女性壓力性尿失禁的解剖學發病機制探討

Anatomical pathogenesis of female stress urinary incontinence

SHEN Jihong，LI Ling

（Department of Urology，The First Affiliated Hospital of Kunming Medical University，Kunming 650032，China）

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.

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

摘要：女性控尿是一個復雜的生理過程，本文從解剖學層面分析靜態的尿道解剖結構改變和動態的功能解剖學變化因素在女性壓力性尿失禁（SUI）發生中的作用。在SUI患者中，尿道自身的解剖學變化包括管腔黏膜萎縮、管壁彈性下降、尿道括約肌功能缺陷和功能尿道長度縮短；尿道周圍支撐結構方面的變化包括膀胱頸支撐力減弱、吊床結構損傷、恥骨尿道韌帶薄弱、肛提肌薄弱或功能障礙等；盆底神經的損傷在SUI的病理過程中也起到了重要的作用。在動態功能解剖方面，本文分析了膀胱頸與提肌板互鎖、尿道外括約肌與肛提肌互鎖、尿道中后段與會陰體互鎖的3個動態互鎖機制。借由這些動態互鎖機制，靜態結構得到了協調與支持，從而有助于維持正常的控尿功能，對這些互鎖機制的分析能夠幫助理解SUI患者控尿問題的機制。總之，本文試圖通過對女性控尿機制靜態和動態因素的系統化分析，構建清晰的理論框架為女性SUI的臨床診療提供充實的理論基礎。

關鍵詞：功能解剖學；女性壓力性尿失禁；膀胱頸與提肌板互鎖；尿道外括約肌與肛提肌互鎖；尿道中后段與會陰體互鎖；發病機制

中圖分類號：R711.59 文獻標志碼：ADOI：10.3969/j.issn.1009-8291.2025.02.003

收稿日期：2024-10-11 修回日期：2024-12-16

基金項目：國家自然科學基金地區基金項目（No.82260297）

通信作者：李玲，住院醫師。E-mail：201601384@kmmu.edu.cn

作者簡介：申吉泓，博士，主任醫師。研究方向：功能盆底及尿控。

E-mail：shenjihong@kmmu.edu.cn

女性壓力性尿失禁（stress urinary incontinence，SUI）是指在噴嚏、咳嗽、大笑或運動等腹壓增高的情況下出現不自主的尿液自尿道口漏出，其尿動力學檢查表現為充盈性膀胱測壓時，在腹壓增高而無逼尿肌收縮的情況下出現不隨意的漏尿^［1］。……