Contrôle neurologique de l’éjaculation

The brain control of the genital tract and sexual behaviour remains poorly understood. Clinical results and basic research indicate that the neural control of ejaculation depends on three levels of organization. The first level consists of peripheral autonomic and somatic nerves. Leaving the spinal cord, these nerves control the motility, secretions and blood supply of the genital tract, and contractions of perineal striated muscles. Their path in the abdominal cavity and the effects of their neuro-transmitters on peripheral tissues have been established. These nerves also convey sensory information from the genital tract to the spinal cord. The second level is represented by the spinal cord. The thoracolumbar (sympathetic), and sacral (parasympathetic and pudendal) segments of the cord contain the somata of autonomic and somatic motoneurons, whose axons run in the above nerves. These motoneurons are part of a spinal network that likely organizes the activity of the whole genital tract in a given context such as copulation. The role of the different spinal cord segments in the control of ejaculation is mainly inferred from observations of the deleterious effects of spinal cord injury in human patients. A small population of galaninergic positive neurons has recently been identified in the lumbar segments of the rat spinal cord that plays a major role in ejaculation (Truitt and Coolen, 2003). Selective lesion of this population abolishes in copula ejaculations, but spares erection. Finally, the third level of organization is represented by supraspinal nervous structures. The spinal cord receives direct excitatory and inhibitory information from the brainstem, pons and hypothalamus. In turn, these structures receive sensory information from the genital tract. However, their role in the control of ejaculation remains poorly investigated. Again, it is mainly inferred from the observation of the deleterious effects of pharmacological treatments on brain neurotransmission. Positron emission tomography has recently been used to observe brain areas whose activity is enhanced during ejaculation in humans (Holstege et al., 2003). In this study, several areas of the right side of the cortex and the cerebellum were activated. The targets of future clinical and basic research include: the neural basis of the required coordination between spinal autonomic and somatic nuclei that innervate the genital tract, the role of sensory information from the genital tract in the recruitment and coordination of spinal and supraspinal nuclei, and finally the integration of descending excitatory and inhibitory influences onto the spinal cord. Both the organization during development and the activation at puberty of the spinal neural network that controls the genital tract are dependent on androgens. Future research should identify the regulatory factors that, in response to the action of androgens, provide neurons with the possibility of building their connexions and selecting their neurotransmitters and receptors.     

F-spondin: a gene expressed at high levels in the floor plate encodes a secreted protein that promotes neural cell adhesion and neurite extension.

The floor plate is a cell group implicated in the control of neural cell pattern and axonal growth in the developing vertebrate nervous system. To identify molecules that might mediate the functions of the floor plate, we have used subtractive hybridization techniques to isolate floor plate-enriched cDNA clones. One such clone encodes a novel secreted protein, F-spondin, which is expressed at high levels in the floor plate. The C-terminal half of the protein contains six repeats identified previously in thrombospondin and other proteins implicated in cell adhesion. F-spondin is expressed in the floor plate at the time that axons first extend and at lower levels in the peripheral nerve. Recombinant F-spondin promotes the attachment of spinal cord and sensory neuron cells and the outgrowth of neurites in vitro. F-spondin may contribute to the growth and guidance of axons in both the spinal cord and the PNS.     

Calretinin-immunoreactive nerves in the uterus, pelvic autonomic ganglia, lumbosacral dorsal root ganglia and lumbosacral spinal cord

Nerves containing the calcium-binding protein calretinin have been reported in several organs but not in female reproductive organs and associated ganglia. This study was undertaken to determine if nerves associated with the uterus contain calretinin and the source(s) of calretinin-synthesizing nerves in the rat (are they sensory, efferent, or both?). Calretinin-immunoreactive nerves were present in the uterine horns and cervix where they were associated with arteries, uterine smooth muscle, glands, and the epithelium. Calretinin-immunoreactive terminals were apposed to neurons in the paracervical ganglia; in addition, some postganglionic neurons in this ganglion were calretinin positive. Calretinin perikarya were present in the lumbosacral dorsal root ganglia, no-dose ganglia, and lumbosacral spinal cord. Retrograde axonal tracing, utilizing Fluorogold injected into the uterus or paracervical parasympathetic ganglia, revealed calretinin-positive/Fluorogold-labeled neurons in the dorsal root and nodose ganglia. Also, capsaicin treatment substantially reduced the calretinin-positive fibers in the uterus and pelvic ganglia, thus indicating the sensory nature of these fibers. The presence of calretinin immunoreactivity identifies a subset of nerves that are involved in innervation of the pelvic viscera and have origins from lumbosacral dorsal root ganglia and vagal nodose ganglia. Though the exact function of calretinin in these nerves is not currently known, calretinin is likely to play a role in calcium regulation and their function.     

盆底肌肉康复训练联合盆底重建术对女性盆底功能障碍性疾病患者炎症反应及应激反应的影响

目的:观察盆底肌肉康复训练联合盆底重建术治疗女性盆底功能障碍性疾病(PFD)的疗效及对炎症反应及应激反应的影响。方法:选择2019年1月~2021年1月期间我院收治的PFD患者200例,按乱数表法分为对照组(100例)和研究组(100例)。对照组患者接受盆底重建术治疗,研究组患者接受盆底肌肉康复训练联合盆底重建术治疗。观察两组治疗后的疗效及术后并发症发生情况,对比两组相关量表评分、炎症反应及应激反应指标。结果:研究组治疗后盆底功能影响问卷简表(PFIQ-7)、盆底不适调查表简表(PFDI-20)评分低于对照组(P<0.05)。研究组治疗后盆底Ⅰ类肌纤维肌电压、盆底Ⅱ类肌纤维肌电压高于对照组(P<0.05)。研究组治疗后白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)低于对照组(P<0.05)。研究组治疗后皮质醇(COR)、去甲肾上腺素(NE)、前列腺素E2(PGE2)低于对照组(P<0.05)。研究组术后并发症发生率低于对照组(P<0.05)。结论:盆底肌肉康复训练联合盆底重建术治疗PFD,可促进盆底功能恢复,减轻机体炎症反应及应激反应,降低术后并发症发生率。     

髋部肌锻炼联合盆底电刺激生物反馈对盆底功能障碍性疾病患者盆底功能及应激反应的影响

摘要 目的：探讨髋部肌锻炼联合盆底电刺激生物反馈对盆底功能障碍性疾病（PFD）患者盆底功能及应激反应的影响。方法：选取2021年1月-2022年12月在我院接受治疗的120例PFD患者作为研究对象,按随机数字表法分为对照组和观察组,每组各60例。对照组患者进行髋部肌锻炼,观察组患者在对照组的基础上联合盆底电刺激生物反馈治疗,观察分析两组患者盆底功能以及应激反应的变化。结果：两组治疗后观察组临床总有效率显著高于对照组（P＜0.05）;两组患者治疗后PFDI-20、PISQ-12及PFIQ-7评分显著优于治疗前,且观察组上述指标明显优于对照组（P＜0.05）;治疗后两组患者前盆底肌电位、动态肌张力、静态肌张力及收缩力较治疗前显著改善,且观察组相较于对照组上述指标显著提升（P＜0.05）;治疗后两组患者去甲肾上腺素（NE）、前列腺素（PGE₂）、皮质醇（COR）水平明显提高,且观察组明显优于对照组（P＜0.05）。结论：髋部肌锻炼联合盆底电刺激生物反馈使肌肉功能得到锻炼,提高了盆底肌张力水平,促进盆底功能的恢复和应激反应的提高,明显提高患者的生活质量。     

Evolution of the ischial spine and of the pelvic floor in the Hominoidea

Study of the pelvis in 143 different mammals reveals that in quadrupeds the ischial spines are barely noticeable and are located posteriorly near the sacrum. In humans, the ischial spines are prominent and more anteriorly located. As a consequence of their position and size, the ischial spines in humans become an obstacle to parturition. Herein a theory is proposed to account for what appears to be an incongruous development and orientation of the ischial spines in humans. The pelvic diaphragm is a vertical pelvic "wall" in tailed mammals and is composed of muscles involved mostly with the motion of the tail. In humans, the muscles of the pelvic diaphragm have a very different anatomical orientation. They form a horizontal pelvic "floor," and their functions are first to support the abdominopelvic organs and resist intra-abdominal pressure that is exerted from above, and second, as levator ani, to control the anal sphincter. In humans the muscles and fascias of the pelvic diaphragm are inserted on the ischial spines either directly or indirectly through the sacrospinous ligament and the tendinous arch of the pelvic fascia. The result is a medial pull on the ischial spines to produce a more rigid and narrower pelvic floor. An inconstant ossification center for the ischial spines make them more prominent. The backward tilt of the sacrum placed the bispinal line in a diameter position. Pongids and even fossil hominids occupy an intermediate position between tailed mammals and Homo sapiens. The present form of the pelvis in Homo sapiens may be determined by a significant genetic component but may also be partly acquired during childhood and adolescence.     

Dorsally derived netrin 1 provides an inhibitory cue and elaborates the 'waiting period' for primary sensory axons in the developing spinal cord

Dorsal root ganglion (DRG) neurons extend axons to specific targets in the gray matter of the spinal cord. During development, DRG axons grow into the dorsolateral margin of the spinal cord and projection into the dorsal mantle layer occurs after a ;waiting period' of a few days. Netrin 1 is a long-range diffusible factor expressed in the ventral midline of the developing neural tube, and has chemoattractive and chemorepulsive effects on growing axons. Netrin 1 is also expressed in the dorsal spinal cord. However, the roles of dorsally derived netrin 1 remain totally unknown. Here, we show that dorsal netrin 1 controls the correct guidance of primary sensory axons. During the waiting period, netrin 1 is transiently expressed or upregulated in the dorsal spinal cord, and the absence of netrin 1 results in the aberrant projection of sensory axons, including both cutaneous and proprioceptive afferents, into the dorsal mantle layer. Netrin 1 derived from the dorsal spinal cord, but not the floor plate, is involved in the correct projection of DRG axons. Furthermore, netrin 1 suppresses axon outgrowth from DRG in vitro. Unc5c(rcm) mutant shows abnormal invasion of DRG axons as observed in netrin 1 mutants. These results are the first direct evidence that netrin 1 in the dorsal spinal cord acts as an inhibitory cue for primary sensory axons and is a crucial signal for the formation of sensory afferent neural networks.     

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。     

Quantification of abdominal and pelvic floor muscle synergies in response to voluntary pelvic floor muscle contractions

The relative levels of pelvic floor muscle (PFM) activation and pressure generated by maximum voluntary PFM contractions were investigated in healthy continent women. The normal sequence of abdominal and PFM activation was determined.Fifteen women performed single and repeated maximum voluntary PFM contractions in supine, sitting and standing. PFM electromyographic (EMG) signals and associated intra-vaginal pressure data were recorded simultaneously. Surface EMG data were recorded from rectus abdominus (RA), external obliques (EO), internal obliques (IO) and transversus abdominus (TA).Abdominal and PFM EMG and intra-vaginal pressure amplitudes generated during voluntary PFM contractions were not different among the positions. Muscle activation sequence differed by position. In supine, EO activation preceded all other muscles by 27 ms (p = 0.043). In sitting, all of the muscles were activated simultaneously. In standing, RA and EO were activated 11 and 17 ms, respectively, prior to the PFMs and TA and IO were activated 10 and 12 ms, respectively, after the PFMs (p ≪ 0.001).The results suggest that women are able to perform equally strong PFM contractions in supine, sitting and standing, however the pattern of abdominal and PFM activation varies by position. These differences may be related to position-dependent urine leakage in women with stress incontinence.     

盆底电刺激对大鼠盆底肌肌肉、神经发育的形态学影响研究

目的:探讨与研究盆底电刺激对大鼠盆底肌肌肉、神经发育的形态学影响.方法:36只Wistar产后健康雌性大鼠分为对照组、模型组与刺激组,每组12只.模型组与刺激组都建立了压力性尿失禁模型,对照组不给予任何处理.建模后刺激组给予盆底电刺激,每3 d一次,持续治疗12d;模型组在建模后不给予任何治疗处理.结果:模型组与刺激组...     

基于经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效

摘要 目的：探讨经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效。方法：选择2020年9月至2022年9月我院收治的96例产后盆底功能障碍患者,根据随机数字表法将患者分为两组,对照组（48例）采用盆底肌锻炼治疗,研究组（48例）采用生物反馈电刺激联合盆底肌锻炼治疗。治疗前后采用经会阴实时三维超声检查,对比两组治疗前后的盆底功能障碍调查表（PFDI-20）、盆底障碍影响简易问卷7（PFIQ-7）评分、静息和Valsalva动作状态下的肛提肌超声参数。分析肛提肌超声参数与PFDI-20、PFIQ-7评分的相关性。结果：两组治疗后PFDI-20、PFIQ-7评分,静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积较治疗前降低（P＜0.05）,静息时肛提肌厚度较治疗前增加（P＜0.05）。研究组治疗后PFDI-20、PFIQ-7评分,静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积低于对照组（P＜0.05）,静息时肛提肌厚度大于对照组（P＜0.05）。静息和Valsalva状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积与PFDI-20、PFIQ-7评分呈正相关（P＜0.05）,静息状态肛提肌厚度与PFDI-20、PFIQ-7评分呈负相关（P＜0.05）。结论：经生物反馈电刺激联合盆底肌锻炼治疗后肛提肌裂孔大小较治疗前降低,肛提肌厚度较治疗前增加,且与PFDI-20、PFIQ-7评分改善有关,经会阴实时三维超声可客观、有效评价产后盆底功能障碍患者的治疗效果。     

电针阴部神经刺激疗法联合Kegel盆底康复训练对产后压力性尿失禁患者盆底肌力、尿流动力学和生活质量的影响

摘要 目的：探讨电针阴部神经刺激疗法联合Kegel盆底康复训练对产后压力性尿失禁（SUI）患者盆底肌力、尿流动力学和生活质量的影响。方法：选取2019年6月~2021年11月期间于我院就诊的产后SUI患者109例,按照入院就诊奇偶顺序分为两组,其中对照组54例,接受Kegel盆底康复训练,研究组55例,接受电针阴部神经刺激疗法联合Kegel盆底康复训练。对比两组疗效、漏尿量、尿失禁程度、盆底肌力、尿流动力学和生活质量。结果：研究组的临床总有效率高于对照组（P<0.05）。两组治疗后盆底肌肌力各指标（手测肌力和Ⅰ类肌纤维最大值、Ⅱ类肌纤维平均值）均升高,且研究组高于对照组（P<0.05）。两组治疗后漏尿量、尿失禁程度评分均下降,且研究组低于对照组（P<0.05）。两组治疗后尿流动力学相关指标[腹压漏尿点压（AL-PP）、最大尿流率（Qmax）和最大尿道闭合压力（MUCP）]均升高,且研究组高于对照组（P<0.05）。两组治疗后尿失禁生活质量量表（I-QOL）各维度（限制性行为、心理影响、社交活动受限）评分及总分均升高,且研究组高于对照组（P<0.05）。结论：电针阴部神经刺激疗法联合Kegel盆底康复训练可有效改善产后SUI患者的盆底肌肌力和尿失禁情况,减少漏尿量,同时可促进尿流动力学恢复,进而提高患者的生活质量。     

生物反馈联合电刺激在女性盆底功能障碍性疾病治疗中的临床应用

目的:分析生物反馈联合电刺激对女性盆底功能障碍性疾病(PFD)的治疗效果。方法:选择2011年1月至2016年3月我院收治的1000例PFD患者为研究对象,按随机数字表法分为实验组和对照组,每组各500例。实验组给予生物反馈联合电刺激,对照组给予功能性电刺激治疗。比较两组治疗前后盆底肌肉肌力分级的变化,测定盆底功能相关指标的改善及患者治疗前后排尿情况。结果:治疗后2组盆底肌力分级均呈明显上升趋势(Z=52.587,37.581;P0.001),且观察组改善效果优于对照组(Z=27.588,P0.001);治疗后实验组盆底肌肉肌力正常率高于对照组,差异有统计学意义(x~2=68.323,P0.05);治疗后实验组最大收缩压、持续收缩压提升幅度较大,膀胱颈移动度明显减小,与对照组各项指标对比差异有统计学意义(P0.05),且治疗后两组排尿情况均有所好转,实验组效果优于对照组(P0.05)。结论:生物反馈联合电刺激对女性PFD具有较好的效果,能提高患者盆底最大收缩压、持续收缩压,减小膀胱颈移动度,改善患者排尿功能。     

A shell finite element model of the pelvic floor muscles

The pelvic floor gives support to the organs in the abdominal cavity. Using the dataset made public in (Janda et al. J. Biomech. (2003) 36(6), pp. 749-757), we have reconstructed the geometry of one of the most important parts of the pelvic floor, the levator ani, using NURB surfaces. Once the surface is triangulated, the corresponding mesh is used in a finite element analysis with shell elements.Based on the 3D behavior of the muscle we have constructed a shell that takes into account the direction of the muscle fibers and the incompressibility of the tissue. The constitutive model for the isotropic strain energy and the passive strain energy stored in the fibers is adapted from Humphrey's model for cardiac muscles. To this the active behavior of the skeletal muscle is added.We present preliminary results of a simulation of the levator ani muscle under pressure and with active contraction. This research aims at helping simulate the damages to the pelvic floor that can occur after childbirth.     

生物反馈电刺激联合Kegel训练对产后盆底功能障碍性疾病患者盆底功能电生理指标和生活质量的影响

目的:观察生物反馈电刺激联合Kegel训练对产后盆底功能障碍性疾病(PFD)患者盆底功能电生理指标和生活质量的影响。方法:研究对象为2018年3月~2020年12月我院收治的80例产后PFD患者。采用双色球随机分组法将患者分为对照组(n=40)和研究组(n=40)。对照组给予Kegel训练,研究组给予生物反馈电刺激联合Kegel训练,两组均治疗8周。对比两组治疗8周后的疗效和尿失禁、盆底器官脱垂程度的改善情况。对比两组治疗前、治疗8周后的盆底功能电生理指标、日常生活质量和性生活质量。结果:治疗8周后,研究组的临床总有效率较对照组高(P<0.05)。治疗8周后,研究组I类肌纤维疲劳度、Ⅱ类肌纤维疲劳度、快肌最大肌电值及阴道动态压力均优于对照组(P<0.05)。研究组治疗8周后尿失禁、盆底器官脱垂程度的改善情况优于对照组(P<0.05)。治疗8周后,研究组盆底功能影响问卷简表(PIFQ-7)评分、盆腔器官脱垂-尿失禁性功能问卷(PISQ-12)评分均低于对照组(P<0.05)。结论:产后PFD患者采用生物反馈电刺激联合Kegel训练治疗疗效明确,可促进尿失禁、盆底器官脱垂程度情况及盆底功能改善,提高患者日常生活质量和性生活质量。     

Tissue Selective Androgen Receptor Modulators (SARMs) Increase Pelvic Floor Muscle Mass in Ovariectomized Mice

Stress urinary incontinence (SUI), a prevalent condition, is represented by an involuntary leakage of urine that results, at least in part, from weakened or damaged pelvic floor muscles and is triggered by physical stress. Current treatment options are limited with no oral therapies available. The pelvic floor is rich in androgen receptor and molecules with anabolic activity including selective androgen receptor modulators (SARMs) may serve as therapeutic options for individuals with SUI. In this study, two SARMs (GTx‐024 and GTx‐027) were evaluated in a post‐menopausal animal model in order to determine their effect on pelvic floor muscles. Female C57BL/6 mice were ovariectomized and their pelvic muscles allowed to regress. The animals were then treated with vehicle or doses of GTx‐024 or GTx‐027. Animal total body weight, lean body mass, and pelvic floor muscle weights were measured along with the expression of genes associated with muscle catabolism. Treatment with the SARMs resulted in a restoration of the pelvic muscles to the sham‐operated weight. Coordinately, the induction of genes associated with muscle catabolism was inhibited. Although a trend was observed towards an increase in total lean body mass in the SARM‐treated groups, no significant differences were detected. Treatment of an ovariectomized mouse model with SARMs resulted in an increase in pelvic floor muscles, which may translate to an improvement of symptoms associated with SUI and serves as the basis for evaluating their clinical use. J. Cell. Biochem. 118: 640–646, 2017. © 2016 The Authors. Journal of Cellular Biochemistry published by Wiley Periodicals, Inc.     

Adult neurogenesis and neuronal regeneration in the brain of teleost fish

Whereas adult neurogenesis appears to be a universal phenomenon in the vertebrate brain, enormous differences exist in neurogenic potential between “lower” and “higher” vertebrates. Studies in the gymnotiform fish Apteronotus leptorhynchus and in zebrafish have indicated that the relative number of new cells, as well as the number of neurogenic sites, are at least one, if not two, orders of magnitude larger in teleosts than in mammals. In teleosts, these neurogenic sites include brain regions homologous to the mammalian hippocampus and olfactory bulb, both of which have consistently exhibited neurogenesis in all species examined thus far. The source of the new cells in the teleostean brain are intrinsic stem cells that give rise to both glial cells and neurons. In several brain regions, the young cells migrate, guided by radial glial fibers, to specific target areas where they integrate into existing neural networks. Approximately half of the new cells survive for the rest of the fish’s life, whereas the other half are eliminated through apoptotic cell death. A potential mechanism regulating development of the new cells is provided by somatic genomic alterations. The generation of new cells, together with elimination of damaged cells through apoptosis, also enables teleost fish rapid and efficient neuronal regeneration after brain injuries. Proteome analysis has identified a number of proteins potentially involved in the individual regenerative processes. Comparative analysis has suggested that differences between teleosts and mammals in the growth of muscles and sensory organs are key to explain the differences in adult neurogenesis that evolved during phylogenetic development of the two taxa.     

三维超声技术对于评估压力性尿失禁女性患者盆底肌肉收缩及膀胱颈活动度的价值研究

摘要 目的：探讨三维超声技术对于评估压力性尿失禁（SUI）女性患者盆底肌肉收缩及膀胱颈活动度的价值。方法：选取2020年1月至2021年8月本院的收治的因产后SUI的女性患者60例作为观察组,另选择同期产后正常的女性受试者60例作为对照组,所有受试者均行经会阴三维超声检查。比较两组之间盆底肌肉收缩及膀胱颈活动度等相关指标的差异。结果：在静息状态和最大Valsalva状态下,观察组中盆膈裂孔前后径、左右径、肛提肌裂孔面积以及膀胱颈后角均显著大于对照组（P<0.05）,观察组尿道长度显著低于对照组（P<0.05）;而仅在最大Valsalva状态下,观察组的膀胱颈位置显著低于对照组（P<0.05）;此外观察组膀胱漏斗化所占比例显著高于对照组（P<0.05）。结论：三维超声技术可以清晰直观地显示女性盆底组织结构和功能,对于评估SUI女性患者盆底肌肉收缩及膀胱颈活动度具有一定的诊断价值,并为临床提供真实客观的影像学证据。     

电针神经刺激疗法联合盆底肌训练对早期宫颈癌广泛性全子宫切除术后患者尿潴留、膀胱功能和免疫功能的影响

摘要 目的：观察电针神经刺激疗法联合盆底肌训练在早期宫颈癌广泛性全子宫切除术后康复中的应用价值。方法：前瞻性收集我院2020年3月~2021年10月期间收治的早期宫颈癌广泛性全子宫切除术患者98例,采用随机数字表法分为研究组和对照组各49例,对照组患者指导其进行盆底肌训练,研究组患者则在盆底肌训练的基础上加以电针神经刺激疗法,对比两组尿潴留发生率以及膀胱功能、免疫功能、盆底功能恢复情况。结果：术后13周时评估结果显示,研究组的盆底肌综合肌力测定正常率高于对照组（P<0.05）。两组术后13周时初始尿意膀胱容量（FVS）、最大尿流率（MFR）、最大尿意膀胱容量（MVS）均较术后1周时升高,残余尿量（PVR）均较术后1周时下降,且研究组术后13周时FVS、MFR、MVS高于对照组,PVR低于对照组（P<0.05）。两组术后13周时血清免疫球蛋白A（IgA）、免疫球蛋白G（IgG）、免疫球蛋白M（IgM）、外周血T淋巴细胞CD3⁺、CD4⁺/CD8⁺均较术后1周时升高,且研究组高于对照组（P<0.05）。研究组尿潴留发生率4.08%（2/49）低于对照组22.45%（11/49）,差异有统计学意义（P<0.05）。结论：电针神经刺激疗法联合盆底肌训练可减少早期宫颈癌广泛性全子宫切除术后患者尿潴留的发生率,改善患者的盆底功能和膀胱功能,促进免疫功能恢复,效果较好。