Zhong X L, Song J, Xu Y L, Lyu X L, Zhong X H, Wang A P, Song Y F
Department of Obstetrics and Gynecology, Fuzhou General Hospital, Fujian Medical University, Fuzhou 350025, China.
Zhonghua Fu Chan Ke Za Zhi. 2017 Sep 25;52(9):600-604. doi: 10.3760/cma.j.issn.0529-567X.2017.09.005.
To evaluate transperineal sonography for lower urinary tract symptoms after pelvic floor reconstruction. Eighty-three patients with severe pelvic organ prolapse received surgeries in Fuzhou General Hospital from September 2014 to September 2015, dividing into two groups: 27 patients were selected to receive transvaginal mesh (TVM) pelvic floor reconstruction surgery with tension-free vaginal tape-Abbrevo (TVT-Abbrevo) incontinence surgery, named TVM+TVT-Abbrevo group; 56 patients were selected to receive TVM pelvic floor reconstruction surgery only, named TVM group. The ultrasonic parameters at rest, on contraction and Valsalva condition respectively were observed and measured, including the bladder neck descent (BND), urethral rotation angle, retrovesical angle, levator urethra gap (LUG), the existence of bladder neck funneling, position of the tape, by using 2D and 3D transperineal ultrasound. The two groups were compared with the ultrasonic parameters before and after operation: two groups of patients with postoperative BND [(2.3±0.5) versus (3.1±0.7) cm, (1.6±0.4) versus (3.6±0.4) cm] were significantly reduced, the difference was statistically significant (0.02, 0.01). The two groups of LUG before and after operation [(3.62±0.45) versus (3.26±0.92) cm, (2.96±0.47) versus (2.72±0.38) cm] both had significant difference by maximum Valsalva (0.01, 0.04). There was statistical significance difference of urethral rotation angle in TVM+TVT-Abbrevo group by maximum Valsalva (0.01). Observation of morphology: (1) 2 patients with difficulty in urination in TVM+TVT-Abbrevo group, ultrasound showed when the position of the bladder down the urethra discount; 4 patients with stress urinary incontinence (SUI), ultrasound showed slings off or release. (2) One patient with difficulty in urination in TVM group, but ultrasound showed lower urinary tract anatomy were normal; 5 patients with SUI, ultrasound showed the position of the bladder neck were significantly lower in 3 patients, showing high mobility, and the other 2 patients had a larger urethral diameter, showing a tendency of natural deletion. s Anatomy of lower urinary tract could be clearly showed by transperineal sonography. This could provide imaging support for the diagnosis of lower urinary tract symptoms after pelvic floor reconstruction.
评估经会阴超声在盆底重建术后下尿路症状中的应用价值。2014年9月至2015年9月，83例重度盆腔器官脱垂患者在福州总医院接受手术，分为两组：27例患者接受经阴道网片（TVM）盆底重建术联合无张力阴道吊带-Abbrevo（TVT-Abbrevo）尿失禁手术，命名为TVM+TVT-Abbrevo组；56例患者仅接受TVM盆底重建术，命名为TVM组。采用二维和三维经会阴超声分别观察并测量静息、收缩及Valsalva状态下的超声参数，包括膀胱颈下移（BND）、尿道旋转角、膀胱后角、提肛肌尿道间隙（LUG）、膀胱颈漏斗形成情况、吊带位置。比较两组手术前后的超声参数：两组患者术后BND[（2.3±0.5）对（3.1±0.7）cm，（1.6±0.4）对（3.6±0.4）cm]均显著降低，差异有统计学意义（0.02，0.01）。两组患者最大Valsalva状态下手术前后LUG[（3.62±0.45）对（3.26±0.92）cm，（2.96±0.47）对（2.72±0.38）cm]均有显著差异（0.01，0.04）。TVM+TVT-Abbrevo组最大Valsalva状态下尿道旋转角有统计学意义（0.01）。形态学观察：（1）TVM+TVT-Abbrevo组2例排尿困难患者，超声显示膀胱位置下移尿道打折；4例压力性尿失禁（SUI）患者，超声显示吊带脱落或松弛。（2）TVM组1例排尿困难患者，但超声显示下尿路解剖结构正常；5例SUI患者，超声显示膀胱颈位置明显下移3例，显示高活动度，另2例尿道直径增大，显示自然缺失倾向。经会阴超声可清晰显示下尿路解剖结构。可为盆底重建术后下尿路症状的诊断提供影像学支持。
