未产妇和盆底器官脱垂女性的盆底超声研究
|
摘要
研究目的:盆底器官脱垂是中老年女性的常见病,严重影响了妇女的生活质量,目前该病的手术复发率仍很高,究其原因,术前对患者的盆底情况评估不充分是重要的原因之一。基于盆底器官脱垂的发病特点,准确全面地诊断和评价盆底功能是进行彻底治疗的前提。临床物理检查准确性不高,容易漏诊。而手术探查盆腔无法充分用力,易出现假阴性,且盆底功能性疾病亦不可能通过病理检查得到证实,影像学检查是一种有效的诊断方法。所以,找到一种能够有效充分评估盆底结构功能状态的影像学是提高盆底器官脱垂术手术效果的关键之一。本研究在尸体解剖的基础上,研究探讨女性盆底支持系统和盆底脏器的解剖结构,然后联合应用二维和三维超声对未产妇盆底结构进行了研究,初步认识了正常的盆底器官的位置和运动情况以及肛提肌、盆膈裂孔、阴道周围支持结构等盆底结构的声像图特点,再进一步应用联合二维和三维超声探测的方法探讨盆底脱垂患者的盆底结构特异性的超声声像图特点,并通过对照分析超声评估与盆底脱垂定量评估系统的相关性,评价超声在盆底器官脱垂疾病的临床应用性。
第一部分女性尸体的盆底支持结构解剖
材料与方法:10%福尔马林固定的成年女性尸体4具,未经防腐处理的新鲜成年女性尸体1具,对尸体标本的盆底进行解剖,包括经会阴由浅入深解剖和经盆腔由上至下解剖盆底支持结构。
结果:盆底支持结构主要包括盆底肌和盆底结缔组织。盆底肌中以肛提肌作用最大,肛提肌分成前后两部分。前方的耻骨内脏肌部分形成一缝隙样结构称为盆膈裂孔,是盆底器官的通道,耻骨内脏肌始终保持一定的张力,紧紧夹持住中间的盆底器官;后方的尾骨肌部分和髂尾肌共同构成一水平板(提肌板),为盆底器官提供一休憩平台,支持直肠和上三分之二阴道。盆底结缔组织包括韧带和筋膜,将尿道、阴道及直肠牢牢固定于盆壁之上,以阴道周围的结缔组织最为丰富。不同阴道水平的阴道周围支持结构不同,对应的阴道横断面的形态也不同。盆筋膜在盆底中线处形成分隔,将女性盆腔在垂直方向分成前、中、后三个腔室。
结论:盆底器官依靠由盆底肌、筋膜、韧带等构成的盆底支持结构维持其在盆底的正常位置。
第二部分未产妇的盆底声像图研究
材料与方法:对50名未产妇,经会阴联合应用二维和三维超声探查盆底结构。
结果:静止期,未产妇尿道膀胱连接部、宫颈外口、肛管直肠连接部的位置就处于高位,缩肛期三者向上移动,张力期三者位置轻度下移,始终位于耻骨联合下缘水平以上,张力期盆底形态变化不明显,无脱垂表现。张力期尿道轴向背侧偏转,肛直角变大;缩肛期尿道轴向腹侧偏转,肛直角变小。未产妇的盆膈裂孔呈菱形,由两侧耻骨支和左右两支耻骨内脏肌围绕而成,裂孔内从前至后依次排列尿道、阴道和直肠,耻骨内脏肌两侧对称连续性好,无撕脱断裂现象,阴道周围结构完整,tenting结构存在。张力期盆膈裂孔面积变大,耻骨内脏肌变薄,耻骨内脏肌后角增大;缩肛期盆膈裂孔面积变小,耻骨内脏肌变厚,耻骨内脏肌后角减小。
结论:经会阴超声联合应用二维和三维超声是研究盆底解剖、形态和运动的一种较好的影像手段,通过二维超声矢状切面观察盆底器官的位置及运动情况,通过三维超声成像可对盆底进行多角度、多切面观察,获得盆底横断面的形态结构学信息。未产妇盆底超声显示无盆腔器官脱垂,盆底器官位置较高,盆腔用力时盆底形态上变化不明显,盆腔器官移动度小,盆膈裂孔向着增大的趋势变化;缩肛期盆膈裂孔向减小的趋势变化。盆底支持组织完好无缺损。对未产妇盆底结构的探测为盆底脱垂疾病的超声评价提供了探测方法学和影像学的基础。
第三部分盆底器官脱垂女性的盆底声像图研究
材料与方法:对50例盆底器官脱垂女性患者经会阴联合应用二维和三维超声探测盆底结构,并将超声评估结果和盆底器官脱垂定量评估结果进行相关分析。
结果:盆底脱垂患者的盆底器官静止期就处于低下位置,张力期位置更为低下,有些甚至低于耻骨联合下缘水平。张力期向下移动幅度较正常组明显增大,缩肛期向上移动度较正常组明显缩小。盆底器官脱垂患者声像图表现往往可见合并多个脏器脱垂,包括膀胱膨出、尿道移动度大、子宫脱垂、肠疝、直肠膨出、会阴体下降等。盆底器官脱垂患者的盆膈裂孔明显增大,形态由正常的菱形变为类圆形,两侧耻骨内脏肌较正常未产女性薄,后角增大,与耻骨联合之间有撕脱、断裂等现象,阴道周围结构有缺损,可见tenting结构消失。应用超声评估系统对盆底脱垂患者进行评估,并与POP-Q评估系统进行对比,两者之间有显著的相关性,说明超声评估系统是切实可行的。
结论:盆底器官脱垂患者声像图常表现为多个盆腔器官的脱垂和盆底病变,包括膀胱膨出,尿道移动度大,子宫脱垂,肠疝,直肠膨出,会阴体下降等,同时伴有盆隔裂孔的明显增大、耻骨内脏肌的撕脱和断裂、阴道周围支持结构的缺失以及tenting结构的消失等特异性声像图表现。超声评估系统能够准确、全面地评价盆底形态和盆腔所有器官的脱垂,为指导临床制定治疗计划提供可靠的客观依据。
Objectives Pelvic organ prolapse is a common problem significantly affecting women’s quality of life, particularly in later years. To data, the ultimate method to the symptomatic pelvic organ prolapse is surgery, which has been improved and innovated continually,but still recurrence rate is high as the statistical data has shown. One of the important cause is lack of enough information of pelvic floor preoperation,which prompts us it crucial for improving surgery effect to study an effective imaging technique for the morphological observation of pelvic floor.After studying the anatomy of the female pelvic floor by anatomizing 5 female cadavers,this paper studied the pelvic organs position and mobility,and three-dimensional ultrasound image of levator ani, urogenital hiatus and paravaginal supports in 50 nulliparous women and 50 pelvic organ prolapse women, combined with two- and three-dimensional ultrasound,and went on to compare findings obtained by ultrasound quantification of prolapse with the results of pelvic organ prolapse quantification system (POPQ) adopted by the International Continence Society (ICS) to evaluate the use of ultrasound in the quantification of prolapse.
Part One The anatomy of female cadaveric pelvic support
Methods Five female cadavers (4 dipped in 10% formalin,1 fresh body) were anatomized to study the anatomy of the female pelvic floor.The anatomical routes of pelvic floor support includes perineal anatomy from superficial to deep and pelvic cavity anatomy from above downward.
Results The pelvic support is composed of pelvic floor muscle and pelvic floor connective tissue.The levator ani muscles,the most important part of the pelvic floor muscle , is subdevided into two portions.The anterior pubovisceral portions form a space called urogenital hiatus,and the posterior coccygeal portions together with iliococcygeus form a relatively flat,horizontal shelf (called levator plate)on which the pelvic organs rest,supporting the rectum and upper two thirds of the vagina above it.On each side of the pelvis,the pelvic connective tissue which is most abundant around the vaginal attaches the pelvic organ to the pelvic wall.Paravaginal supports,the pelvic connective tissue around the vaginal,are different in different vaginal level,which make the vagina different configuration according to different level.The pelvic fascia forms a single divider in the middle of the pelvis and divides the pelvis into anterior, middle, and posterior compartments in vertical.
Conclusions Normal pelvic organ position depends on normal structure and function of pelvic support composed of pelvic floor muscles and pelvic connective tissue.
Part Two The study of pelvic floor ultrasound in nulliparas
Methods Fifty nulliparas were examined by translabial ultrasound,using two- and three-dimensional ultrasound.
Results The pelvic organs are in a higher position according to the numerical findings of the position of urethrovesical junction, leading edge of cervix,and anorectum junction relative to the inferior margin of the symphysis pubica at rest in nulliparous women.The pelvic organ is cranioventral shift on levator ani contraction and dorsocaudal displacement on maximal Valsalva,but still above the level of inferoposterior margin of the symphysis pubica.The angle of incline of urethra is dorsal rotation with the angle of anus and rectum bigger on maximal Valsalva while things are on the contrary on levator ani contraction.The urogenital hiatus between pubovisceral and pubic ramus through which the urethra,vagina,and rectum pass is rhombic in nulliparous women,with the pubovisceral muscles symmetrical continuous non-avulsion,perivaginal support intact and tenting present . The urogenital hiatus enlarges on maximal Valsalva with pubovisceral muscles thinner and pubovisceral muscles angle bigger, while things are on the contrary on levator ani contraction.
Conclusions Transperineal ultrasonography combined with two- and three-dimensional ultrasound can be used for the assessment of female pelvic floor for anatomy,morphology and mobility, two-dimensional ultrasonography for the pelvic organ position and mobility , while three-dimensional ultrasonography for the pelvic floor support in multidimensional view.The images of pelvic floor ultrasound in nulliparous women show no pelvic organ prolapse, high pelvic organs position,limit mobility,little morphology change and intact perivaginal support.The study of pelvic floor ultrasound in nulliparas provides the basis of methodology and iconography for ultrasound quantification of prolapse.
Part Three The study of pelvic floor ultrasound in pelvic organ prolapse women
Methods Fifty pelvic organ prolapse women were examined by translabial ultrasound , combined with two- and three-dimensional ultrasound,and findings obtained by ultrasound quantification of prolapse were compared with the results of pelvic organ prolapse quantification system (POPQ) adopted by the International Continence Society (ICS).
Results The pelvic organs are in a lower position at rest in pelvic organ prolapse women,and much lower on maximal Valsalva even below the level of inferrior margin of the symphysis pubica.The pelvic organ shows a less cranioventral shift on levator contraction and a more dorsocaudal displacement on maximal Valsalva.The ultrasound images of pelvic floor in pelvic organ prolapse women always show multi-organ prolapse,including cystocele, urethral hypermobility,uterus prolapse, enterocele,rectocele and perineal hypermobility.The urogenital hiatus in pelvic organ prolapse women becomes bigger and oval,with pubovisceral thinner, rupture or avulsion off the symphysis pubica , perivaginal defects and tenting absent.The good correlation between ultrasound quantification of prolapse and the International Continence Society prolapse assessment system demonstrates that translabial ultrasound can be used to quantify female pelvic organ prolapse.
Conclusions The ultrasound images of pelvic floor in pelvic organ prolapse women always show multi-organ prolapse , including cystocele,urethral hypermobility,uterus prolapse,enterocele, rectocele and perineal hypermobility,with large urogenital hiatus, thinner pubovisceral muscle, rupture or avulsion off the symphysis pubica,perivaginal defects and tenting absent.Ultrasound quantification of prolapse used for the assessment of pelvic floor morphology and prolapse can provide objective credible evidence for clinical medical to choose proper therapy.
第一部分女性尸体的盆底支持结构解剖
材料与方法:10%福尔马林固定的成年女性尸体4具,未经防腐处理的新鲜成年女性尸体1具,对尸体标本的盆底进行解剖,包括经会阴由浅入深解剖和经盆腔由上至下解剖盆底支持结构。
结果:盆底支持结构主要包括盆底肌和盆底结缔组织。盆底肌中以肛提肌作用最大,肛提肌分成前后两部分。前方的耻骨内脏肌部分形成一缝隙样结构称为盆膈裂孔,是盆底器官的通道,耻骨内脏肌始终保持一定的张力,紧紧夹持住中间的盆底器官;后方的尾骨肌部分和髂尾肌共同构成一水平板(提肌板),为盆底器官提供一休憩平台,支持直肠和上三分之二阴道。盆底结缔组织包括韧带和筋膜,将尿道、阴道及直肠牢牢固定于盆壁之上,以阴道周围的结缔组织最为丰富。不同阴道水平的阴道周围支持结构不同,对应的阴道横断面的形态也不同。盆筋膜在盆底中线处形成分隔,将女性盆腔在垂直方向分成前、中、后三个腔室。
结论:盆底器官依靠由盆底肌、筋膜、韧带等构成的盆底支持结构维持其在盆底的正常位置。
第二部分未产妇的盆底声像图研究
材料与方法:对50名未产妇,经会阴联合应用二维和三维超声探查盆底结构。
结果:静止期,未产妇尿道膀胱连接部、宫颈外口、肛管直肠连接部的位置就处于高位,缩肛期三者向上移动,张力期三者位置轻度下移,始终位于耻骨联合下缘水平以上,张力期盆底形态变化不明显,无脱垂表现。张力期尿道轴向背侧偏转,肛直角变大;缩肛期尿道轴向腹侧偏转,肛直角变小。未产妇的盆膈裂孔呈菱形,由两侧耻骨支和左右两支耻骨内脏肌围绕而成,裂孔内从前至后依次排列尿道、阴道和直肠,耻骨内脏肌两侧对称连续性好,无撕脱断裂现象,阴道周围结构完整,tenting结构存在。张力期盆膈裂孔面积变大,耻骨内脏肌变薄,耻骨内脏肌后角增大;缩肛期盆膈裂孔面积变小,耻骨内脏肌变厚,耻骨内脏肌后角减小。
结论:经会阴超声联合应用二维和三维超声是研究盆底解剖、形态和运动的一种较好的影像手段,通过二维超声矢状切面观察盆底器官的位置及运动情况,通过三维超声成像可对盆底进行多角度、多切面观察,获得盆底横断面的形态结构学信息。未产妇盆底超声显示无盆腔器官脱垂,盆底器官位置较高,盆腔用力时盆底形态上变化不明显,盆腔器官移动度小,盆膈裂孔向着增大的趋势变化;缩肛期盆膈裂孔向减小的趋势变化。盆底支持组织完好无缺损。对未产妇盆底结构的探测为盆底脱垂疾病的超声评价提供了探测方法学和影像学的基础。
第三部分盆底器官脱垂女性的盆底声像图研究
材料与方法:对50例盆底器官脱垂女性患者经会阴联合应用二维和三维超声探测盆底结构,并将超声评估结果和盆底器官脱垂定量评估结果进行相关分析。
结果:盆底脱垂患者的盆底器官静止期就处于低下位置,张力期位置更为低下,有些甚至低于耻骨联合下缘水平。张力期向下移动幅度较正常组明显增大,缩肛期向上移动度较正常组明显缩小。盆底器官脱垂患者声像图表现往往可见合并多个脏器脱垂,包括膀胱膨出、尿道移动度大、子宫脱垂、肠疝、直肠膨出、会阴体下降等。盆底器官脱垂患者的盆膈裂孔明显增大,形态由正常的菱形变为类圆形,两侧耻骨内脏肌较正常未产女性薄,后角增大,与耻骨联合之间有撕脱、断裂等现象,阴道周围结构有缺损,可见tenting结构消失。应用超声评估系统对盆底脱垂患者进行评估,并与POP-Q评估系统进行对比,两者之间有显著的相关性,说明超声评估系统是切实可行的。
结论:盆底器官脱垂患者声像图常表现为多个盆腔器官的脱垂和盆底病变,包括膀胱膨出,尿道移动度大,子宫脱垂,肠疝,直肠膨出,会阴体下降等,同时伴有盆隔裂孔的明显增大、耻骨内脏肌的撕脱和断裂、阴道周围支持结构的缺失以及tenting结构的消失等特异性声像图表现。超声评估系统能够准确、全面地评价盆底形态和盆腔所有器官的脱垂,为指导临床制定治疗计划提供可靠的客观依据。
Objectives Pelvic organ prolapse is a common problem significantly affecting women’s quality of life, particularly in later years. To data, the ultimate method to the symptomatic pelvic organ prolapse is surgery, which has been improved and innovated continually,but still recurrence rate is high as the statistical data has shown. One of the important cause is lack of enough information of pelvic floor preoperation,which prompts us it crucial for improving surgery effect to study an effective imaging technique for the morphological observation of pelvic floor.After studying the anatomy of the female pelvic floor by anatomizing 5 female cadavers,this paper studied the pelvic organs position and mobility,and three-dimensional ultrasound image of levator ani, urogenital hiatus and paravaginal supports in 50 nulliparous women and 50 pelvic organ prolapse women, combined with two- and three-dimensional ultrasound,and went on to compare findings obtained by ultrasound quantification of prolapse with the results of pelvic organ prolapse quantification system (POPQ) adopted by the International Continence Society (ICS) to evaluate the use of ultrasound in the quantification of prolapse.
Part One The anatomy of female cadaveric pelvic support
Methods Five female cadavers (4 dipped in 10% formalin,1 fresh body) were anatomized to study the anatomy of the female pelvic floor.The anatomical routes of pelvic floor support includes perineal anatomy from superficial to deep and pelvic cavity anatomy from above downward.
Results The pelvic support is composed of pelvic floor muscle and pelvic floor connective tissue.The levator ani muscles,the most important part of the pelvic floor muscle , is subdevided into two portions.The anterior pubovisceral portions form a space called urogenital hiatus,and the posterior coccygeal portions together with iliococcygeus form a relatively flat,horizontal shelf (called levator plate)on which the pelvic organs rest,supporting the rectum and upper two thirds of the vagina above it.On each side of the pelvis,the pelvic connective tissue which is most abundant around the vaginal attaches the pelvic organ to the pelvic wall.Paravaginal supports,the pelvic connective tissue around the vaginal,are different in different vaginal level,which make the vagina different configuration according to different level.The pelvic fascia forms a single divider in the middle of the pelvis and divides the pelvis into anterior, middle, and posterior compartments in vertical.
Conclusions Normal pelvic organ position depends on normal structure and function of pelvic support composed of pelvic floor muscles and pelvic connective tissue.
Part Two The study of pelvic floor ultrasound in nulliparas
Methods Fifty nulliparas were examined by translabial ultrasound,using two- and three-dimensional ultrasound.
Results The pelvic organs are in a higher position according to the numerical findings of the position of urethrovesical junction, leading edge of cervix,and anorectum junction relative to the inferior margin of the symphysis pubica at rest in nulliparous women.The pelvic organ is cranioventral shift on levator ani contraction and dorsocaudal displacement on maximal Valsalva,but still above the level of inferoposterior margin of the symphysis pubica.The angle of incline of urethra is dorsal rotation with the angle of anus and rectum bigger on maximal Valsalva while things are on the contrary on levator ani contraction.The urogenital hiatus between pubovisceral and pubic ramus through which the urethra,vagina,and rectum pass is rhombic in nulliparous women,with the pubovisceral muscles symmetrical continuous non-avulsion,perivaginal support intact and tenting present . The urogenital hiatus enlarges on maximal Valsalva with pubovisceral muscles thinner and pubovisceral muscles angle bigger, while things are on the contrary on levator ani contraction.
Conclusions Transperineal ultrasonography combined with two- and three-dimensional ultrasound can be used for the assessment of female pelvic floor for anatomy,morphology and mobility, two-dimensional ultrasonography for the pelvic organ position and mobility , while three-dimensional ultrasonography for the pelvic floor support in multidimensional view.The images of pelvic floor ultrasound in nulliparous women show no pelvic organ prolapse, high pelvic organs position,limit mobility,little morphology change and intact perivaginal support.The study of pelvic floor ultrasound in nulliparas provides the basis of methodology and iconography for ultrasound quantification of prolapse.
Part Three The study of pelvic floor ultrasound in pelvic organ prolapse women
Methods Fifty pelvic organ prolapse women were examined by translabial ultrasound , combined with two- and three-dimensional ultrasound,and findings obtained by ultrasound quantification of prolapse were compared with the results of pelvic organ prolapse quantification system (POPQ) adopted by the International Continence Society (ICS).
Results The pelvic organs are in a lower position at rest in pelvic organ prolapse women,and much lower on maximal Valsalva even below the level of inferrior margin of the symphysis pubica.The pelvic organ shows a less cranioventral shift on levator contraction and a more dorsocaudal displacement on maximal Valsalva.The ultrasound images of pelvic floor in pelvic organ prolapse women always show multi-organ prolapse,including cystocele, urethral hypermobility,uterus prolapse, enterocele,rectocele and perineal hypermobility.The urogenital hiatus in pelvic organ prolapse women becomes bigger and oval,with pubovisceral thinner, rupture or avulsion off the symphysis pubica , perivaginal defects and tenting absent.The good correlation between ultrasound quantification of prolapse and the International Continence Society prolapse assessment system demonstrates that translabial ultrasound can be used to quantify female pelvic organ prolapse.
Conclusions The ultrasound images of pelvic floor in pelvic organ prolapse women always show multi-organ prolapse , including cystocele,urethral hypermobility,uterus prolapse,enterocele, rectocele and perineal hypermobility,with large urogenital hiatus, thinner pubovisceral muscle, rupture or avulsion off the symphysis pubica,perivaginal defects and tenting absent.Ultrasound quantification of prolapse used for the assessment of pelvic floor morphology and prolapse can provide objective credible evidence for clinical medical to choose proper therapy.
引文
[1] Swift SE,Tate SB,Nicholas J.Correlation of symptoms with degree of pelvic organ support in a general population of women:What is pelvic organ prolapse?Am J Obstet Gynecol,2003,189(2):372-377
[2] Olsen AL,Smith VG,Bergstrom JO,et al.Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.Obstet Gynecol,1997,89(4):501-506
[3] Swift SE.The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care.Am J Obstet Gynecol, 2000,183(2):277-285
[4] Bump RC,Mattiasson A,Brubaker LP, et al.The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.Am J Obstet Gynecol,1996,175(1):10–17
[5] Hall AF,Theofrastous JP,Cundiff GW,et al.Interobserver and intraobserver reliability of the proposed International Continence Society,Society of Gynecologic Surgeons,and American Urogynecologic Society pelvic organ prolapse classification system.Am J Obstet Gynecol,1996,175(6):1467–1470
[6] Dietz HP,Wilson PD.The influence of bladder volume on the position and mobility of the urethrovesical junction.Int Urogynecol J,1999,10(1): :3–6
[7] Dietz HP,Shek C,Clarke B.Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol,2005,25(6):580–585
[8] Chiaffarino F,Chatenoud L,Dindelli M,et al.Reproductive factors,family history,occupation and risk of urogenital prolapse.Eur J Obstet Gynecol Reprod Biol,1999,82(1):63–67
[9] Samuelsson EC,Victor FT,Tibblin G,et al.Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors.Am J Obstet Gynecol,1999,180(2):299-305
[10] Dietz HP,Schierlitz L.Pelvic floor trauma in labour—myth or reality? Aust N Z J Obstet Gynaecol,2005,45(1):3–11
[11] Lien KC,Mooney B,DeLancey JO,et al.Levator ani muscle stretch induced by simulated vaginal birth.Obstet Gynecol, 2004,103(1):31–40
[12] Sultan AH,Thakar R. Lower genital tract and anal sphincter trauma.Best Pract Res Clin Obstet Gynaecol,2002,16(1):99–115
[13] Smith AR,Hosker GL,Warrell DW.The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolpase and stress incontinence.A neurophysiological study Br J Obstet Gynaecol,1989,96(1):24-28
[14] Progetto Menopausa Italia Study Group.Risk factors for genital prolapse in non-hysterectomized women around menopause,results from a large cross-sectional study in menopausal clinics in Italy.Eur J Obstet Gynecol Reprod Biol,2000,93(1):125-140
[15] Peschers UM,Forster A,Leib B,et al.Changes in levator ani muscle magnetic resonance imaging in women with postpartum stress urinary incontinence.Int Urogynecol J Pelvic Floor Dysfunct,1999,10(1):5.
[16] DeLancey JO,Kearney R,Chow Q,et al.The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery.Obstet Gynecol,2003,101(1)::46–53
[17] Tunn R,DeLancey JO,Howard D,et al.MR imaging of levator ani muscle recovery following vaginal delivery.Int Urogynecol J Pelvic Floor Dysfunct,1999,10(5):300–307
[18] Copas P,Bukovsky A,Asbury B,et al.Estrogen,progesterone and androgen receptor expression in levator ani muscle and fascia.J Womens Health Gend Based, Med,2001,10(8):785-795
[19] Chen GD,Oliver RH,Leung BS,et al.Estrogen receptor a and b expression in the vaginal walls and uterosacral ligaments of premenopausal and postmenopausal women.Fertil Steril,1999,71(1):1099-1102
[1] Hunskaar S,Amold EP,Burgio K,et al.Epidemiology and natural history of urinary incontinence.In Abrams P,Khoury S,Wein AJ eds,Incontinence.Plymouth,UK:Health Publications,1999:197-226
[2] Fothergill WE.Pathology and the operative treatment of displacements of the pelvic viscera.J Obstet Gynaecol Br Emp,1907,13:410-419
[3] Paramore RH.The supports in chief of the female pelvic viscera.J Obstet Gynaecol Br Emp,1908,30:319-409
[4] Strohbehn K.Normal pelvic floor anatomy. Obstet Gynecol Clin North Am,1998,25(4):683-705
[5] Berglas B,Rubin IC.Study of the supportive structures of the uterus by levator myography.Surg Gynecol Obstet,1953,97(6):677-692
[6] Gilpin SA,Gosling JA,Smith AR,et al.The pathogenesis of genitourinary prolapse and stress urinary incontinence of urine:a histological and histochemical study.Br J Obstet Gynaecol,1989,96(1):15-23
[7] Gosling JA,Dixon JS,Critchley HOA,et al.comparative study of the human external sphincter and periurethral levator ani muscles.Br J Urol,1981,53(1):35-41
[8] Critchley HO,Dixon JS,Gosling JA.Comparative study of the periurethral and perianal parts of the human levator ani muscle.Urol Int,1980,35(3):226-232
[9] Sender H.Female pelvic floor anatomy:the pelvic floor,supporting structures,and pelvic organs.Rev Urol,2004,6(5):2-10
[10] DeLancey JO.Anatomic aspects of vaginal eversion after hysterectomy.Am J Obstet Gynecol,1992,166(6):1717-1724
[11] John T,DeLancey JO. Functional anatomy of the pelvic floor and lower urinary tract.Clinical Obstetrics and Gynecology,2004,47( 1):3–17
[12] Matthew D. Barber MHS . Contemporary views on female pelvicanatomy.Cleveland and Clinic Journal of Msdicine,2005,72(4):3-11
[13] Handa VL,Pannu HK,Siddique S,et al.Architectural differences in the bony pelvis of women with and without pelvic floor disorders.Obstet Gynecol,2003,102(6):1283–1290
[1] Boonjunwetwat D,Sungtong P,Rojanasakul A.Defecography in patients with anorectal disorders:a study in 27 cases.J Med Assoc Thai,2001,84(8):1097-1102
[2] Fielding JR,Lee JH ,Dubeau CE,et al.Voiding cystourethrography findings in elderly women with urge incontinence.J Urol,2000,163(4):1216-1218
[3] Bremmer S,Mellgren A,Holmstrom B,et al.Peritoneocele and enterocele. Formation and transformation during rectal evacuation as studied by means of defaecoperitoneography.Acta Radiol,1998,39(2):167-175
[4] Kelvin FM,Hale DS,Maglinte DD,et al.Female pelvic organ prolapse:diagnostic contribution of dynamic cystoproctography and comparison with physical examination.AJR,1999,173(11):31-37
[5] DeLancey JOL,Speights SE,Tunn R,et al.Localized levator ani muscle abnormalities seen in MR images:site,size and side of occurrence.Int Urogynecol J Pelvic Floor Dysfunct,1999,10(1):20–21
[6] Gritzky A,Brandl H.The Voluson (Kretz) technique. In:Merz E,editor.3-D ultrasound in obstetrics and gynecology.Philadelphia:Lippincott Williams & Wilkins Healthcare,1998,9–15
[7] DeLancey JOL.Structural anatomy of the posterior pelvic compartment as it relates to rectocele.Am J Obstet Gynecol,1999,180(4):815–823
[8] Delancey JOL,Hurd WW.Size of the urogenital hiatus in the levator ani muscles in normal women and women with pelvic organ prolapse.Obstet Gynecol,1998,91(3):364–368
[9] Kearney R,Sawhney R,DeLancey JOL.Levator ani muscle anatomy evaluated by origin-insertion pairs.Obstet Gynecol 2004,104(1):168–173
[1] Mant J,Painter R,Vessey M.Epidemiology of genital prolapse:observations from the Oxford Family Planning Association Study.Br J Obstet Gynaecol,1997,104(5):579–585
[2] Olsen A,Smith V,Bergstrom J,et al.Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.Obstet Gynecol,1997,89(4):501–506
[3] Bump R,Mattiasson A,Bo K,et al.The standardisation of terminology of female pelvic organ prolapse and pelvic floor dysfunction.M J Obstet Gynecol,1996,175(1):10–17
[4] Weber AM,Abrams P,Brubaker L,et al.The standardization of terminology for researchers in female pelvic floor disorders.Int Urogynecol J,2001,12(3):178–186
[5] Miklos JR,Kohli N.Laparoscopic paravaginal repair plus burch colposuspension:review and descriptive technique.Urology,2000,56(6 (Suppl. 1)):64–69
[6] Miklos JR,Kohli N.Accuracy of clinical assessment of paravaginal defects in women with anterior vaginal wall prolapse.Am J Obstet Gynecol,2000,182(3):747–749
[7] Shull BL,Baden WF.A six-year experience with paravaginal defect repair for stress urinary incontinence.Am J Obstet Gynecol,1989,160(6):1432–1439
[8] Singh K,Jakab M,Wendy MN,et al.Three-dimensional magnetic resonance imaging assessment of levator ani morphologic features in different grades of prolapse.American Journal of Obstetrics and Gynecology,2003,188(4):910-915
[9] Vakili B,Zheng YT,Loesch H,et al.Levator contraction strength and genital hiatus as risk factors for recurrent pelvic organ prolapse. American journal of obstetrics and gynecology,2005,192 (5), 1592-1598
[10] Snooks SJ,Swash M,Mathers SE,et al.Effect of vaginal delivery on the pelvic floor:a 5-year follow-up. Br J Surg,1990,77:1358–1360
[11] Huddleston HT,Dunnihoo DR,Huddleston PM,et al.Magnetic resonance imaging of defects in DeLancey's vaginal support levels I,II,and III.Am J Obstet Gynecol,1995,172(6):1778-1782
[1] Fielding JR. Practical MR imaging of female pelvic floor weakness.Radiographics,2002,22(2):295-304
[2] Fielding JR. MR imaging of pelvic floor relaxation.Radiol Clin North Am,2003,41(4):747-756.
[3] Snocks SJ,Swash M,Machers SE,et al.Effect of vaginal delivery on the pelvic floor,a five-year follow up.Br J Surg,1990,77::1358-1360
[4] Delancey Jol. Anatomy and biomecganics of genital prolapse.Clin Onstet Gyneco,1993,36:8-10
[5] Busacchi P,Giongio RDE.A histological and immunohisto- chemical study of neuropcptidc containing somatic nervcs in the levator animusclc of women with genitourinary prolapse.Acta Obstet Gynecol Scand,1999 ,78:2-6
[6] Liapis A,Bakas P,pafiti A,et al.Change of collagen type in women with genuine stress incontincnce. Urol Rcs,2000,28( 5):323一326
[7] Liapis A,Bakas P,Pafiti A,et al.Changes of collagen type 3 in female patients with genuine stress incontinence and pelvic floor prolapse.Eur J Obstet Gynccol Rcprod Biol,2001,97( 1):76-79
[8] Yamamoto K,Yamamoto M..Decrease in elastin gene expression and Protein in fibroblasts derived from cardinal ligaments of patients with prolapse uteri.Cell Bio Int,1997,21(9):605-611
[9] Copas P,Bukovsky A.Estrogen,Progesterone and rogen receptor expression in levator ani muscle and Fascia.Women Health and Based Med,2001,10(8):785-795
[10] Rosenfield LR,White RE.Calcium -activated potassium challels and nitric oxide coregulate estrogen inducdcd vasodilation.Am J Physiol Heart Cirl Physio,2000,279( 1): 319-328
[11] Dick GM,Sanders KM.(xcno)estrogen sensitivity of smooth muscle BK channels conferred by the regulatory betal subnit:a study of bettal knockout mice..J Biol Chem,2001,276( 48):44835-44840
[12] 部分省、市、自治区子宫脱垂、尿瘘防治科研协作组。有关子宫脱垂防治的意见。中华妇产科杂志,1979,14:222 – 223
[13] Bump RC,Mattiasson A,Kari B,et al.The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.Am J Obstet Gynecol,1996,175:10 -17
[14] Wallden L.Defecation block in cases of deep rectogenital pouch.Acta Chir Scand,1952,165(suppl):35-60
[15] Jeffcoate TNA,Roberts H.Observations on stress incontinence of urine.Am J Obstet Gynecol,1952,64:721-737
[16] Ducharme JC,Bertrand R,Chacar R.Is it possible to diagnose inguinal hernia by X-ray?a preliminary report on herniography.Can Assoc Radiol J,1967,18:448-451
[17] Halligan S,Bartram CI. Evacuation photography combined with positive contrast Imaging,peritoneography to demonstrate pelvic floor hernias.Abdom,1995,20:442-445 [18 ] Pinho M,Yoshioka K,Keighley MRB.Are pelvic floor movements abnormal in disordered defecation? Dis Colon Rectum,1991,34:1117-1119
[19] Kelvin FM,Maglinte DDT,Hornback JA,et al.Pelvic prolapse assessment with evacuation photography (defecography).Radiology,1992,184:547-551
[20] Brubaker L, Retzky S,Smith C,et al.Pelvic floor evaluation with dynamic fluoroscopy.Obstet Gynecol,1993,82:863-868
[21] Halligan S,Bartram CI. Evacuation photography combined with positive contrast Imaging,peritoneography to demonstrate pelvic floor hernias.Abdom.1995,20:442-445
[22] 刘宝华主编.便秘的诊断及治疗.北京:军事医学科学出版社,2002,202-210
[23] Yang A,Mostwin 3L,Rosenshein NB,et al.Pelvic floor descent in women dynamic evaluation with fast MR imaging and cinematic display.Radiology,1991,179:25-33
[24] Hussain SM,Stoker J,Kuiper 3W,et al.MR imaging of anal sphincter complex with an endoanal coil:normal anatomy and pathology.Radiology,1994,193:445-448
[25] Hilfiker PR,Debatin JF,Schwizer W,et al.MR defecography: depiction of ano rectalanatomy and pathology.J Comput Assist Tomogr,1998,22:749-755
[26] Roos JE,Weishaupt D,Wildermuth S,et al.Experience of 4 years with open MR efecography:pictorial review of anorectal anatomy and disease.Radiographics,2002,22: :817-821
[27] Hilfiker PR, Debatin JF,Schwizer W,et al.MR defecography:depiction of anorectal anatomy and pathology.J Comput Assist Tomogr.1998,22:749-751
[28] Kohorn EI,Scioscia AL,Jeanty P,et al.Ultrasound cystourethrography by perineal scanning for the assessment of female stress urinary incontinence.Obstet Gynecol,1986,68:269-272
[29] White RD,McQuown D,McCarthy TA,et al.Realtime ultrasonography in the evaluation of urinary stress incontinence.Am J Obstet Gynecol,1980,138:235-237
[30] Bernaschek G,Spernol R,Wolf G,et al.Comparative determination of the vesico-urethral angle in incontinence via ultrasound and lateral urethro-cystogram.Geburtshilfe Frauenheilkd,1981,41:339-342
[31] Schaer GN,Koechli OR,Schuessler B,et al.Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence.Obstet Gynecol,1995,85:220-224
[32] Alper T,Cetinkaya M,Okutgen S,et al.Evaluation of urethrovesical angle by ultrasound in women with and without urinary stress incontinence.Int Urogynecol J,2001,12:308-311
[33] Dietz HP,Clarke B.The urethral pressure profile and ultrasound imaging of the lower urinary tract..Int Urogynecol J,2001,12:38-41
[34] Huang WC,Yang JM.Bladder neck funneling on ultrasound cystourethrography in primary stress urinary incontinence:a sign associated with urethral hypermobility and intrinsic sphincter deficiency.Urology,2003,61:936-941
[35] Schaer GN,Koechli OR,Schuessler B,Haller U.Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence.Obstet Gynecol,1995,85:220–224
[36] Dietz HP,McKnoulty L,Clarke B.Translabial color Doppler for imaging in urogynecology: a preliminary report.Ultrasound Obstet Gynecol,1999,14:144-147
[37] Law PJ,Bartram CI.Anal endosonography:Technique and normal anatomy.Gastrointest Radiol,1989,14:349-353
[38] Beets TRG,Morren GL,Beets GL,et al.Measurement of anal sphincter muscles:endoanal US,endoanal MR imaging,or phased-array MR imaging?A study with healthy volunteers.Radiology,2001,220:81-86
[39] Ostrzenski A,Osborne NG,Ostrzenska K,Method for diagnosing paravaginal defects using contrast ultrasonographic technique.J Ultrasound Med,1997,16:673-677
[40] 黄曼维,张华斌,陈朝文,等.经会阴部动态超声盆底的初步报告.中国医学影像技术,2003,19(3):338-340
[41] 赵跃华,祝小璐,杨光,等.经直肠腔内超声检测正常人肛管直肠声像图.上海医学影像杂志,2002,11(4):263-264
[42] 冯静,陈庚敏,张晓红,等.压力性尿失禁患者盆底电刺激治疗临床分析.中国妇产科临床杂志,2006,7:5—8
[43] Silva WA,Karram MM.Scientific basis for use of grafts during vaginal re-constructive procedures.Current Opinion in Obsterics and Gynecology,2005,17:519—529
[44] Fox SD,Stanton SL.Vault prolapse and rectocele: assessment of repair using sacrocolpopeay with mesh interposition.BJOG,2OOO,107:1371一l375
[45] deTayrac R,Gervaise A,Chanveaud A,et a1.Tension-free polypropylene mesh for vaginal repair of anterior vaginal wall prolapse.J Reprod Med,2005,50:75-80
[46] Novara G,ArtihaIli W.Surgery for pelvic organ prolapse:current status and future perspectives.Curr Opin Urol,2005,15:256-262
[2] Olsen AL,Smith VG,Bergstrom JO,et al.Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.Obstet Gynecol,1997,89(4):501-506
[3] Swift SE.The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care.Am J Obstet Gynecol, 2000,183(2):277-285
[4] Bump RC,Mattiasson A,Brubaker LP, et al.The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.Am J Obstet Gynecol,1996,175(1):10–17
[5] Hall AF,Theofrastous JP,Cundiff GW,et al.Interobserver and intraobserver reliability of the proposed International Continence Society,Society of Gynecologic Surgeons,and American Urogynecologic Society pelvic organ prolapse classification system.Am J Obstet Gynecol,1996,175(6):1467–1470
[6] Dietz HP,Wilson PD.The influence of bladder volume on the position and mobility of the urethrovesical junction.Int Urogynecol J,1999,10(1): :3–6
[7] Dietz HP,Shek C,Clarke B.Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol,2005,25(6):580–585
[8] Chiaffarino F,Chatenoud L,Dindelli M,et al.Reproductive factors,family history,occupation and risk of urogenital prolapse.Eur J Obstet Gynecol Reprod Biol,1999,82(1):63–67
[9] Samuelsson EC,Victor FT,Tibblin G,et al.Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors.Am J Obstet Gynecol,1999,180(2):299-305
[10] Dietz HP,Schierlitz L.Pelvic floor trauma in labour—myth or reality? Aust N Z J Obstet Gynaecol,2005,45(1):3–11
[11] Lien KC,Mooney B,DeLancey JO,et al.Levator ani muscle stretch induced by simulated vaginal birth.Obstet Gynecol, 2004,103(1):31–40
[12] Sultan AH,Thakar R. Lower genital tract and anal sphincter trauma.Best Pract Res Clin Obstet Gynaecol,2002,16(1):99–115
[13] Smith AR,Hosker GL,Warrell DW.The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolpase and stress incontinence.A neurophysiological study Br J Obstet Gynaecol,1989,96(1):24-28
[14] Progetto Menopausa Italia Study Group.Risk factors for genital prolapse in non-hysterectomized women around menopause,results from a large cross-sectional study in menopausal clinics in Italy.Eur J Obstet Gynecol Reprod Biol,2000,93(1):125-140
[15] Peschers UM,Forster A,Leib B,et al.Changes in levator ani muscle magnetic resonance imaging in women with postpartum stress urinary incontinence.Int Urogynecol J Pelvic Floor Dysfunct,1999,10(1):5.
[16] DeLancey JO,Kearney R,Chow Q,et al.The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery.Obstet Gynecol,2003,101(1)::46–53
[17] Tunn R,DeLancey JO,Howard D,et al.MR imaging of levator ani muscle recovery following vaginal delivery.Int Urogynecol J Pelvic Floor Dysfunct,1999,10(5):300–307
[18] Copas P,Bukovsky A,Asbury B,et al.Estrogen,progesterone and androgen receptor expression in levator ani muscle and fascia.J Womens Health Gend Based, Med,2001,10(8):785-795
[19] Chen GD,Oliver RH,Leung BS,et al.Estrogen receptor a and b expression in the vaginal walls and uterosacral ligaments of premenopausal and postmenopausal women.Fertil Steril,1999,71(1):1099-1102
[1] Hunskaar S,Amold EP,Burgio K,et al.Epidemiology and natural history of urinary incontinence.In Abrams P,Khoury S,Wein AJ eds,Incontinence.Plymouth,UK:Health Publications,1999:197-226
[2] Fothergill WE.Pathology and the operative treatment of displacements of the pelvic viscera.J Obstet Gynaecol Br Emp,1907,13:410-419
[3] Paramore RH.The supports in chief of the female pelvic viscera.J Obstet Gynaecol Br Emp,1908,30:319-409
[4] Strohbehn K.Normal pelvic floor anatomy. Obstet Gynecol Clin North Am,1998,25(4):683-705
[5] Berglas B,Rubin IC.Study of the supportive structures of the uterus by levator myography.Surg Gynecol Obstet,1953,97(6):677-692
[6] Gilpin SA,Gosling JA,Smith AR,et al.The pathogenesis of genitourinary prolapse and stress urinary incontinence of urine:a histological and histochemical study.Br J Obstet Gynaecol,1989,96(1):15-23
[7] Gosling JA,Dixon JS,Critchley HOA,et al.comparative study of the human external sphincter and periurethral levator ani muscles.Br J Urol,1981,53(1):35-41
[8] Critchley HO,Dixon JS,Gosling JA.Comparative study of the periurethral and perianal parts of the human levator ani muscle.Urol Int,1980,35(3):226-232
[9] Sender H.Female pelvic floor anatomy:the pelvic floor,supporting structures,and pelvic organs.Rev Urol,2004,6(5):2-10
[10] DeLancey JO.Anatomic aspects of vaginal eversion after hysterectomy.Am J Obstet Gynecol,1992,166(6):1717-1724
[11] John T,DeLancey JO. Functional anatomy of the pelvic floor and lower urinary tract.Clinical Obstetrics and Gynecology,2004,47( 1):3–17
[12] Matthew D. Barber MHS . Contemporary views on female pelvicanatomy.Cleveland and Clinic Journal of Msdicine,2005,72(4):3-11
[13] Handa VL,Pannu HK,Siddique S,et al.Architectural differences in the bony pelvis of women with and without pelvic floor disorders.Obstet Gynecol,2003,102(6):1283–1290
[1] Boonjunwetwat D,Sungtong P,Rojanasakul A.Defecography in patients with anorectal disorders:a study in 27 cases.J Med Assoc Thai,2001,84(8):1097-1102
[2] Fielding JR,Lee JH ,Dubeau CE,et al.Voiding cystourethrography findings in elderly women with urge incontinence.J Urol,2000,163(4):1216-1218
[3] Bremmer S,Mellgren A,Holmstrom B,et al.Peritoneocele and enterocele. Formation and transformation during rectal evacuation as studied by means of defaecoperitoneography.Acta Radiol,1998,39(2):167-175
[4] Kelvin FM,Hale DS,Maglinte DD,et al.Female pelvic organ prolapse:diagnostic contribution of dynamic cystoproctography and comparison with physical examination.AJR,1999,173(11):31-37
[5] DeLancey JOL,Speights SE,Tunn R,et al.Localized levator ani muscle abnormalities seen in MR images:site,size and side of occurrence.Int Urogynecol J Pelvic Floor Dysfunct,1999,10(1):20–21
[6] Gritzky A,Brandl H.The Voluson (Kretz) technique. In:Merz E,editor.3-D ultrasound in obstetrics and gynecology.Philadelphia:Lippincott Williams & Wilkins Healthcare,1998,9–15
[7] DeLancey JOL.Structural anatomy of the posterior pelvic compartment as it relates to rectocele.Am J Obstet Gynecol,1999,180(4):815–823
[8] Delancey JOL,Hurd WW.Size of the urogenital hiatus in the levator ani muscles in normal women and women with pelvic organ prolapse.Obstet Gynecol,1998,91(3):364–368
[9] Kearney R,Sawhney R,DeLancey JOL.Levator ani muscle anatomy evaluated by origin-insertion pairs.Obstet Gynecol 2004,104(1):168–173
[1] Mant J,Painter R,Vessey M.Epidemiology of genital prolapse:observations from the Oxford Family Planning Association Study.Br J Obstet Gynaecol,1997,104(5):579–585
[2] Olsen A,Smith V,Bergstrom J,et al.Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.Obstet Gynecol,1997,89(4):501–506
[3] Bump R,Mattiasson A,Bo K,et al.The standardisation of terminology of female pelvic organ prolapse and pelvic floor dysfunction.M J Obstet Gynecol,1996,175(1):10–17
[4] Weber AM,Abrams P,Brubaker L,et al.The standardization of terminology for researchers in female pelvic floor disorders.Int Urogynecol J,2001,12(3):178–186
[5] Miklos JR,Kohli N.Laparoscopic paravaginal repair plus burch colposuspension:review and descriptive technique.Urology,2000,56(6 (Suppl. 1)):64–69
[6] Miklos JR,Kohli N.Accuracy of clinical assessment of paravaginal defects in women with anterior vaginal wall prolapse.Am J Obstet Gynecol,2000,182(3):747–749
[7] Shull BL,Baden WF.A six-year experience with paravaginal defect repair for stress urinary incontinence.Am J Obstet Gynecol,1989,160(6):1432–1439
[8] Singh K,Jakab M,Wendy MN,et al.Three-dimensional magnetic resonance imaging assessment of levator ani morphologic features in different grades of prolapse.American Journal of Obstetrics and Gynecology,2003,188(4):910-915
[9] Vakili B,Zheng YT,Loesch H,et al.Levator contraction strength and genital hiatus as risk factors for recurrent pelvic organ prolapse. American journal of obstetrics and gynecology,2005,192 (5), 1592-1598
[10] Snooks SJ,Swash M,Mathers SE,et al.Effect of vaginal delivery on the pelvic floor:a 5-year follow-up. Br J Surg,1990,77:1358–1360
[11] Huddleston HT,Dunnihoo DR,Huddleston PM,et al.Magnetic resonance imaging of defects in DeLancey's vaginal support levels I,II,and III.Am J Obstet Gynecol,1995,172(6):1778-1782
[1] Fielding JR. Practical MR imaging of female pelvic floor weakness.Radiographics,2002,22(2):295-304
[2] Fielding JR. MR imaging of pelvic floor relaxation.Radiol Clin North Am,2003,41(4):747-756.
[3] Snocks SJ,Swash M,Machers SE,et al.Effect of vaginal delivery on the pelvic floor,a five-year follow up.Br J Surg,1990,77::1358-1360
[4] Delancey Jol. Anatomy and biomecganics of genital prolapse.Clin Onstet Gyneco,1993,36:8-10
[5] Busacchi P,Giongio RDE.A histological and immunohisto- chemical study of neuropcptidc containing somatic nervcs in the levator animusclc of women with genitourinary prolapse.Acta Obstet Gynecol Scand,1999 ,78:2-6
[6] Liapis A,Bakas P,pafiti A,et al.Change of collagen type in women with genuine stress incontincnce. Urol Rcs,2000,28( 5):323一326
[7] Liapis A,Bakas P,Pafiti A,et al.Changes of collagen type 3 in female patients with genuine stress incontinence and pelvic floor prolapse.Eur J Obstet Gynccol Rcprod Biol,2001,97( 1):76-79
[8] Yamamoto K,Yamamoto M..Decrease in elastin gene expression and Protein in fibroblasts derived from cardinal ligaments of patients with prolapse uteri.Cell Bio Int,1997,21(9):605-611
[9] Copas P,Bukovsky A.Estrogen,Progesterone and rogen receptor expression in levator ani muscle and Fascia.Women Health and Based Med,2001,10(8):785-795
[10] Rosenfield LR,White RE.Calcium -activated potassium challels and nitric oxide coregulate estrogen inducdcd vasodilation.Am J Physiol Heart Cirl Physio,2000,279( 1): 319-328
[11] Dick GM,Sanders KM.(xcno)estrogen sensitivity of smooth muscle BK channels conferred by the regulatory betal subnit:a study of bettal knockout mice..J Biol Chem,2001,276( 48):44835-44840
[12] 部分省、市、自治区子宫脱垂、尿瘘防治科研协作组。有关子宫脱垂防治的意见。中华妇产科杂志,1979,14:222 – 223
[13] Bump RC,Mattiasson A,Kari B,et al.The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.Am J Obstet Gynecol,1996,175:10 -17
[14] Wallden L.Defecation block in cases of deep rectogenital pouch.Acta Chir Scand,1952,165(suppl):35-60
[15] Jeffcoate TNA,Roberts H.Observations on stress incontinence of urine.Am J Obstet Gynecol,1952,64:721-737
[16] Ducharme JC,Bertrand R,Chacar R.Is it possible to diagnose inguinal hernia by X-ray?a preliminary report on herniography.Can Assoc Radiol J,1967,18:448-451
[17] Halligan S,Bartram CI. Evacuation photography combined with positive contrast Imaging,peritoneography to demonstrate pelvic floor hernias.Abdom,1995,20:442-445 [18 ] Pinho M,Yoshioka K,Keighley MRB.Are pelvic floor movements abnormal in disordered defecation? Dis Colon Rectum,1991,34:1117-1119
[19] Kelvin FM,Maglinte DDT,Hornback JA,et al.Pelvic prolapse assessment with evacuation photography (defecography).Radiology,1992,184:547-551
[20] Brubaker L, Retzky S,Smith C,et al.Pelvic floor evaluation with dynamic fluoroscopy.Obstet Gynecol,1993,82:863-868
[21] Halligan S,Bartram CI. Evacuation photography combined with positive contrast Imaging,peritoneography to demonstrate pelvic floor hernias.Abdom.1995,20:442-445
[22] 刘宝华主编.便秘的诊断及治疗.北京:军事医学科学出版社,2002,202-210
[23] Yang A,Mostwin 3L,Rosenshein NB,et al.Pelvic floor descent in women dynamic evaluation with fast MR imaging and cinematic display.Radiology,1991,179:25-33
[24] Hussain SM,Stoker J,Kuiper 3W,et al.MR imaging of anal sphincter complex with an endoanal coil:normal anatomy and pathology.Radiology,1994,193:445-448
[25] Hilfiker PR,Debatin JF,Schwizer W,et al.MR defecography: depiction of ano rectalanatomy and pathology.J Comput Assist Tomogr,1998,22:749-755
[26] Roos JE,Weishaupt D,Wildermuth S,et al.Experience of 4 years with open MR efecography:pictorial review of anorectal anatomy and disease.Radiographics,2002,22: :817-821
[27] Hilfiker PR, Debatin JF,Schwizer W,et al.MR defecography:depiction of anorectal anatomy and pathology.J Comput Assist Tomogr.1998,22:749-751
[28] Kohorn EI,Scioscia AL,Jeanty P,et al.Ultrasound cystourethrography by perineal scanning for the assessment of female stress urinary incontinence.Obstet Gynecol,1986,68:269-272
[29] White RD,McQuown D,McCarthy TA,et al.Realtime ultrasonography in the evaluation of urinary stress incontinence.Am J Obstet Gynecol,1980,138:235-237
[30] Bernaschek G,Spernol R,Wolf G,et al.Comparative determination of the vesico-urethral angle in incontinence via ultrasound and lateral urethro-cystogram.Geburtshilfe Frauenheilkd,1981,41:339-342
[31] Schaer GN,Koechli OR,Schuessler B,et al.Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence.Obstet Gynecol,1995,85:220-224
[32] Alper T,Cetinkaya M,Okutgen S,et al.Evaluation of urethrovesical angle by ultrasound in women with and without urinary stress incontinence.Int Urogynecol J,2001,12:308-311
[33] Dietz HP,Clarke B.The urethral pressure profile and ultrasound imaging of the lower urinary tract..Int Urogynecol J,2001,12:38-41
[34] Huang WC,Yang JM.Bladder neck funneling on ultrasound cystourethrography in primary stress urinary incontinence:a sign associated with urethral hypermobility and intrinsic sphincter deficiency.Urology,2003,61:936-941
[35] Schaer GN,Koechli OR,Schuessler B,Haller U.Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence.Obstet Gynecol,1995,85:220–224
[36] Dietz HP,McKnoulty L,Clarke B.Translabial color Doppler for imaging in urogynecology: a preliminary report.Ultrasound Obstet Gynecol,1999,14:144-147
[37] Law PJ,Bartram CI.Anal endosonography:Technique and normal anatomy.Gastrointest Radiol,1989,14:349-353
[38] Beets TRG,Morren GL,Beets GL,et al.Measurement of anal sphincter muscles:endoanal US,endoanal MR imaging,or phased-array MR imaging?A study with healthy volunteers.Radiology,2001,220:81-86
[39] Ostrzenski A,Osborne NG,Ostrzenska K,Method for diagnosing paravaginal defects using contrast ultrasonographic technique.J Ultrasound Med,1997,16:673-677
[40] 黄曼维,张华斌,陈朝文,等.经会阴部动态超声盆底的初步报告.中国医学影像技术,2003,19(3):338-340
[41] 赵跃华,祝小璐,杨光,等.经直肠腔内超声检测正常人肛管直肠声像图.上海医学影像杂志,2002,11(4):263-264
[42] 冯静,陈庚敏,张晓红,等.压力性尿失禁患者盆底电刺激治疗临床分析.中国妇产科临床杂志,2006,7:5—8
[43] Silva WA,Karram MM.Scientific basis for use of grafts during vaginal re-constructive procedures.Current Opinion in Obsterics and Gynecology,2005,17:519—529
[44] Fox SD,Stanton SL.Vault prolapse and rectocele: assessment of repair using sacrocolpopeay with mesh interposition.BJOG,2OOO,107:1371一l375
[45] deTayrac R,Gervaise A,Chanveaud A,et a1.Tension-free polypropylene mesh for vaginal repair of anterior vaginal wall prolapse.J Reprod Med,2005,50:75-80
[46] Novara G,ArtihaIli W.Surgery for pelvic organ prolapse:current status and future perspectives.Curr Opin Urol,2005,15:256-262
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |