Krutova V A, Nadtochy A V, Naumova N V, Boldovskaya E A
Kuban State Medical University, Krasnodar, Russia.
Vopr Kurortol Fizioter Lech Fiz Kult. 2021;98(3):29-38. doi: 10.17116/kurort20219803129.
Pelvic floor surgery is currently recognized as the only effective method for treating genital prolapse but it is not able to restore fully the qualitative characteristics of perineal tissues. The risk of recurrence of the pathological process in the long-term period remains a serious negative aspect. Optimization of pelvic floor rehabilitation after surgical correction of perineal ptosis remains an urgent problem in the female population. The validated method of questioning is a priority in assessing the dynamics of clinical manifestations of failure of the anatomical and functional structures of the pelvic floor, their impact on the life quality of patients before and after the biofeedback method (BFB therapy) and electrical impulse stimulation (EIS) of muscles. Multi-parametric ultrasound diagnostics of perineal tissues can confirm the improvement of the echo-structure of the anatomical and functional elements of the pelvic floor after the complex application of physiotherapeutic effects using modern high-tech hardware systems through an external feedback channel by means of acoustic, visual and tactile perception.
To evaluate the effectiveness of biofeedback therapy and EIS of the neuromuscular apparatus of the pelvic floor in patients operated on for stage III, IV of genital prolapse using mesh implants by means of validated questionnaire survey and measuring the parameters of perineal tissues by the method of multi-parametric ultrasound.
The study included 187 women after surgical correction of stage III and IV genital prolapse according to POP-Q using mesh technologies. The 149 women underwent the observation program; 36 patients of the control group were recommended to modify their lifestyle; 113 patients of the main group - biofeedback therapy and EIS. The indicators of validated questionnaires (determination of the of perineal structures failure influence index on the life quality, ILQ) and ultrasound multi-parametric examination were assessed at baseline, 6 months and 1 year after the program of observation and rehabilitation.
The clinical effectiveness of biofeedback therapy and EIS was confirmed by validated questionnaire: after 1 year, the ILQ in the control group decreased by 7.7%, in the main group - by 43.3% (<0.05). Multi-parametric ultrasound assessment of perineal tissues after surgical correction of stages III and IV of genital prolapse showed a positive effect of conservative rehabilitation on the anatomical and functional structures of the pelvic floor. The diagnostic advantage of endo-anal sonography in the analysis of the echo-structure of the pelvic floor elements, detection of pathologies that cannot be scanned endo-vaginally and trans-perineally has been established. There were 2 (5.5%) cases of recurrence of genital prolapse in the control group; there were no relapsesamong the patients of the main group.
The validated questioning for the ILQ and ultrasound multi-parametric study by measuring the parameters of perineal tissues confirmed the effectiveness of biofeedback therapy and EIS after surgical correction of stage III and IV genital prolapse using mesh technologies. Endo-anal sonography is essential in the examination of gynecological patients. The adherence to the monitoring and rehabilitation program was 79.6%.
盆底手术目前被认为是治疗生殖器脱垂的唯一有效方法，但它无法完全恢复会阴组织的质性特征。长期来看，病理过程复发的风险仍然是一个严重的负面因素。会阴下垂手术矫正后盆底康复的优化仍是女性群体中一个亟待解决的问题。经过验证的问诊方法是评估盆底解剖和功能结构衰竭的临床表现动态变化、其对生物反馈疗法（BFB疗法）和肌肉电脉冲刺激（EIS）前后患者生活质量影响的首要任务。通过外部反馈通道，利用现代高科技硬件系统，借助声学、视觉和触觉感知，对会阴组织进行多参数超声诊断，可以确认在综合应用物理治疗效果后盆底解剖和功能元件的回声结构得到改善。
通过经过验证的问卷调查以及采用多参数超声方法测量会阴组织参数，评估使用网状植入物对Ⅲ期、Ⅳ期生殖器脱垂患者进行盆底神经肌肉装置的生物反馈疗法和EIS的有效性。
该研究纳入了187例根据盆腔器官脱垂定量分期系统（POP-Q）使用网状技术对Ⅲ期和Ⅳ期生殖器脱垂进行手术矫正后的女性。149例女性接受了观察方案；36例对照组患者被建议改变生活方式；113例主要组患者接受生物反馈疗法和EIS。在观察和康复方案实施前、6个月和1年后，评估经过验证的问卷指标（确定会阴结构衰竭对生活质量的影响指数，ILQ）和超声多参数检查结果。
经过验证的问卷证实了生物反馈疗法和EIS的临床有效性：1年后，对照组的ILQ下降了7.7%，主要组下降了43.3%（<0.05）。对Ⅲ期和Ⅳ期生殖器脱垂手术矫正后会阴组织的多参数超声评估显示，保守康复对盆底的解剖和功能结构有积极影响。已确定经肛门超声检查在分析盆底元件回声结构、检测经阴道和经会阴无法扫描的病变方面具有诊断优势。对照组有2例（5.5%）生殖器脱垂复发；主要组患者无复发情况。
通过测量会阴组织参数对ILQ进行经过验证的询问和超声多参数研究，证实了使用网状技术对Ⅲ期和Ⅳ期生殖器脱垂进行手术矫正后生物反馈疗法和EIS的有效性。经肛门超声检查对妇科患者检查至关重要。监测和康复方案的依从率为79.6%。
