CAJ | 학술논문

目的：利用超声观察子宫切除术后女性膀胱和尿道静态及动态的形态变化，从而评估其解剖结构的改变。方法：收集2012年6月-2013年3月于广东省人民医院进行检查的、因子宫病变行全子宫切除术的术后患者136例，根据手术方式及切除范围将其分为3组：A组为腹腔镜辅助的阴式子宫切除术者29例，B组为开腹子宫切除术者41例，C组为开腹广泛子宫切除术者66例。另将无盆腔或腹部手术史者50例设为对照组。4组均行经腹及经会阴超声检查，测量参数包括静止期及压力期（Valsalva呼吸时）膀胱颈移动度（UVJ-M）、膀胱尿道后角（PUVA）及膀胱残余尿量。结果：C组患者术后膀胱及尿道等下尿路解剖结构发生明显改变，UVJ-M、PUVA-r、PUVA-s等参数与对照组比较差异均有统计学意义（均P＜0.01）。 B组患者术后膀胱及尿道等下尿路解剖结构也发生变化，改变程度较C组小，UVJ-M参数与对照组、C组相比差异有统计学意义（均P＜0.01），PUVA-r、PUVA-s等参数与对照组相比差异无统计学意义（均P＞0.05）。 A组患者术后膀胱及尿道等下尿路解剖结构无明显改变，UVJ-M、PUVA-r、PUVA-s等参数与对照组比较差异均无统计学意义（均P＞0.05）。结论：①超声可对子宫全切术后女性膀胱及尿道形态学变化进行实时观察、客观评价解剖结构的改变。②子宫切除的3种手术方式中以开腹广泛子宫切除术对女性膀胱及尿道解剖结构改变最大，腹腔镜辅助的阴式子宫切除术则几乎没有影响。
목적：이용초성관찰자궁절제술후녀성방광화뇨도정태급동태적형태변화，종이평고기해부결구적개변。방법：수집2012년6월-2013년3월우광동성인민의원진행검사적、인자궁병변행전자궁절제술적술후환자136례，근거수술방식급절제범위장기분위3조：A조위복강경보조적음식자궁절제술자29례，B조위개복자궁절제술자41례，C조위개복엄범자궁절제술자66례。령장무분강혹복부수술사자50례설위대조조。4조균행경복급경회음초성검사，측량삼수포괄정지기급압력기（Valsalva호흡시）방광경이동도（UVJ-M）、방광뇨도후각（PUVA）급방광잔여뇨량。결과：C조환자술후방광급뇨도등하뇨로해부결구발생명현개변，UVJ-M、PUVA-r、PUVA-s등삼수여대조조비교차이균유통계학의의（균P＜0.01）。 B조환자술후방광급뇨도등하뇨로해부결구야발생변화，개변정도교C조소，UVJ-M삼수여대조조、C조상비차이유통계학의의（균P＜0.01），PUVA-r、PUVA-s등삼수여대조조상비차이무통계학의의（균P＞0.05）。 A조환자술후방광급뇨도등하뇨로해부결구무명현개변，UVJ-M、PUVA-r、PUVA-s등삼수여대조조비교차이균무통계학의의（균P＞0.05）。결론：①초성가대자궁전절술후녀성방광급뇨도형태학변화진행실시관찰、객관평개해부결구적개변。②자궁절제적3충수술방식중이개복엄범자궁절제술대녀성방광급뇨도해부결구개변최대，복강경보조적음식자궁절제술칙궤호몰유영향。
Objective: To investigate the static and dynamic morphological changes of bladder and urethral after hysterectomy by ultrasound,and evaluate the anatomical changes. Methods:Grouping 136 cases of hysterectomy patients according to surgical mode and scope of removal,Group A:29 cases of laparoscopic-assisted vaginal hysterectomy;Group B:41 cases of abdominal hysterectomy;Group C:66 cases of abdominal radical hysterectomy. Control group:50 cases of no pelvic or abdomen surgical operation experience. Apply abdominal and perineal ultrasound inspection to the groups ,measuring parameters include UVJ-M,PUVA and bladder post-void residual volume. Results:There were significant changes in the anatomical structure of urinary tract like bladder and urethra in group C cases after surgery, UVJ-M, PUVA-r and PUVA-s had significant differences between group C and control group(P<0.01). There were changes in the anatomical structure of urinary tract like bladder and urethra in group B cases after surgery, but the degree of change is small compared with group C, UVJ-M had significant changes between group B and control group or group B and group C (P<0.01), PUVA-r, PUVA-s had no significant changes between group B and control group (P>0.05). There were no significant changes in the anatomical structure of urinary tract like bladder and urethra in group A cases after surgery, UVJ-M, PUVA-r and PUVA-s had no significant changes between group A and control group (P>0.05). Conclusions: ①Ultrasound can provide a real time observation for the morphological changes of bladder and urethral after hysterectomy and provide an objective evaluation for the anatomical changes. ②Abdominal radical hysterectomy brings the most significant morphological changes of bladder and urethral compared with the other 2 types of hysterectomy,and there are almost no changes by laparoscopic-assisted vaginal hysterectomy.