经会阴超声及POP-Q评分在分娩后盆腔器官脱垂合并压力性尿失禁中的诊断价值研究  

The diagnostic value of perineal ultrasound and POP-Q score in pelvic organ prolapse with stress urinary incontinence after delivery

作　　者：邓舒昊 张渊[1] 施秀荣 单君 朱一成 王永兵 江泉[1] Deng Shuhao;Zhang Yuan;Shi Xiurong;Shan Jun;Zhu Yicheng;Wang Yongbing;Jiang Quan(Department of Ultrasound,Pudong New Area Peoples'Hospital Affiliated to Shanghai Health University,Shanghai 201200,P.R.China)

机构地区：[1]上海健康医学院附属浦东新区人民医院超声科,上海201200

出　　处：《中国计划生育和妇产科》2021年第8期43-46,I0001,共5页Chinese Journal of Family Planning & Gynecotokology

基　　金：浦东新区卫计委重要薄弱学科(项目编号:PWZbr2017-10);浦东新区科技发展基金资助(项目编号:PKJ2018-Y11);浦东新区卫生和生育计划委员会青年科技项目(项目编号:PW2018B-04)。

摘　　要：目的探讨经会阴超声及盆腔器官脱垂定量分期法(pelvic organ prolapse quantitation,POP-Q)评分在分娩后盆腔器官脱垂合并压力性尿失禁(stress urinary incontinence,SUI)中的诊断价值。方法收集2016年4月至2018年4月在上海健康医学院附属浦东新区人民医院就诊的75例盆腔器官脱垂患者,经临床检查、尿道动力学检查证实,40例合并SUI,设为研究组。余下35例为单纯盆腔器官脱垂,未合并SUI,设为对照组。两组均行POP-Q评分、经会阴盆底二维超声检查。以临床综合诊断结果为金标准,分析经会阴超声及POP-Q评分在分娩后盆底功能障碍性疾病中的诊断价值。结果ROC曲线分析结果显示,Aa(距处女膜3 cm的阴道前壁)、Ba(阴道前壁脱出离处女膜最远处)及联合预测是否合并SUI的AUC分别为0.721、0.711、0.863,差异均有统计学意义(P<0.01)。Aa、Ba联合检测用于判断是否合并SUI的敏感度和特异度分别为82.5%、80.0%。膀胱后壁最低点下降值、尿道旋转角及联合预测在是否合并SUI预测中的AUC分别为0.745、0.723、0.877,差异均有统计学意义(P<0.01)。膀胱后壁最低点下降值、尿道旋转角及联合预测用于判断是否合并SUI的敏感度和特异度分别为85.0%、80.0%。结论POP-Q评分中Aa、Ba指示点与盆腔脏器脱垂是否合并SUI具有一定的相关性。超声检查可以为盆腔脏器脱垂是否合并SUI的诊断提供影像学定位。Objective To explore the diagnostic value of perineal ultrasound and pelvic organ prolapse quantitation(POP-Q)score in pelvic organ prolapse with stress urinary incontinence(SUI)after delivery.Methods From April 2016 to April 2018,75 patients with pelvic organ prolapse admitted to Pudong New Area Peoples’Hospital Affiliated to Shanghai Health University were confirmed by clinical examination and urethral dynamics examination,and 40 patients with SUI were enrolled as the study group.The remaining 35 cases were simple pelvic organ prolapse without SUI,and were set as the control group.POP-Q score and two-dimensional perineal pelvic floor ultrasonography were performed in both groups.The diagnostic value of trans perineal ultrasound and POP-Q score in pelvic floor dysfunction after delivery was analyzed with the clinical comprehensive diagnosis results as the gold standard.Results The ROC curve analysis results showed that the AUC of Aa,Ba and the combined prediction of SUI was 0.721,0.711 and 0.863,respectively,with statistical significance(P<0.01).The sensitivity and specificity of Aa and Ba combined test to determine whether SUI was complicated were 82.5%and 80.0%,respectively.The AUC of the lowest point of the posterior wall of the bladder,urethral rotation angle and combined prediction in the prediction of whether SUI was combined were 0.745,0.723 and 0.877,respectively,which were of statistical significance(P<0.01).The sensitivity and specificity of the lowest point of the posterior wall of the bladder,the rotation angle of the urethra and the combined prediction used to determine whether SUI was complicated were 85.0%and 80.0%,respectively.Conclusion Aa and Ba indicators in POP-Q score were correlated with whether pelvic organ prolapse combined with SUI.Ultrasonic examination can provide radiographic localization for the diagnosis of pelvic organ prolapse with SUI.

关 键 词：超声 POP-Q评分 膀胱脱垂 压力性尿失禁 

分 类 号：R711.2[医药卫生—妇产科学]