盆底功能障碍性疾病盆底解剖学静动态磁共振成像研究

目的:通过静动态磁共振成像(MRI)检查,比较女性盆底功能障碍性疾病(PFD)患者及正常女性盆底解剖结构改变,探讨盆底特定解剖学异常是否与PFD有关,为盆底重建手术提供客观依据。方法:选择2008年1月至2009年3月确诊为PFD患者46例为研究对象(PFD组),其中盆腔器官脱垂(POP)24例,压力性尿失禁(SUI)10例,POP合并SUI12例;同期选取正常女性14例为对照组。采用静动态MRI进行盆底扫描。比较两组髂尾肌、耻尾肌及耻直肌静动态面积、肛提肌裂孔静动态宽度、膀胱尿道后角、LH线及M线长度、肛提肌角等参数值的变化。结果:PFD组患者静态髂尾肌、耻尾肌、耻直肌的面积大于动态,肛提肌裂孔宽度在静态时小于动态(P<0.05)。而对照组以上参数值在静动态下无明显改变(P>0.05)。PFD组患者膀胱尿道后角、LH线、M线均大于对照组,肛提肌角小于对照组(P<0.05)。结论:MRI能清楚显示盆底解剖结构及功能,肛提肌的形态及功能异常与PFD有关。     

盆底功能障碍性疾病基础研究进展

女性盆底功能障碍性疾病（FPFD）是影响女性身心健康的常见慢性病之一,临床上以盆腔器官脱垂（POP）和压力性尿失禁（SUI）最为常见。目前的基础和临床研究表明,各种病因造成的盆底肌肉损伤和盆底支持组织相关蛋白代谢异常是FPFD的主要发病机制。其中,妊娠和绝经是引起盆底肌肉损伤的主要原因;而盆底支持组织胶原蛋白代谢异常与转化生长因子β（TGF-β）、核心蛋白聚糖（DN）、基质金属蛋白酶（MMPs）及其组织抑制剂（TIMPs）有关,弹性蛋白的代谢异常则与赖氨酰氧化酶（LOX）和Fubilin蛋白相关。就盆底肌肉损伤和盆底支持组织调节相关因素的基础研究新进展进行综述,以期加深医务工作者对FPFD的理解,为临床治疗提供参考依据。     

Pelvic Floor Exercises During and After Pregnancy: A Systematic Review of Their Role in Preventing Pelvic Floor Dysfunction

Objective: To review the literature on the origin, anatomical rationale, techniques, and evidence-based effectiveness of peripartum pelvic floor exercises (PFEs) in the prevention of pelvic floor problems including urinary and anal incontinence, and prolapse.Data Sources: Literature was reviewed for background information. MEDLINE, EMBASE, CINAHL, and proceedings of scientific meetings were searched for evidence-based data. A comprehensive literature search was performed to find all studies that involved the use of antepartum and/or postpartum PFEs. For the MEDLINE (1966 to 2002) and CINAHL (1980 to 2002) searches, the following key words were used: urinary incontinence (prevention and control, rehabilitation, therapy), fecal incontinence, exercise or exercise therapy, Kegel, muscle contraction, muscle tonus, muscle development, pelvic floor, pregnancy, puerperium, puerperal disorders. For the EMBASE (1980 to 2002) search, the following key words were used: micturition disorder (prevention, rehab, disease management, therapy), fecal incontinence, labour complication, pregnancy disorder, puerperal disorder, antepartum care, pregnancy, kinesiotherapy, exercise, pelvic floor, bladder. A manual search was performed of available abstracts presented at the annual scientific meetings of the International Continence Society (1997, 1999 to 2002), American Urogynecologic Association (1997 to 1998, 2000 to 2002), and International Urogynecological Association (1997, 1999 to 2002). Twelve studies evaluating the role of antepartum PFE were found, of which 3 randomized controlled trials (RCTs) comparing PFEs for the prevention of urinary incontinence to controls were included. Twelve studies evaluating postpartum PFEs for prevention of urinary incontinence were reviewed, of which 4 RCTs were included. Five studies evaluating postpartum PFEs for the prevention of anal incontinence were reviewed, of which 4 RCTs were included. Participants in the studies were primiparous women.Data Tabulation and Integration: Data were extracted using a standardized collection form. Quality of the data was evaluated using the Jadad scale. Where possible, a meta-analysis was conducted using a random effect model. Heterogeneity between trials was assessed and sensitivity analyses were performed.Results: Antepartum PFEs, when used with biofeedback and taught by trained health care personnel, using a conservative model, does not result in significant short-term (3 months) decrease in postpartum urinary incontinence, or pelvic floor strength. Postpartum PFEs, when performed with a vaginal device providing resistance or feedback, appear to decrease postpartum urinary incontinence and to increase strength. Reminder and motivational systems to perform “Kegel” exercises are ineffective in preventing postpartum urinary incontinence. Postpartum PFEs do not consistently reduce the incidence of anal incontinence.Conclusion: Postpartum PFEs appear to be effective in decreasing postpartum urinary incontinence. Data regarding the effect of PFEs on prevention of anal incontinence are lacking, and also on its prevention of prolapse.     

产后盆底功能障碍性疾病与盆底肌收缩力及其相关因素分析

目的:探讨产后盆底功能障碍性疾病(PFD)与盆底肌收缩力的关系及其相关因素。方法:选择产后42~60天有产后尿失禁(UI)或盆腔器官脱垂(POP)的妇女为研究组(102例),其中UI患者66例(UI组),POP患者36例(POP组);另选择同期产后复查的正常产妇100例为对照组。对研究组和对照组的一般情况进行问卷调查,并采用肌电图描记法对UI组、POP组和对照组的盆底肌力进行评估。结果:1研究组的年龄、分娩前体重指数(BMI)、新生儿体重、阴道分娩率及有腹压增高史率明显高于对照组(P0.05;P0.01)。2研究组肌电图持续收缩值和快速收缩值均明显低于对照组(P0.01)。3研究组中UI组的快速收缩值明显低于POP组和对照组(P0.01),研究组中POP组的持续收缩值明显低于UI组和对照组(P0.01)。结论:产后PFD的发生可能与年龄、分娩前BMI、新生儿体重、阴道分娩等因素有关;产后PFD与盆底肌收缩力下降有关,其中POP可能与Ⅰ类肌力下降有关,而UI可能与Ⅱ类肌力下降有关。     

葛根在盆底功能障碍性疾病治疗中的作用及其机制

目的:研究葛根在盆底韧带组织中对Ⅰ型、Ⅲ型胶原蛋白及弹性蛋白表达的影响,探讨其在盆底功能障碍性疾病(pelvic floor dysfunction,PFD)治疗中的作用及可能机制。方法:选择2010年12月—2012年11月绝经后行阴式全子宫切除术的PFD患者60例。根据盆腔器官脱垂定量分度法(POP-Q)评分,Ⅰ~Ⅱ度患者为轻度者(30例),Ⅲ~Ⅳ度患者为重度者(30例)。将轻度者和重度者随机分配,术前给予葛根治疗60 d者为用药组(30例),其中Ⅰ~Ⅱ度15例,Ⅲ~Ⅳ度15例;未使用任何外源性雌激素患者为对照组(30例),其中Ⅰ~Ⅱ度15例,Ⅲ~Ⅳ度15例。术中取宫骶韧带组织,行苏木素-伊红(HE)染色及Weigert染色在光镜下观察比较胶原蛋白及弹性蛋白的形态,再采用免疫组化二步法和图像分析检测Ⅰ型、Ⅲ型胶原蛋白及弹性蛋白的表达情况。结果:1韧带组织在光镜下HE染色及Weigert染色可见胶原蛋白及弹性蛋白表达,且用药组比对照组两者染色均更深、更均匀,数量更丰富,分布更密集。2对照组中轻度者的韧带组织中Ⅰ型、Ⅲ型胶原蛋白及弹性蛋白的表达率均高于重度者(P0.01)。3用药组中轻度者和重度者的韧带组织中Ⅰ型、Ⅲ型胶原蛋白及弹性蛋白的表达率均高于对照组(P0.01)。结论:葛根可通过增加盆底组织细胞外基质中作为主要成分的胶原蛋白和弹性蛋白的含量,增强盆底结缔组织的强度,从而能改善PFD的症状,为葛根作为治疗PFD的有效药物提供了可能的理论依据。     

Assessment of treatment outcomes of interstitial cystitis with hydrodistention and bladder training by O'Leary-Sant Interstitial Cystitis Symptom and Problem Indices

Objective

To investigate whether the O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI) is efficacy measure tool for interstitial Cystitis (IC) treatment with hydrodistention (HD) and bladder training (BT).