经会阴盆底超声定量评估后盆腔脱垂的可行性研究  

Feasibility of transperineal ultrasound in quantitative assessment of posterior compartment prolapse

作　　者：林欣 吴曼丽 黄泽萍[1] 徐净[1] 王旭东[2] 陈莹[1] 吴双玉 符元春 陈海燕[4] 南淑良 黄伟俊[6] 陈禹[7] 王莉 荆春丽 陈文娟[10] 田家玮[2] 张新玲[1] Lin Xin;Wu Manli;Huang Zeping;Xu Jing;Wang Xudong;Chen Ying;Wu Shuangyu;Fu Yuanchun;Chen Haiyan;Nan Shuliang;Huang Weijun;Chen Yu;Wang Li;Jing Chunli;Chen Wenjuan;Tian Jiawei;Zhang Xinling(Department of Ultrasound,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Ultrasound,the Second Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of Ultrasound,Hunan Provincial Maternal and Child Health Care Hospital,Changsha 410000,China;Department of Ultrasound,Zhongshan People′s Hospital,Zhongshan 528403,China;Ultrasound Diagnosis Center,Shaanxi Provincial People′s Hospital,the Third Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710068,China;Department of Ultrasound,the First People′s Hospital of Foshan,Foshan 528000,China;Department of Medical Ultrasound,the Fourth Hospital of Shijiazhuang,Shijiazhuang 050000,China;Department of Ultrasound Diagnosis,Tangdu Hospital,Fourth Military Medical University,Xi′an 710000,China;Department of Ultrasound,Dalian Maternal and Child Health Care Hospital,Dalian 116000,China;Department of Ultrasound,Jiujiang City Maternal and Child Health Care Hospital,Jiujiang 332000,China)

机构地区：[1]中山大学附属第三医院超声科,广州510630 [2]哈尔滨医科大学附属第二医院超声科,150001 [3]湖南省妇幼保健院超声科,长沙410000 [4]中山市人民医院超声影像科,528403 [5]陕西省人民医院暨西安交通大学医学院第三附属医院超声诊断中心,710068 [6]佛山市第一人民医院超声诊疗中心,528000 [7]石家庄市第四医院超声科,050000 [8]空军军医大学唐都医院超声诊断科,西安710000 [9]大连市妇幼保健院超声科,116000 [10]九江市妇幼保健院超声科,332000

出　　处：《中华超声影像学杂志》2020年第9期771-776,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(91859115)。

摘　　要：目的探讨经会阴盆底超声定量评估女性后盆腔脱垂的可行性。方法纳入2017年1月至2019年1月在研究分中心单位就诊的485例女性患者,对其进行问诊、行盆腔器官脱垂量化(pelvic organ prolapse quantification,POP-Q)分期及盆底超声检查,采集静息状态及最大Valsalva状态的盆底超声容积数据。结果患者后盆腔脱垂POP-Q分期越高,最大Valsalva状态直肠壶腹部位置越低(POP-Q分期=0对POP-Q分期=1,P<0.001;POP-Q分期=1对POP-Q分期≥2,P<0.001),直肠壶腹部移动度越大(POP-Q分期=0对POP-Q分期=1,P<0.001;POP-Q分期=1对POP-Q分期≥2,P=0.007)。静息状态及最大Valsalva状态下直肠壶腹部位置和直肠膨出高度与脱垂症状存在相关性(r=-0.200,P<0.001;r=-0.252,P<0.001;r=0.086,P=0.045)。最大Valsalva状态下直肠壶腹部位置诊断后盆腔脱垂(POP-Q分期≥1)和中重度后盆腔脱垂(POP-Q分期≥2)的ROC曲线下面积分别为0.75和0.85,相应的最佳截断值分别为线下7.32 mm和线下12 mm。结论经会阴盆底超声检查测量指标与后盆腔脱垂POP-Q分期具有较好的相关性,能够定量评估女性后盆腔脱垂的严重程度。Objective To investigate the feasibility of transperineal ultrasound in quantitative assessment of posterior compartment prolapse among Chinese women.Methods The prospective multicenter study enrolled 485 women between January 2017 and January 2019.All patients underwent a standard clinical interview,pelvic organ prolapse quantification(POP-Q)examination and transperineal ultrasound examination.Volume data of transperineal ultrasound examinations were obtained at rest and in maximal Valsalva maneuver.Results The higher POP-Q stage of posterior compartment,the lower rectal ampulla position in maximal Valsalva maneuver(POP-Q stage=0 vs POP-Q stage=1,P<0.001;POP-Q stage=1 vs POP-Q stage≥2,P<0.001),and the greater rectal ampulla hypermobility(POP-Q stage=0 vs POP-Q stage=1,P<0.001;POP-Q stage=1 vs POP-Q stage≥2,P=0.007).The rectal ampulla position at rest and in maximal Valsalva maneuver and rectocele depth were correlated with prolapse symptoms(r=-0.200,P<0.001;r=-0.252,P<0.001;r=0.086,P=0.045).The corresponding cut-off values of rectal ampulla position in maximal Valsalva in diagnosing posterior compartment prolapse(POP-Q stage≥1)and clinical significant posterior compartment prolapse(POP-Q stage≥2)were 7.32 mm below the symphysis pubis and 12 mm below the symphysis pubis,respectively,with the area under the ROC curve as 0.75 and 0.85,respectively.Conclusions The ultrasonic measurements by transperineal ultrasound is significantly associated with POP-Q examination in posterior compartment,and it is demonstrated as a useful tool in quantitative assessment of the severity of posterior compartment prolapse.

关 键 词：经会阴盆底超声 盆腔器官脱垂量化分析 后盆腔脱垂 

分 类 号：R445.1[医药卫生—影像医学与核医学] R711.2[医药卫生—诊断学]