女性压力性尿失禁的解剖学发病机制探讨

Anatomical pathogenesis of female stress urinary incontinence

摘要

女性控尿是一个复杂的生理过程，本文从解剖学层面分析静态的尿道解剖结构改变和动态的功能解剖学变化因素在女性压力性尿失禁（SUI）发生中的作用。在SUI患者中，尿道自身的解剖学变化包括管腔黏膜萎缩、管壁弹性下降、尿道括约肌功能缺陷和功能尿道长度缩短；尿道周围支撑结构方面的变化包括膀胱颈支撑力减弱、吊床结构损伤、耻骨尿道韧带薄弱、肛提肌薄弱或功能障碍等；盆底神经的损伤在SUI的病理过程中也起到了重要的作用。在动态功能解剖方面，本文分析了膀胱颈与提肌板互锁、尿道外括约肌与肛提肌互锁、尿道中后段与会阴体互锁的3个动态互锁机制。借由这些动态互锁机制，静态结构得到了协调与支持，从而有助于维持正常的控尿功能，对这些互锁机制的分析能够帮助理解SUI患者控尿问题的机制。总之，本文试图通过对女性控尿机制静态和动态因素的系统化分析，构建清晰的理论框架为女性SUI的临床诊疗提供充实的理论基础。

Abstract

Urinary control in females is a complex physiological process. From an anatomical perspective, this article explores the role of static urethral anatomical changes and dynamic functional anatomical changes in the occurrence of female stress urinary incontinence (SUI). In SUI patients, the changes in the urethra include mucosal atrophy, reduced elasticity, sphincter dysfunction, and shortening of the functional urethral length. The surrounding supportive structures involved in the development of SUI include weakened bladder neck support, damage to the hammock structure, weakened pubic urethral ligament and dysfunction of the levator ani muscle. Additionally, damage to the pelvic floor nerve plays an important role in the pathophysiology of SUI. In terms of dynamic functional anatomy, this article analyzes three dynamic interlocking mechanisms, including the interlock between the bladder neck and pelvic diaphragm, the external urethral sphincter and levator ani muscle, the posterior urethra and perineal body. Through these dynamic mechanisms, the static structure is coordinated and supported, helping to maintain normal urinary control function. These analyses aid in understanding the mechanisms underlying urinary control problems in SUI patients. In summary, this article attempts to construct a clear theoretical framework for the clinical diagnosis and treatment of female SUI by systematically analyzing the static and dynamic factors of female urinary control mechanisms.

关键词

功能解剖学 / 女性压力性尿失禁 / 膀胱颈与提肌板互锁 / 尿道外括约肌与肛提肌互锁 / 尿道中后段与会阴体互锁 / 发病机制

Key words

functional anatomy / female stress urinary incontinence / bladder neck and pelvic diaphragm interlock / external urethral sphincter and levator ani muscle interlock / posterior urethra and perineal body interlock / pathogenesis

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基金资助

国家自然科学基金地区基金项目(82260297)