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女性压力性尿失禁患者MRI表现特征

作者:周艳梅1 罗穗豫2 郝 凯3

所属单位:1.河南省人民医院省直第一医院妇 产科 (河南 郑州 450000) 2.河南省人民医院妇产科 (河南 郑州 450000) 3.郑州人民医院影像科 (河南 郑州 450000)

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摘要

目的 分析女性压力性尿失禁MRI 影像学特征。方法 回顾分析我院32例压 力性尿失禁女性患者临床资料,作为观察 组,患者均予以闭孔尿道吊带术治疗, 同时以20例无压力性尿失禁的患者为对照 组,研究对象均进行MRI检测,记录两组 对象的尿道括约肌形态变化,治疗1周后 进行MRI检查,分析所有研究对象的尿道 括约肌、膀胱尿道后角及尿道倾斜角的变 化情况,统计膀胱漏斗阳性发生率。结 果 静息状态下观察组尿道中段外括约肌 厚度(2.24±0.45)mm,显著低于对照组 (2.73±0.56)mm(P<0.05);静息状态下功 能尿道长度为(2.71±0.41)cm,显著低于 对照组(2.96±0.47)cm(P<0.05),屏气用 力状态下功能尿道长度两者的功能尿道长 度无统计学意义(P<0.05);静息状态及屏 气用力状态下,观察组的膀胱尿道后角、 尿道倾斜角均显著高于对照组(P<0.05), 观察组18例膀胱漏斗阳性,且在屏气状态 下更为明显;但观察组经手术治疗后,各 指标均与对照组无统计学意义(P<0.05)。 结论 MRI能有效反映压力性尿失禁患者尿 道周围支持结构及尿道活动性等变化,可 用于女性压力性尿失禁的诊断及手术疗效 评估。

Objective To analyze the MRI findings of stress urinary incontinence (SUI) in female. Methods The clinical data of 32 female patients with SUI in the hospital were analyzed retrospectively. They were included into the observation group and were treated by transobturator supraubc arch sling. Another 20 patients without SUI were included in the control group. All subjects were examined by MRI, and the morphological changes of the urethral sphincter in the two groups were recorded. The MRI test was performed after 1 week of treatment. The changes of urethral sphincter, posterior urethra-vesical angle and urethral inclination angle were analyzed, and the incidence rate of bladder funnel was analyzed statistically. Results The resting-state thickness of external sphincter of the middle urethra and urethral length in the observation group were significantly smaller than those in the control group [(2.24±0.45)mm, (2.71±0.41)cm vs (2.73±0.56) mm, (2.96±0.47) cm] (P<0.05). There was no statistically significant difference in functional urethral length between the two groups under breath holding state and forcing state (P<0.05). The posterior urethra-vesical angle and urethral inclination angle in the observation group were significantly larger than those in the control group under breath holding state and forcing state (P<0.05). There were 18 cases of positive bladder funnel in the observation group, and they were more obvious under the breath holding state. After operation, there was no significant difference between the two groups in the indexes (P<0.05). Conclusion MRI can reflect the changes of urethral support structure and urethral mobility in patients with SUI.

【关键词】压力性尿失禁;磁共振;尿道 括约肌;解剖与组织学;诊断 成像;治疗

【中图分类号】R69;R44

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2019.02.028

前言

压力性尿失禁(Stress urinary incontinence,SUI)属盆底功能 障碍,以中老年女性为主,患者在打喷嚏、咳嗽或运动时,因腹内压 增高出现不自主尿液流出,严重影响患者生活质量[1]。治疗SUI的方法 众多,但远期治疗效果仍不理想,分析其原因,除治疗方法不适用于 该患者外,缺乏全面有效的尿道评估也是关键问题[2]。引起SUI的病理 机制较为复杂,尿道周围支持韧带、肌肉或筋膜薄弱引起的尿道高活 动性、支配控尿组织结构的神经系统障碍等,均可引起SUI[3]。尿道外 括括约肌对抵抗突发压力增高起着主要作用,而尿道中段是外括约肌 最后处,以增高尿道闭合压作用为主,可观察尿道括约肌形态,判断 患者SUI严重程度[4]。因盆底结构较为复杂,与CT、尿道造影等检查方 法比较,MRI对软组织对比度高、放射线剂量大等优点,故本研究将其 用于临床诊断,取得结果如下。