摘要
目的探讨经直肠双平面高频超声评估MRKH综合征腹膜代阴道成形术后人工阴道的应用价值。方法前瞻性选取2021年1月至2022年3月深圳市罗湖区人民医院的82例MRKH综合征术前患者(术前组)、30例正常生育期女性(正常对照组)和85例MRKH综合征行腹腔镜下腹膜代阴道成形术后复查患者为研究对象,其中69例术后1个月以内复查的患者为术后A组,16例术后1个月以上复查的患者为术后B组。应用双平面高频超声经直肠在矢状切面和横切面观察MRKH综合征患者术前及术后膀胱尿道后壁与直肠前壁之间间隙形态结构的变化,并在尿道内口水平测量此间隙的厚度;在矢状切面和横切面观察正常对照组膀胱尿道后壁与直肠前壁之间女性阴道形态,并在尿道内口水平测量阴道前后壁的总厚度。采用Kruskal-Wallis H检验比较术前组、正常对照组、术后A组和术后B组尿道内口水平膀胱尿道后壁与直肠前壁之间间隙厚度的差异。结果(1)术前组患者在矢状切面及横切面上膀胱尿道后壁与直肠前壁之间仅见低回声结缔组织,此间隙厚度为3.01(2.33,3.52)mm,彩色多普勒血流成像(CDFI)显示:低回声内可见少许血流信号。(2)正常对照组膀胱尿道后壁与直肠前壁之间的正常阴道在矢状切面和横切面上表现为“三线两区”征,阴道的厚度为(10.07±2.93)mm,CDFI:阴道壁内可见较丰富的血流信号。(3)术后A组患者在矢状切面和横切面上膀胱尿道后壁与直肠前壁之间可见人工阴道,表现为“一线两区”征,厚度为(13.25±3.06)mm,CDFI:人工阴道走行区域可见丰富的血流信号。(4)术后B组患者在矢状切面和横切面上膀胱尿道后壁与直肠前壁之间也可见人工阴道,表现为“一线两区”征,厚度为(11.03±3.26)mm,CDFI:人工阴道走行区域可见较丰富的血流信号。(5)Kruskal-Wallis H检验显示,术前组、正常对照组、术后A组及术后B组尿道内口水平膀胱尿道后壁与直肠前壁之间的厚度差异有统计学意义(H=150.301,P<0.001)。结论经直肠双平面高频超声可为MRKH综合征腹膜代阴道成形术术前及术后膀胱尿道后壁与直肠前壁之间形态结构变化的评估提供直接可靠的影像学依据,还可提供术后人工阴道从形成到成熟不同时间段的声像图特征。
Objective To assess the value of transrectal biplane high-frequency ultrasound in evaluating artificial vagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome(MRKH)after peritoneal vaginoplasty.Methods Eighty-two preoperative patients with MRKH syndrome(preoperative group),30 normal reproductive women(normal control group),and 85 patients with MRKH syndrome after operation at Luohu District People's Hospital of Shenzhen were enrolled as the research participants from January 2021 to March 2022.Among the 85 postoperative patients with MRKH syndrome,69 who underwent reexamination within one month after surgery were included in postoperative group A,and 16 who were reexamined more than 1 month after surgery were included in postoperative group B.The morphological and structural changes in the urethra and bladder posteriorly and the rectum anteriorly in the four groups were observed by transrectal biplanar high-frequency ultrasound in sagittal and cross-sectional sections,and the thickness of the gaps at the level of the urethral orifice was measured and compared by the Kruskal-Wallis H test.Results In the 82 patients in the preoperative group,only hypoechoic connective tissue was seen between the urethra and bladder posteriorly and the rectum anteriorly in sagittal and cross-sectional sections,the thickness of the gap was about 3.01(2.33,3.52)mm,and color Doppler flow imaging(CDFI)revealed a little blood flow signal in the gap.The vagina showed"three lines and two zones"between the urethra and bladder posteriorly and the rectum anteriorly in sagittal and cross-sectional sections in 30 women in the normal control group,CDFI revealed that there were abundant blood flow signals in the vaginal wall,and the average thickness of the vaginal wall was about(10.07±2.93)mm.The artificial vagina could be seen between the urethra and bladder posteriorly and the rectum anteriorly in sagittal and cross-sectional sections and showed"one line and two areas"in 69 patients in the postoperative group A,CDFI revealed abundant blood flow signals in the deformed area of artificial vagina,and the average thickness of the artificial vaginal wall was(13.25±3.06)mm.The artificial vagina could also be seen between the urethra and bladder posteriorly and the rectum anteriorly in sagittal and cross-sectional sections and showed"one line and two areas"in 16 patients in the postoperative group B,CDFI revealed abundant blood flow signals in the deformed area of artificial vagina,and the average thickness of the artificial vaginal wall was(11.03±3.26)mm.The Kruskal-Wallis H test showed that there was a significant difference in the thickness between the urethra and bladder posteriorly and the rectum anteriorly at the level of the urethral orifice among the four groups(H=150.301,P<0.001).Conclusion Transrectal biplanar high-frequency ultrasound provides a direct and reliable imaging tool for the assessment of morphological and structural changes between the urethra and bladder posteriorly and the rectum anteriorly in patients with MRKH syndrome before and after peritoneal vaginoplasty,and it could also provide the sonoimagedata characteristics of the postoperative artificial vagina from formation to maturity.
作者
陈广兰
胡守容
郭蓉
张丹丹
贺玉梅
张蕾
陈小清
华琪
张元吉
林燕秋
王慧芳
Guanglan Chen;Shourong Hu;Rong Guo;Dandan Zhang;Yumei He;Lei Zhang;Xiaoqing Chen;Qi Hua;Yuanji Zhang;Yanqiu Lin;Huifang Wang(Department of Ultrasound,Shenzhen Luohu People's Hospital,the Third Affiliated Hospital of Shenzhen University,Shenzhen 518001,China)
出处
《中华医学超声杂志（电子版）》
CSCD
北大核心
2023年第11期1132-1138,共7页
Chinese Journal of Medical Ultrasound(Electronic Edition)
作者简介
通信作者:王慧芳,Email:kuangwhf2006@126.com。
