经会阴超声在经阴道植入网片术后近期评估盆腔器官脱垂中的价值  

Value of Transperineal Ultrasound in Short-term Evaluation of Pelvic Organ Prolapse after Transvaginal Mesh Implantation

作　　者：刘真真 谭莉 莎仁高娃 张也 陈娟[3] 朱兰[3] LIU Zhenzhen;TAN Li;SHAREN Gaowa;ZHANG Ye;CHEN Juan;ZHU Lan(Department of Ultrasound Medicine,PUMC Hospital,CAMS and PUMC,Beijing 100730,China;Department of Health Management,PUMC Hospital,CAMS and PUMC,Beijing 100730,China;Department of Obstetrics and Gynecology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院超声医学科,北京100730 [2]中国医学科学院,北京协和医学院,北京协和医院健康医学部,北京100730 [3]中国医学科学院,北京协和医学院,北京协和医院妇产科,北京100730

出　　处：《中国医学科学院学报》2021年第6期892-896,共5页Acta Academiae Medicinae Sinicae

基　　金：国家自然科学基金(81830043);中国医学科学院医学与健康科技创新工程项目(CAMS-I2M、2017-I2M-1-002);国家超声医学质量控制中心盆底质控项目(IHECC-2019-C-0070)。

摘　　要：目的应用经会阴超声检查技术对经阴道植入网片(TVM)盆底重建手术后患者进行观察,比较超声与临床查体诊断盆腔器官脱垂(POP)的一致性,分析差异原因,探讨超声在术后评估中的作用,探索脱垂复发的相关因素。方法回顾2013年9月至2019年11月于本院行经会阴超声检查的TVM术后6个月内患者临床查体(国际尿控协会POP-Q评分)和超声检查资料,比较二者诊断结果;比较超声脱垂组与对照组肛提肌裂孔面积增大和肛提肌撕裂发生率的差异。结果共纳入147例患者。超声与POP-Q评分法在前盆腔和后盆腔脱垂的诊断一致性Kappa值分别为0.268(P=0.000)和0.235(P=0.001);超声与临床不一致病例共计37例,其中前盆腔14例(9.52%)、后盆腔23例(15.65%);超声诊断脱垂较临床多32例,其中前盆腔13例(8.84%)、后盆腔19例(12.93%)。超声脱垂组的肛提肌裂孔面积增大发生率显著高于对照组(51.35%比33.94%,χ^(2)=3.950,P=0.047);组间肛提肌撕裂发生率差异无统计学意义(P=1.000)。结论经会阴超声检查与临床查体存在一致性,超声能够检出更多的POP,可作为临床诊断的补充。TVM术后脱垂复发与肛提肌裂孔面积增大有相关性。Objective To observe the patients after transvaginal mesh(TVM)implantation surgery by using transperineal ultrasound(TPUS),compare the diagnosis of pelvic organ prolapse(POP)by TPUS and clinical examination[according to the Pelvic Organ Prolapse Quantification(POP-Q)system published by the International Continence Society],and to explore the role of ultrasound in postoperative evaluation as well as the high-risk factors of post-surgery POP recurrence.Methods This is a retrospective study based on the POP-Q records and TPUS data sets of patients within 6 months after TVM surgery during September 2013 and November 2019.The diagnostic results of TPUS and POP-Q were compared.The incidences of hiatal ballooning and levator avulsion were separately compared between the TPUS group and the control group.Results A total of 147 patients were enrolled.The Kappa values between TPUS and POP-Q in the diagnosis of anterior and posterior compartment POP were 0.268(P=0.000)and 0.235(P=0.001),respectively.There were altogether 37 cases diagnosed inconsistently between TPUS and POP-Q,including 14(9.52%)cases of anterior compartment prolapse and 23(15.65%)cases of posterior compartment prolapse.TPUS diagnosed 32 more cases of prolapse than POP-Q,which included 13(8.84%)cases of anterior compartment prolapse and 19(12.93%)cases of posterior compartment prolapse.The incidence of hiatal ballooning in the TPUS prolapse group was significantly higher than control group(51.35%vs.33.94%,χ^(2)=3.950,P=0.047).The incidence of levator avulsion showed no significant difference between the two groups(P=1.000).Conclusions TPUS diagnosis of POP after TVM surgery has consistency with the POP-Q diagnosis of International Continence Society.TPUS can detect more POP cases,and thus it may act as a supplement for clinical diagnosis.Hiatal ballooning is associated with POP recurrence after TVM surgery.

关 键 词：三维经会阴超声 盆腔器官脱垂 经阴道植入网片 诊断影像学 

分 类 号：R445.1[医药卫生—影像医学与核医学]