中田 真木

Maki NAKATA

三井記念病院産婦人科

Department of Obstetrics and Gynecology, Mitsui Memorial Hospital

キーワード : transperineal ultrasonography, translabial ultrasonography, introital ultrasonography, pelvic organ prolapse, stress urinary incontinence

ウロギネコロジー領域の外来において，経会陰超音波検査（transperineal ultrasonography: TPUS）は汎用性が高い．TPUSにより，骨盤底と下部尿路の評価に役立つ豊富な情報が得られる．TPUSには，経陰唇超音波検査（translabial ultrasonography: TLUS）と腟入口部超音波検査（introital ultrasonography: IUS）がある．TLUSは，骨盤底の力学的な支持不全を検出するために行われる．この検査は主に動的超音波検査の枠組みで行われ，カバーをかけたコンベックスプローブを用い，患者にすぼめ，咳払い，いきみなどの力を負荷させて観察する．ふつうこの検査は婦人科診察台で行うが，適宜中腰態勢での検査を追加し支持不全箇所の検出に務める．IUSは解像力の高い経腟プローブにより3次元の超音波データを取り込み，骨盤底支持構造の変容や欠損を画像化する新たな手法である．妊娠・分娩によって会陰，肛門，骨盤隔膜などに生じた損傷箇所の多くは，この手法により可視化される．TPUSは，外科治療により便益を得る患者をスクリーニングするのに有用である．この検査が産婦人科もしくは泌尿器科を標榜する診療所で広く行われるようになれば，どの患者をどの高次施設に紹介するべきか，判定しやすくなる．それぞれの医療施設のウロギネコロジー領域における役割を見直し施設間の連携を形成していくために，TPUSの担う役割は大きい．

Transperineal ultrasonography (TPUS) is a versatile diagnostic tool in urogynecological outpatient practices. It provides rich information that helps us understand the structural and functional integrity of the pelvic floor and the lower urinary tract. TPUS is subdivided into two classes: translabial ultrasonography (TLUS) and introital ultrasonography (IUS). TLUS is used to detect sites of mechanical failure within the pelvic floor. This procedure is usually performed in the context of dynamic ultrasonography, by normal convex probe adequately covered, with squeezing, coughing, and straining efforts that the subject addresses to the pelvic floor. The subject is normally placed in the gynecologic position during this procedure, but an examination in a semi-crouching position may reveal another pelvic floor weakness that has been masked while the subject was placed horizontally. IUS is an emerging method of examination to detect acoustic alterations in the pelvic floor, by breaking down three-dimensional high-resolution ultrasonographic data. Many of the obstetric injuries in the perineum, in the anus, and in the pelvic diaphragm are visualized by this technique. TPUS helps screen the cases that may benefit from surgical treatment. If this procedure is put in practical use widely by gynecological and urological outpatient clinics, it will enable them to determine which cases should be referred to which advanced medical facilities. TPUS may assume a substantial role in reassigning the tasks in the field of urogynecology, forging a new relationship between clinics and hospitals.