首页|经会阴盆底超声联合剪切波弹性成像对女性压力性尿失禁康复治疗效果的评估价值

经会阴盆底超声联合剪切波弹性成像对女性压力性尿失禁康复治疗效果的评估价值

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[目的]探讨经会阴盆底超声联合剪切波弹性成像对女性压力性尿失禁(SUI)康复治疗效果的评估价值.[方法]选取2021年1月至11月在西安市中医医院诊治的70例女性SUI患者,所有患者均采用热敏灸联合Kegel训练治疗,在治疗前及治疗后8周进行临床量表评分及盆底超声成像,测量在静息状态下和Valsalva动作下膀胱尿道后角(PUVA)、肛提肌裂孔面积(LHA)、肛提肌裂孔横径(LHD)以及Valsalva动作下的膀胱颈移动度(BND),采用剪切波弹性成像测量静息状态下及最大缩肛状态下双侧耻骨直肠肌的厚度和杨氏模量平均值(Emean).[结果]SUI患者在热敏灸联合Kegel训练治疗8周后的总体有效率为88.57%(62/70);与治疗前比较,SUI患者治疗后尿失禁问卷简表(ICIQ-SF)评分降低(P<0.05),24 h尿失禁次数、1 h漏尿量减少(P<0.05).在静息状态下,SUI患者治疗后PUVA、LHD、LHA均较治疗前减少,差异均有统计学意义(P<0.05);在Val-salva动作下,SUI患者治疗后PUVA、BND、LHD、LHA均较治疗前减少,差异均有统计学意义(P<0.05).在静息状态下及最大缩肛状态下,SUI患者治疗前后双侧耻骨直肠肌厚度比较,差异无统计学意义(P>0.05);SUI患者治疗后双侧耻骨直肠肌Emean均较治疗前增大,差异有统计学意义(P<0.05).ICIQ-SF评分治疗前后差值与PUVA治疗前后差值呈正相关(r=0.67,P<0.05),ICIQ-SF评分治疗前后差值与最大缩肛状态下双侧耻骨直肠肌Emean治疗前后差值呈负相关(r=-0.58、-0.61,P<0.05).[结论]经会阴盆底超声联合弹性成像能动态定量评估女性SUI热敏灸联合Kegel训练后的疗效,为中医临床疗效评估提供客观、可靠依据.
The Evaluation Value of Three-dimensional Perineal Ultrasound Combined with Shear Wave Elas-tography in the Rehabilitation Treatment of Female Stress Urinary Incontinence
[Objective]To explore the evaluation value of transperineal pelvic floor ultrasound combined with shear wave elastography in the rehabilitation treatment of female stress urinary incontinence(SUI).[Methods]A total of 70 female SUI patients treated at the Xi'an Hospital of Traditional Chinese Medicine from January 2021 to November 2021 were selected.All patients were treated with thermosensitive moxibustion combined with Kegel training.Clinical scale scores and pelvic floor ultrasound imaging were performed before and 8 weeks after treat-ment.The bladder urethra posterior(PUVA),levator ani muscle hiatus area(LHA),levator ani muscle hiatus di-ameter(LHD),and bladder neck movement(BND)were measured under resting state and Valsalva action,The thickness and mean Youngs modulus(Emean)of bilateral puborectal muscles were measured using shear wave elas-tography in both resting and maximum anal contraction states.[Results]The overall effective rate of SUI patients after 8 weeks of thermal moxibustion combined with Kegel exercise treatment was 88.57%(62/70);Compared with before treatment,SUI patients showed a decrease in the Short Form Urinary Incontinence Questionnaire(ICIQ-SF)score after treatment(P<0.05),as well as a decrease in the frequency of 24-hour urinary incontinence and 1-hour urine leakage(P<0.05).In the resting state,the PUVA,LHD,and LHA of SUI patients decreased significantly after treatment compared to before treatment(P<0.05);Under Valsalva maneuver,SUI patients showed a statistically significant decrease in PUVA,BND,LHD,and LHA after treatment compared to before treatment(P<0.05).There was no statistically significant difference in the thickness of bilateral puborectal mus-cles between SUI patients before and after treatment in both resting and maximum anal contraction states(P>0.05);After treatment,the bilateral puborectal muscle Emean of SUI patients increased compared to before treat-ment,and the difference was statistically significant(P<0.05).The difference in ICIQ-SF score before and after treatment was positively correlated with the difference in PUVA score before and after treatment(r=0.67,P<0.05).The difference in ICIQ-SF score before and after treatment was negatively correlated with the difference in bilateral puborectal muscle Emean under maximum anal contraction state(r=-0.58,-0.61,P<0.05).[Conclu-sion]Perineal pelvic floor ultrasound combined with elastography can dynamically and quantitatively evaluate the therapeutic effect of female SUI thermal moxibustion combined with Kegel training,providing objective and relia-ble basis for clinical efficacy evaluation of traditional Chinese medicine.

Urinary Incontinence,Stress/RHUltrasonographyElasticity Imaging TechniquesTreatment Outcome

王荣荣、黄丽珍、康亚宁、安军明、何鑫

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西安市中医医院超声科,陕西 西安 710016

西安市中医医院针灸推拿康复科,陕西 西安 710016

西安交通大学第二附属医院超声科,陕西 西安 710004

尿失禁,压力性/康复 超声检查 弹性成像技术 治疗结果

陕西省重点研发计划一般项目

2023-YBSF-513

2024

医学临床研究
湖南省医学会

医学临床研究

影响因子:0.595
ISSN:1671-7171
年,卷(期):2024.41(6)
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