盆底超声诊断老年女性压力性尿失禁对膀胱功能的影响

Pelvic floor ultrasound for determining the bladder function in the elderly women with stress urinary incontinence

摘要:

目的 探讨不同程度老年女性压力性尿失禁(SUI)盆底超声相关参数,为临床判断SUI程度提供参考。方法 选取2016年1月至2018年1月西安交通大学第一附属医院超声科收治的老年女性SUI患者378例,根据SUI严重程度将患者分为轻度组167例,中度组114例,重度组87例,同时选取在本院进行体检的无SUI的健康老年妇女100名作为对照组,均经会阴盆底超声观察静息状态、Valsalva状态下相关盆底参数。采用SPSS 19.0软件进行统计分析。根据数据类型,组间比较采用方差分析、LSD-t检验或卡方检验。结果 4组受试者基线资料比较差异无统计学意义。静息状态下,与对照组比较,轻、中、重度SUI患者膀胱逼尿肌厚度、膀胱尿道后角及尿道内口漏斗形成率显著增大,膀胱颈与耻骨联合的垂直距离(BN-S)显著减小,差异均有统计学意义(P＜0.05)；轻、中、高度SUI患者间上述盆底超声参数比较,差异无统计学意义(P＞0.05)。Valsalva动作下,与对照组比较,轻、中、重度SUI患者膀胱尿道后角、尿道旋转角度、膀胱颈移动度及尿道内口漏斗形成率显著增大,BN-S显著减小,差异有统计学意义(P＜0.05)；随SUI程度加重,膀胱颈移动度明显增加,轻、中、重度组患者两两比较,差异均有统计学意义[(25.18±3.82) vs(29.80±3.78) vs(33.13±3.60)mm,P＜0.05]。结论 经盆底超声可观察出老年女性SUI患者盆底结构与健康人群的不同,且不同程度SUI患者膀胱颈移动度不同,对SUI程度判断有参考意义。

Abstract:

Objective To investigate the pelvic floor ultrasound parameters in relation to the severity of stress urinary incontinence (SUI) in the elderly women to provide reference for determining the degree of SUI in clinical practice. Methods Included in the study were 378 SUI patients treated in the Department of Ultrasound of the First Hospital of Xi′an Jiaotong University from January 2016 to January 2018, of whom 167 were mild (mild group), 114 moderate (moderate group), and 87 severe (severe group). Also, 100 elderly women without SUI who had physical check-ups in the same hospital were randomly selected as the control group. The pelvic floor ultrasound parameters were observed at rest and in Valsalva maneuver. Statistical analysis was performed using SPSS statistics 19.0. Depending on data type, comparison among groups was made by variance analysis, LSD-t test or Chi-square test. Results There were no significant differences among the four groups in baseline data. At rest, patients in all SUI group had thinker detrusor, wider posterior urethra-vesical angle, greater incidence of urethral funnel formation, but lower vertical distance between bladder neck and synchondroses pubis (BN-S) than those in the control group (P<0.05), the differences being statistically significant. There was no statistically significant differences among the SUI groups in the above parameters (P>0.05). In Valsalva maneuver, posterior urethra-vesical angle, urethral rotation angle, bladder neck mobility, incidence of urethral funnel formation increased significantly in the SUI groups as compared with the control group (P<0.05), and BN-S was significantly lower in the former than in the latter, the diffe-rences being of statistical significance (P<0.05). The bladder neck mobility increased with the severity of SUI, and the differences wereof statistical significance among the mild, moderate and severe groups[(25.18±3.82) vs (29.80±3.78) vs (33.13±3.60)mm, P＜0.05]. Conclusion Pelvic floor ultrasound can be used to observe the differences in the pelvic floor structures between the elderly women with SUI and those without, and bladder neck mobility differs in patients with SUI of different severity, providing a reference for determining SUI severity.