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目的研究三维经会阴超声对绝经后女性压力性尿失禁(stress urinary incontinence,SUI)患者行无张力阴道吊带术(tension-free viginal tape-obturator system,TVT-O)手术前后膀胱和尿道超声参数变化,评价其临床价值。方法选取西安医学院第二附属医院2014年6月至2016年6月收治的绝经后SUI患者42例为研究组,以同年龄段健康体检者42例为对照组。两组在静息和Valsalva状态(令患者行强力闭呼动作)下行超声检查,观察、测量两组患者膀胱颈活动度、膀胱尿道后角和尿道角等参数;SUI患者TVT-O后再次行超声检查,并与术前和对照组的超声参数分别进行比较。结果 TVT-O术后研究组临床治疗有效率为95.2%;研究组手术前膀胱颈活动度、膀胱尿道后角、尿道角与对照组比较差异有统计学意义(t=27.32、7.76、9.09,P<0.05);研究组行TVT-O手术后的膀胱颈活动度和膀胱尿道后角比手术前缩小,尿道角与术前相比增大,各指标与术前比较差异有统计学意义(t=28.41、6.74、8.68,P<0.05);研究组手术后膀胱颈活动度、膀胱尿道后角、尿道角与对照组比较差异无统计学意义(t=1.92、0.89、1.55,P>0.05)。结论三维经会阴超声对于TVT-O术中吊带位置的确定有重要作用,为临床治疗效果的评价提供形态学依据。
OBJECTIVE: To study the changes of ultrasound parameters of bladder and urethra before and after tension-free viginal tape-obturator system (TVT-O) operation in menopausal women with stress urinary incontinence (SUI) , Evaluate its clinical value. Methods Forty-two patients with SUI in the Second Affiliated Hospital of Xi’an Medical College from June 2014 to June 2016 were selected as the research group and 42 healthy subjects of the same age group as the control group. The two groups underwent ultrasound and ultrasound examination under resting and Valsalva states (patients were forced to close). The bladder neck mobility, vesical posterior urethra and urethral angle were observed and measured in two groups. After TVT-O, SUI patients were re-treated Ultrasonography was performed and compared with preoperative and control ultrasound parameters respectively. Results The effective rate of clinical treatment in TVT-O postoperative study group was 95.2%. The activity of bladder neck, urinary bladder urethral angle and urethral angle before operation in the study group were significantly different from those in the control group (t = 27.32, 7.76, 9.09, P <0.05). The activity of bladder neck and urinary bladder urethra after TVT-O operation in study group were smaller than those before operation, and the urethral angle increased compared with that before operation. There was significant difference between each index and preoperative t = 28.41,6.74,8.68, P <0.05). There was no significant difference in bladder neck mobility, urinary bladder urethral angle and urethral angle between the two groups after operation (t = 1.92,0.89,1.55, P> 0.05 ). Conclusion The three-dimensional trans-perineal ultrasound plays an important role in the determination of the position of the sling in TVT-O and provides a morphological basis for the evaluation of the clinical therapeutic effect.