女性壓力性尿失禁應(yīng)用TVT-O治療術(shù)中超聲參數(shù)分析
發(fā)布時(shí)間：2019-03-18 19:20
【摘要】：目的：隨著診療技術(shù)的不斷更新發(fā)展,以及女性患者對(duì)疾病本身認(rèn)識(shí)和對(duì)生活質(zhì)量的要求不斷提高,在臨床上工作中女性壓力性尿失禁患者越來(lái)越多見(jiàn),就診率的提高,更要求我們有比較系統(tǒng)的診治體系�，F(xiàn)在臨床上對(duì)SUI患者的治療,輕度主要以藥物、鍛煉等保守措施進(jìn)行醫(yī)治,而對(duì)于中重度患者常采取外科手術(shù)以達(dá)到緩解或治愈。手術(shù)治療,是我們對(duì)中重度SUI患者在臨床上療效較為肯定的治療方式,TVT-O術(shù)式的出現(xiàn),成為我們臨床上一個(gè)較好的手術(shù)方式,此手術(shù)較之前的TVT或TOT手術(shù)更減小了術(shù)中對(duì)膀胱或其他腹內(nèi)臟器的損傷,但是因?yàn)闊o(wú)特殊的參數(shù),在術(shù)中對(duì)患者進(jìn)行的手術(shù)操作大部分是憑借手術(shù)醫(yī)師長(zhǎng)期的經(jīng)驗(yàn),使用咳嗽-漏尿等實(shí)驗(yàn)對(duì)吊帶放置的松緊程度進(jìn)行大致的判斷,以便對(duì)術(shù)后的恢復(fù)情況進(jìn)行預(yù)測(cè)和評(píng)估。我們的研究是對(duì)SUI患者行經(jīng)陰道閉孔無(wú)張力尿道中段懸吊術(shù)(Tension-free vaginal tape-obturator, TVT-O),并應(yīng)用經(jīng)會(huì)陰超聲來(lái)觀察術(shù)中盆腔的膀胱、尿道等情況實(shí)時(shí)圖像,同時(shí)對(duì)TVT-O手術(shù)前后膀胱和尿道超聲學(xué)參數(shù)進(jìn)行分析并和對(duì)照組數(shù)據(jù)進(jìn)行比較。 方法：本實(shí)驗(yàn)設(shè)置SUI組21例和對(duì)照組17例,SUI組選擇在2012年2月——2014年2月在我院因壓力性尿失禁行TVT-O術(shù)的女性患者,而對(duì)照組選擇健康的體檢人群。根據(jù)下文中的詳細(xì)入組條件,對(duì)入組的人群進(jìn)行嚴(yán)格挑選,在年齡、孕次、產(chǎn)次、體重指數(shù)無(wú)統(tǒng)計(jì)學(xué)差異的條件下進(jìn)行我們的研究。術(shù)前對(duì)兩個(gè)研究組的人員分別進(jìn)行評(píng)估,對(duì)于入選實(shí)驗(yàn)的人員進(jìn)行一般檢查和超聲檢查。被研究對(duì)象取截石位,預(yù)設(shè)膀胱容量為300ml,在靜息和Valsalva狀態(tài)下用超聲對(duì)盆腔內(nèi)器官和解剖結(jié)構(gòu)進(jìn)行觀察,以測(cè)量膀胱頸活動(dòng)度、膀胱尿道后角、吊帶角度和尿道角等相關(guān)參數(shù)。對(duì)SUI組的患者還需進(jìn)行尿動(dòng)力學(xué)、指壓實(shí)驗(yàn)等,TVT-O術(shù)后重復(fù)測(cè)量以上數(shù)值。最后對(duì)所得數(shù)值分別進(jìn)行對(duì)比分析,即SUI組手術(shù)前后、SUI組術(shù)前和對(duì)照組以及SUI組術(shù)后和對(duì)照組分別進(jìn)行對(duì)照研究,以判斷其對(duì)手術(shù)效果的影響。 結(jié)果：對(duì)所得到的超聲參數(shù)使用SPSS應(yīng)用t檢驗(yàn)進(jìn)行比較,通過(guò)實(shí)驗(yàn)數(shù)據(jù)及計(jì)算結(jié)果可以看出,TVT-O術(shù)后的膀胱頸活動(dòng)度和膀胱尿道后角和術(shù)前相比均減小(p0.001),但是和對(duì)照組的超聲參數(shù)相比無(wú)統(tǒng)計(jì)學(xué)差異(p0.05),而尿道角的統(tǒng)計(jì)結(jié)果和前兩個(gè)數(shù)值相反,術(shù)后的超聲參數(shù)和術(shù)前參數(shù)相比是增大的。SUI組與對(duì)照組的參數(shù)是有統(tǒng)計(jì)學(xué)意義的,而SUI組在術(shù)后和對(duì)照組的參數(shù)是無(wú)統(tǒng)計(jì)學(xué)意義。在術(shù)前,SUI組患者的膀胱頸活動(dòng)度和膀胱尿道后角和對(duì)照組相比均較大。 結(jié)論：中、重度壓力性尿失禁的女性患者使用TVT-O手術(shù)在臨床上有著較好的療效,且手術(shù)操作相對(duì)便捷,恢復(fù)較快,不良并發(fā)癥較少。尿道的高活動(dòng)性是女性壓力性尿失禁發(fā)病機(jī)制之一。超聲在術(shù)中對(duì)膀胱和尿道的參數(shù)及TVT-O吊帶的定位發(fā)揮重要作用。術(shù)中的超聲參數(shù)可作為TVT-O吊帶的位置參考。
[Abstract]:Objective: With the continuous development of the diagnosis and treatment technology, as well as the improvement of the requirement of the female patients to the disease itself and the quality of life, the patients with stress urinary incontinence are more and more common in the clinical work, and the rate of the visit is increased. We are more demanding that we have a system of diagnosis and treatment of the system. The treatment of the SUI patients is now clinically indicated, and the mild is mainly treated by conservative measures such as medicine, exercise and the like, and the surgical operation is often taken for moderate and severe patients to achieve the remission or cure. Surgical treatment is a more positive treatment for patients with moderate to severe SUI, and the occurrence of TVT-O operation is a good surgical method in our clinical practice. The previous TVT or TOT procedure has reduced the damage to the bladder or other internal organs in the operation. However, because there is no special parameter, most of the operation performed by the patient during the operation is based on the experience of the surgeon for a long time, and the degree of tightness of the hanging strip is judged by using the experiments such as cough and urine leakage, so as to predict and evaluate the postoperative recovery. Our study was to apply transvaginal closed-cell suspension (TVT-O) to SUI patients without tension-free vaginal tape-obtuator (TVT-O), and to apply transperineal ultrasound to observe real-time images of the bladder, urethra, etc. of the pelvis. At the same time, the parameters of the bladder and the urethra before and after TVT-O operation were analyzed and compared with the control data. Methods: In this experiment,21 cases of SUI group and 17 cases of control group were set. The group of SUI was selected to be a female patient with TVT-O operation in our hospital from February to February,2014. The population of the enrolled group was selected strictly according to the detailed entry conditions set out below, and our study was conducted under the conditions of age, pregnancy, birth, and body mass index without statistical difference. Study. The personnel of the two study groups were evaluated before operation, and the general and ultrasonic tests were performed on the personnel selected for the experiment. The internal organs and the anatomical structure of the pelvic cavity were observed under the condition of resting and Valsalva in order to measure the range of the bladder neck, the posterior angle of the urinary bladder, the angle of the sling and the angle of the urethra. The number of patients in the SUI group should also be subject to urodynamics, finger pressure test, etc., and the above number should be repeated after TVT-O. The results were compared with the control group before and after the operation of the SUI group and the control group after the operation of the SUI group and the control group. Results: The obtained ultrasonic parameters were compared with the t-test of the SPSS. The results of the experimental data and the calculation results showed that the bladder neck motion and the posterior angle of the bladder after TVT-O were all decreased compared with that of the pre-operation (p0.05). 01), but no statistical difference (p0.05) was found in the ultrasound parameters of the control group, whereas the statistical results for the urethral angle and the first two values were opposite, and the postoperative ultrasound parameters were compared to the pre-operative parameters The parameters of the SUI group and the control group were statistically significant and the parameters of the SUI group and the control group were not statistically significant. Study significance. Before the operation, the bladder neck motion of the patients in the SUI group and the posterior angle of the urinary bladder were compared with the control group. Conclusion: The use of TVT-O in female patients with moderate and severe stress urinary incontinence has a good curative effect in clinic, and the operation is relatively convenient, and the recovery is fast and bad. Low complications. The high mobility of the urethra is a female stress urinary incontinence. One of the mechanisms of the disease mechanism. The parameters of the bladder and the urethra and the positioning of the TVT-O sling during the operation The intraoperative ultrasound parameters can be used as TVT-O sling
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699
本文編號(hào)：2443154
[Abstract]:Objective: With the continuous development of the diagnosis and treatment technology, as well as the improvement of the requirement of the female patients to the disease itself and the quality of life, the patients with stress urinary incontinence are more and more common in the clinical work, and the rate of the visit is increased. We are more demanding that we have a system of diagnosis and treatment of the system. The treatment of the SUI patients is now clinically indicated, and the mild is mainly treated by conservative measures such as medicine, exercise and the like, and the surgical operation is often taken for moderate and severe patients to achieve the remission or cure. Surgical treatment is a more positive treatment for patients with moderate to severe SUI, and the occurrence of TVT-O operation is a good surgical method in our clinical practice. The previous TVT or TOT procedure has reduced the damage to the bladder or other internal organs in the operation. However, because there is no special parameter, most of the operation performed by the patient during the operation is based on the experience of the surgeon for a long time, and the degree of tightness of the hanging strip is judged by using the experiments such as cough and urine leakage, so as to predict and evaluate the postoperative recovery. Our study was to apply transvaginal closed-cell suspension (TVT-O) to SUI patients without tension-free vaginal tape-obtuator (TVT-O), and to apply transperineal ultrasound to observe real-time images of the bladder, urethra, etc. of the pelvis. At the same time, the parameters of the bladder and the urethra before and after TVT-O operation were analyzed and compared with the control data. Methods: In this experiment,21 cases of SUI group and 17 cases of control group were set. The group of SUI was selected to be a female patient with TVT-O operation in our hospital from February to February,2014. The population of the enrolled group was selected strictly according to the detailed entry conditions set out below, and our study was conducted under the conditions of age, pregnancy, birth, and body mass index without statistical difference. Study. The personnel of the two study groups were evaluated before operation, and the general and ultrasonic tests were performed on the personnel selected for the experiment. The internal organs and the anatomical structure of the pelvic cavity were observed under the condition of resting and Valsalva in order to measure the range of the bladder neck, the posterior angle of the urinary bladder, the angle of the sling and the angle of the urethra. The number of patients in the SUI group should also be subject to urodynamics, finger pressure test, etc., and the above number should be repeated after TVT-O. The results were compared with the control group before and after the operation of the SUI group and the control group after the operation of the SUI group and the control group. Results: The obtained ultrasonic parameters were compared with the t-test of the SPSS. The results of the experimental data and the calculation results showed that the bladder neck motion and the posterior angle of the bladder after TVT-O were all decreased compared with that of the pre-operation (p0.05). 01), but no statistical difference (p0.05) was found in the ultrasound parameters of the control group, whereas the statistical results for the urethral angle and the first two values were opposite, and the postoperative ultrasound parameters were compared to the pre-operative parameters The parameters of the SUI group and the control group were statistically significant and the parameters of the SUI group and the control group were not statistically significant. Study significance. Before the operation, the bladder neck motion of the patients in the SUI group and the posterior angle of the urinary bladder were compared with the control group. Conclusion: The use of TVT-O in female patients with moderate and severe stress urinary incontinence has a good curative effect in clinic, and the operation is relatively convenient, and the recovery is fast and bad. Low complications. The high mobility of the urethra is a female stress urinary incontinence. One of the mechanisms of the disease mechanism. The parameters of the bladder and the urethra and the positioning of the TVT-O sling during the operation The intraoperative ultrasound parameters can be used as TVT-O sling
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699
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