0.05,P<0.01)。POP合并OSUI组患者R-ALH在静息状态及Valsalva动作后均较POP组显著增大(P<0.05);BND大于POP组(P<0.01);UR在Valsalva动作时大于POP组(P<0.05)。静息状态下和Valsalva动作时,POP合并OSUI组漏斗型尿道口发生率均高于POP组(P均<0.05)。结论 POP是否合并隐匿性尿失禁,前盆腔Aa、Ba指示点与其有一定的相关性,POP基础上肛提肌损伤程度、BND、UR、漏斗形尿道内口的形成可能与POP合并OSUI的发生有关。两者相互结合评估重度POP患者,可以提高隐匿性尿失禁的诊断率。
Objective To investigate the relationship between POP and OSUI and POP in severe female pelvic organ by three-dimensional perineal ultrasonography and POP-Q (pelvic organ prolapse quantitative index) Correlation analysis to objectively understand the changes of pelvic floor tissue in patients with occult urinary incontinence and to provide new ideas and methods for the preoperative assessment of severe POP combined with OSUI and the choice of surgical options. Methods Seventy-nine patients with severe POP who underwent pelvic floor reconstruction from September 2014 to June 2016 were enrolled in this study. Their urine dynamics were divided into two groups: POP combined with OSUI group and POP group. The preoperative POP-Q score , Age, pregnancy and other related information, three-dimensional color Doppler ultrasound were measured at rest and Valsalva urethral orifice morphology, urethra tilt angle (UI), bladder neck and pubic symphysis vertical distance (BN-S) and levator ani Holes area (LHA). Urinary rotation angle (UR) and bladder neck mobility (BND) were calculated. Results The POP-Q scores of the two groups were only Aa, Ba statistically significant difference (P <0.05, P <0.01). The R-ALH in POP combined with OSUI group was significantly higher than that in POP group (P <0.05), BND was greater than that in POP group (P <0.01), while in resting Valsalva group, UR was greater than that in POP group (P < 0.05). At rest and in Valsalva, the incidence of funnel-type urethra in the OSUI group was higher than that in the POP group (all P <0.05). CONCLUSIONS: Whether occult occult urine incontinence is associated with POP or not, the former pelvic Aa, Ba indication points are related to it. The degree of levator ani muscle damage based on POP, BND, UR and the formation of funnel-shaped urethra may be related to the occurrence of POP combined with OSUI related. Combined assessment of severe POP patients, can improve the diagnostic rate of occult urinary incontinence.