Transperineal color Doppler ultrasound parameters of women with postpartum stress urinary incontinence and effect of pelvic floor biofeedback electrical stimulation
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摘要:
目的 采用经会阴彩色多谱勒超声评估女性产后压力性尿失禁(SUI)患者盆底生物电反馈刺激治疗的盆底超声参数特征及效果。 方法 选择2019年1月~2021年10月本院收治的120例产后SUI女性作为研究对象，按随机数字表法分为治疗组与对照组，60例/组。对照组予常规健康教育和产后保健，治疗组予盆底生物电反馈刺激治疗。于治疗前及治疗后3月对两组患者进行1 h尿垫试验、盆底超声参数测量和生活质量问卷评估，比较两组治疗有效率、治疗前后膀胱残余尿量、漏尿次数及漏尿量。 结果 治疗组总有效率较对照组更高(95.00% vs 81.67%，P < 0.05)；治疗后，两组膀胱颈移动度、膀胱最低点位置、膀胱后角、肛提肌裂孔面积、膀胱残余尿量、漏尿次数、漏尿量、国际尿失禁咨询委员会尿失禁问卷简表(ICIQ-SF)及尿失禁影响问卷简表(IIQ-7)评分较治疗前降低，肛提肌厚度升高(P < 0.05)；治疗组治疗后膀胱颈移动度、膀胱最低点位置、膀胱后角、肛提肌裂孔面积、膀胱残余尿量、漏尿次数、漏尿量、ICIQ-SF及IIQ-7评分低于对照组，肛提肌厚度高于对照组(P < 0.05)。 结论 女性产后SUI患者采用盆底生物电反馈刺激治疗可提升疗效，改善患者盆底功能，减轻SUI症状；采用经会阴彩色多谱勒超声检查能为SUI患者盆底功能损伤和康复提供客观评价指标。 Abstract:Objective To evaluate the transperineal color Doppler ultrasound parameters of women with postpartum stress urinary incontinence (SUI), and the effect of pelvic floor biofeedback electrical stimulation. Methods A total of 120 women with postpartum SUI admitted to the hospital from January 2019 to October 2021 were selected. They were divided into treatment group and control group by random number table method, with 60 cases in each group. The control group was treated with routine health education and postpartum health care. The treatment group was treated with biofeedback electrical stimulation. 1-hour pad test was conducted, pelvic floor ultrasound parameters were measured, and quality of life was evaluated before treatment and after 3 months of treatment. The treatment response rate, residual urine volume before and after treatment, frequency and volume of urine leakage were compared between the two groups. Results The total response rate of treatment group was higher than control group (95.00% vs 81.67%, P < 0.05). After treatment, the bladder neck descent, bladder lowest descent, retrovesical angle, levator hiatus area, residual urine volume, frequency and volume of urine leakage, the International Consultation Incontinence Questionnaire Short-Form (ICIQ-SF) scores and the Incontinence Impact Questionnaire (IIQ-7) scores were reduced, while levator thickness was increased in the two groups (P < 0.05). After treatment, bladder neck descent, bladder lowest descent, retrovesical angle, levator hiatus area, residual urine volume, frequency and volume of urine leakage, the ICIQ-SF scores and IIQ-7 scores of treatment group were smaller/lower than those of the control group, and levator thickness was larger than that of the control group (P < 0.05). Conclusion Applying pelvic floor biofeedback electrical stimulation to women with postpartum SUI can improve the curative effect and pelvic floor function, relieve symptoms of SUI. Transperineal color Doppler ultrasonography can provide objective evaluation indicators for pelvic floor function damage and rehabilitation in SUI patients. -
图 1 某女性患者超声参数测量示意图
A、B: 分别为静息、Valsalva动作正中矢状面，测量BND(a+b)、BLD(a); C: Valsalva动作正中矢状面RVA的测量(α); D: Valsalva动作三维成像时LHA的测量.
Figure 1. Schematic diagrams of ultrasound parameter measurement of a female patient.
表 1 两组患者一般资料比较
Table 1. Comparison of general data between the two groups (n=60, Mean±SD)
组别 年龄(岁) BMl(kg/m2) 分娩孕周(周) 第二产程延长[n(%)] 受教育时间(年) 治疗组 31.10±5.29 22.34±3.27 39.12±1.56 23(38.33) 12.35±3.19 对照组 30.97±5.14 21.49±3.50 38.58±2.00 25(41.67) 12.74±3.51 t/χ2 0.137 1.375 1.649 0.139 0.392 P 0.892 0.172 0.102 0.709 0.696 
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表 2 两组患者的疗效比较
Table 2. Comparison of curative effect between the two groups [n=60, n(%)]
组别 治愈 好转 无效 总有效 治疗组 32(53.33) 25(41.67) 3(5.00) 57(95.00) 对照组 22(36.67) 27(45.00) 11(18.33) 49(81.67) χ2 5.175 P 0.023
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表 3 两组治疗前后盆底超声参数比较
Table 3. Comparison of pelvic floor ultrasound parameters between the two groups before and after treatment (n=60, Mean±SD)
时间 组别 BND(mm) BLD(mm) RVA(°) T(mm) LHA(cm2) 治疗前 治疗组 33.85±5.17 27.35±7.10 144.35±12.30 10.75±2.21 29.26±4.61 对照组 34.19±5.32 27.69±6.88 145.53±12.36 10.23±2.00 30.53±4.13 t 0.355 0.266 0.524 1.351 1.525 P 0.723 0.790 0.601 0.179 0.130 治疗后 治疗组 27.96±4.07* 21.23±5.68* 124.59±10.12* 15.41±4.43* 21.63±4.35* 对照组 33.57±4.98* 25.24±6.17* 132.42±11.54* 13.24±3.70* 25.59±4.41* t 6.756 3.704 3.952 2.912 4.952 P < 0.001 < 0.001 < 0.001 0.004 < 0.001 *P < 0.05 vs同组治疗前. BND: 膀胱颈移动度; BLD: 膀胱最低点位置; RVA: 膀胱后角; T: 肛提肌厚度; LHA: 肛提肌裂孔面积.
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表 4 两组治疗前后膀胱残余尿量、漏尿次数及漏尿量比较
Table 4. Comparison of residual urine volume, urinary leakage frequency and leakage volume between the two groups before and after treatment (n=60, Mean±SD)
时间 组别 膀胱残余尿量(mL) 漏尿次数(d) 漏尿量(mL) 治疗前 治疗组 69.58±20.14 5.75±1.23 10.95±2.69 对照组 68.71±21.25 6.09±1.10 10.53±2.71 t 0.230 1.596 0.852 P 0.818 0.113 0.396 治疗后 治疗组 16.31±5.07* 0.98±0.31* 1.07±0.26* 对照组 28.19±6.65* 1.67±0.59* 1.79±0.43* t 11.004 8.019 11.099 P < 0.001 < 0.001 < 0.001 *P < 0.05 vs同组治疗前.
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表 5 两组治疗前后ICIQ-SF、IIQ-7评分比较
Table 5. Comparison of ICIQ- SF scores and IIQ- 7 scores between the two groups before and after treatment (point, n=60, Mean±SD)
时间 组别 ICIQ-SF评分 IIQ-7评分 治疗前 治疗组 12.56±2.60 10.67±2.38 对照组 12.70±2.49 10.29±2.46 t 0.301 0.860 P 0.764 0.392 治疗后 治疗组 3.09±0.81* 1.78±0.56* 对照组 4.27±1.12* 2.43±0.60* t 6.613 6.135 P < 0.001 < 0.001 *P < 0.05 vs同组治疗前. ICIQ-SF: 国际尿失禁咨询委员会尿失禁问卷简表; IIQ-7: 尿失禁影响问卷简表.
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