探讨盆底超声对子宫脱垂患者经阴道改良补片双侧骶棘韧带固定术的评估作用。

选取2016年3月至2017年1月在杭州市妇幼保健院就诊的32例子宫脱垂患者，所有患者术前均行盆底超声检查评估脏器脱垂情况，明确诊断后行经阴道改良补片双侧骶棘韧带固定术治疗，8例伴有膀胱膨出及3例伴有直肠膨出的患者同时修补阴道前后壁并行会阴重建术，术后经阴道二维及三维盆底超声观察静息状态、最大Valsalva动作及缩肛状态下植入改良补片的位置、形态及活动情况，并经会阴二维及四维盆底超声观察盆底功能变化，比较术前、术后膀胱最低点、子宫下缘、直肠壶腹部到参考线（耻骨联合后下缘水平线）距离，以及盆底裂孔面积、肛提肌厚度。

经阴道二维及三维盆底超声观察术后补片情况：可以清晰显示宫颈前方及两侧的"U"形高回声结构及活动情况；经会阴二维及四维盆底超声检查观察32例患者盆底脏器情况：最大Valsalva状态下膀胱最低点、子宫下缘、直肠壶腹部到参考线距离（cm），肛提肌厚度（cm）术后较术前测值增大（0.65±1.85 vs 0.15±1.85，2.80±1.10 vs -1.00±1.50，0.60±1.90 vs -0.55±1.55，0.51±0.24 vs 0.37±0.19），盆底裂孔面积（cm²）术后较术前测值减小（20.15±7.20 vs 29.00±9.50），差异均有统计学意义（P均<0.05）。8例合并膀胱膨出的患者5例术后膀胱膨出治愈、3例术后膀胱膨出情况有改善，3例合并直肠膨出的患者术后直肠膨出均治愈。

经阴道及经会阴两种扫查方式结合的盆底超声检查能够清晰显示经阴道改良补片双侧骶棘韧带固定术术后改良补片的悬吊情况，可以为术前观察盆腔功能及术后疗效评估提供有价值的影像学依据及指导意义。

To investigate the value of evaluation of pelvic floor ultrasound in the transvaginal modified patch repair and sacrospinous ligament fixation in uterine prolapse patients.

Thirty-two patients with uterine prolapse were included in the retrospective study from March 2016 to January 2017 in Hangzhou maternity and child health care hospital. All patients were detected by pelvic floor ultrasound before operation and cured by vaginal patch bilateral sacral spine ligament fixation treatment after. Of them, 8 cases were complicated with cystocele and 3 cases with anorectal prolapse, and all the complications were treated at the same time. The observations of the change of position, shape and activity of the implant by transvaginal at rest, on maxium Valsalva and contraction, and the transperineal pelvic ultrasound were performed to evaluate the change of pelvic floor function and compare the distance from the lowest point of the bladder, uterus and the rectal ampulla to reference line (the horizontal line at the lower margin of the pubic bone), area of levator hiatus and the thickness of the puborectalis muscle before and after operation.

The patches were observed 2D and 3D postoperatively by pelvic ultrasound. The U-shaped hyperecho could be clearly shown around the cervix and activity of patches were clearly shown. The observation of 32 cases of patients with pelvic viscera situation by the transperineal 2D and 4D pelvic ultrasound: the distance from the lowest point of the bladder, uterus and the rectal ampulla to reference line and the thickness of the puborectalis muscle enlarged after operation (0.65±1.85 vs 0.15±1.85, 2.80±1.10 vs -1.00±1.50, 0.60±1.90 vs -0.55±1.55, 0.51±0.24 vs 0.37±0.19) onmaxium valsalva, the area of levator hiatus decreased after operation (20.15±7.20 vs 29.00±9.50). The differences were both statistically significant (all P<0.05). Uterine prolapse were not found after operation. In the 8 cases with cystocele, 5 cases were cured and 3 cases were improved. And all the 3 cases of patients with anorectal prolapse were all cured.

Combined application of transvaginal and transperineal pelvic ultrasound can clearly show the suspension of the patch after the treatment of modified patch repair and Sacrospinous ligament fixation, which provide valuable imaging information in the evaluation of preoperative pelvic functionand postoperative therapeutic effect.