女性盆底功能媛障碍性疾病防治与展望.pptVIP

This is a dorsal lithotomy view of the pelvic floor muscles. This is a superior view of the pelvis. Again, orient yourself in terms of the sacrum, pubis, and left and right os coxae. Also notice the openings for the urethra, vagina, and anal canal. The vessel anterior to the urethra is the deep dorsal vein of the clitoris. There are additional muscles that comprise the pelvic floor. These muscles include the piriformis, coccygeus, and obturator internus. The arcus tendineus fasciae pelvis (fascial white line) is a thickening of the parietal pelvic fascia. It extends from the posterior aspect of the pubic bone to the ischial spine. It serves as the ultimate attachment of the horizontal supports of the pubocervical fascia and the rectovaginal septum. The pubocervical fascia indirectly attaches laterally to the arcus tendineus fascia pelvis (fascial white line). A curvilinear thickening of the parietal pelvic fascia covering the obturator internus muscle from the posterior and lateral aspect of the pubic bone toward the ischial spine gives rise to the levator ani muscles. This thickening is called the arcus tendineus levator ani (muscle white line), which stretches between the body of the pubis and the ischial spine. 盆底肌肉训练（kegel训练） 使尿道闭合压升高，伴随患者症状改善 轻度尿失禁患者，68%明显改善 重度尿失禁患者，13%明显改善 Elia G，Berghmans A，1993 盆底肌肉训练方法（kegel训练） 做缩紧肛门阴道的动作 每次收紧不少于3秒后放松 连续做15-30分钟 每日进行2-3次，或每日做150-200次 6-8周为1个疗程 4-6周患者有改善 3个月明显效果 盆底肌肉训练（kegel训练） 目的：加强盆底肌肉 改善尿道、肛门括约肌的功能 适应症： 轻-中度尿失禁 轻度子宫、膀胱、直肠脱垂 术前术后的辅助治疗 改善性生活质量 产后盆底康复 无副作用及并发症 盆底肌纤维类型 Ⅰ类纤维：强直收缩，长而持久，不易疲劳 耻骨-阴道肌和耻骨-直肠肌70% 耻骨-尾骨肌90% 髂骨-尾骨肌68% Ⅱ类纤维：阶段性收缩，快速短暂，易疲劳 Ⅱa类纤维和Ⅱb类纤维：浅层肌 盆底深层肌纤维 Ⅰ类肌力↓的表现：阴道松弛、子宫或阴道脱垂、体位性持续漏尿 Ⅱ类肌力↓的表现：咳嗽、大笑、运动、运动等动作时的漏尿 盆底浅层肌纤维Ⅰ类肌力↓ 表现为阴道口松弛、性功能障碍、反复泌尿感染、尿急、尿频 盆底肌肌力下降的临床表现 Mechanical, Electrical and physiological Properties of Muscle Fibres肌肉纤维的机械的，肌电生理学的特征 Ⅰ