实时三维盆底超声对产后压力性尿失禁患者疗效评估作用及与尿动力学的相关性分析

摘要 目的：探讨实时三维盆底超声对产后压力性尿失禁（SUI）患者疗效评估作用及与尿动力学的相关性。方法：选择2020年4月至2022年12月石家庄市人民医院收治的139例产后SUI患者，均接受盆底生物反馈电刺激联合盆底肌锻炼治疗。治疗前后分别进行实时三维盆底超声检查和尿动力学检查。比较治疗前后实时三维盆底超声参数、尿动力学指标差异。Pearson法分析实时三维盆底超声参数与尿动力学指标的相关性。结果：实时三维盆底超声图像特征显示：治疗前盆膈裂孔内的结构疏松，回声变弱，盆腔器官结缔组织疏松，间隙增宽，盆膈裂孔面积、尿道旋转角、膀胱尿道后角以及膀胱颈移动度较大；治疗后盆膈裂孔两侧耻骨直肠肌对称，耻骨内脏肌呈带状高回声，盆膈裂孔面积、尿道旋转角、膀胱尿道后角以及膀胱颈移动度较治疗前降低。产后SUI患者治疗后静息状态和Valsalva状态下盆膈裂孔面积、尿道旋转角、膀胱尿道后角、膀胱颈移动度均较治疗前降低（P＜0.05），腹压漏尿点压、最大逼尿肌压力均较治疗前增加（P＜0.05）。产后SUI患者静息状态和Valsalva状态下盆膈裂孔面积、尿道旋转角、膀胱尿道后角、膀胱颈移动度与最大逼尿肌压力、腹压漏尿点压呈负相关（P＜0.05），与最大膀胱容量和残余尿量无关（P＞0.05）。结论：产后SUI患者经盆底生物反馈电刺激联合盆底肌锻炼治疗后实时三维盆底超声参数较治疗前降低，与尿动力学改善有关。临床可通过实时三维盆底超声检查，对产后SUI患者进行临床疗效评价，以指导临床治疗。

Effect of Real-time Three-dimensional Pelvic Floor Ultrasound on the Evaluation of the Efficacy of Postpartum Stress Urinary Incontinence Patients and Its Correlation Analysis with Urodynamics

ABSTRACT Objective: To explore the effect of real-time three-dimensional pelvic floor ultrasound on the evaluation of the efficacy of postpartum stress urinary incontinence (SUI) patients and its correlation with urodynamics. Methods: 139 postpartum SUI patients who were admitted to Shijiazhuang People''s Hospital from April 2020 to December 2022 were selected, and all patients received pelvic floor biofeedback electrical stimulation combined with pelvic floor muscle exercise. Real-time three-dimensional pelvic floor ultrasound and urodynamic examination were performed before and after treatment. The differences in real-time three-dimensional pelvic floor ultrasound parameters and urodynamic indicators before and after treatment were compared. The correlation between real-time three-dimensional pelvic floor ultrasound parameters and urodynamic indicators were analyzed by Pearson method. Results: Real-time three-dimensional pelvic floor ultrasound image feature showed that the structure inside the pelvic hiatus became loose, the echo became weak, the connective tissue of pelvic organs became loose, the gap widened, pelvic diaphragm hiatus area, urethral rotation angle, bladder urethra posterior angle, and bladder neck mobility was relatively large before treatment. After treatment, the puborectal muscles on both sides of the pelvic diaphragm hiatus were symmetrical, and the pubic visceral muscles showed banded hyperechogenicity, pelvic diaphragm hiatus area, urethral rotation angle, bladder urethra posterior angle, and bladder neck mobility decreased compared with before treatment. After treatment, the pelvic diaphragm hiatus area, urethral rotation angle, bladder urethra posterior angle, and bladder neck mobility decreased in postpartum SUI patients in resting state and Valsalva state compared with before treatment(P<0.05), the abdominal pressure leakage point pressure and maximum detrusor muscle pressure increased compared with before treatment(P<0.05). The pelvic diaphragm hiatus area, urethral rotation angle, bladder urethra posterior angle, and bladder neck mobility in postpartum SUI patients in resting state and Valsalva state were negatively correlated with maximum detrusor muscle pressure, abdominal pressure leakage point pressure (P<0.05), and it was not related to maximum bladder capacity and residual urine volume(P>0.05). Conclusion: The real-time three-dimensional pelvic floor ultrasound parameters in postpartum SUI patients after the treatment of pelvic floor biofeedback electrical stimulation combine with pelvic floor muscle exercise are lower than those before treatment, which is related to improvement in urodynamics. Real-time three-dimensional pelvic floor ultrasound examination can be used in clinical practice, evaluate the clinical efficacy in postpartum SUI patients, and to guide clinical treatment.