经会阴超声监测LHap变化在盆底功能障碍患者诊断中的价值  

Value of transperineal ultrasound assessment of levator hiatal antero-posterior diameter changes in the prediction of pelvic floor dysfunction

作　　者：毛卉 马建婷[1] 杨春林[1] 严映波 赵敏娜[1] 姜海英[1] Mao Hui;Ma Jianting;Yang Chunlin;Yan Yingbo;Zhao Minna;Jiang Haiying(Department of Obstetrics and Gynecology,Yuyao People's Hospital of Zhejiang Province,Yuyao 315400,Zhejiang Province,China;Department of Ultrasound,Yuyao People's Hospital of Zhejiang Province,Yuyao 315400,Zhejiang Province,China)

机构地区：[1]余姚市人民医院妇产科,余姚315400 [2]余姚市人民医院超声科,余姚315400

出　　处：《中国基层医药》2022年第8期1125-1129,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省余姚市科技计划项目(2021YPT05)。

摘　　要：目的探讨在盆底功能障碍患者诊断中经会阴超声监测肛提肌裂孔前后径(LHap)变化的价值。方法回顾性研究余姚市人民医院2020年10月至2021年6月收治的疑似与盆底功能障碍有关的患者246例的临床资料,均进行临床检查、牛津评分(MOS),根据评分分为观察组(盆底肌收缩力低下)和对照组(盆底肌收缩力正常);对所有患者进行三种状态下(静息时、缩肛时以及最大Valsalva动作时)超声检查并测量LHap,计算缩短百分比(PDC%)以及伸长百分比(PIV%),分析两组患者间的差异,并通过受试者工作特征曲线评价PDC%以及PIV%的诊断价值。结果观察组患者年龄、体质量指数、经产妇比例以及阴道分娩比例显著高于对照组(均P < 0.001);观察组患者静息LHap[(45.23±5.74)mm]、缩肛LHap[(37.71±8.44)mm]、最大Valsalva时LHap[(51.03±7.41)mm]以及PIV%[(11.42±4.79)%]均显著高于对照组[(41.78±4.56)mm、(29.15±4.64)mm、(44.28±4.87)mm、(6.05±2.13)%](t=-4.62、-8.29、-7.26、-9.36,均P < 0.001),PDC%[(17.52±5.58)%]显著低于对照组[(32.19±4.27)%](t=20.39,P < 0.001);MOS评分与PDC%呈正相关(r=0.56,P < 0.001),与PIV%呈负相关(r=-0.49,P < 0.001);将PDC% < 35.36%作为截断值进行预测的曲线下面积(AUC)为0.85,敏感度为66.40%,特异度为97.38%,准确度为73.90%;将PIV% > 5.18%作为截断值进行预测的AUC为0.70,敏感度为71.45%,特异度为57.90%,准确度为68.15%;将两者联合使用进行预测时的AUC为0.73,敏感度为84.57%,特异度为55.05%,准确度为77.32%。结论盆底功能障碍患者诊断中经会阴超声监测HLap伸长和缩短的变化具有一定价值,能够为临床医生诊断提供客观、定量的数据支撑。Objective To investigate the value of transperineal ultrasound assessment of levator hiatal antero-posterior(LHap)diameter changes in the diagnosis of pelvic floor dysfunction.Methods The clinical data of 246 patients with suspected pelvic floor dysfunction who received treatment in Yuyao People's Hospital of Zhejiang Province from October 2020 to June 2021 were retrospectively analyzed.All these patients underwent clinical examination and modified Oxford score(MOS)evaluation.They were divided into observation group(low pelvic floor muscle contractility)and control group(normal pelvic floor muscle contractility)according to MOS.All patients were subjected to ultrasound examination and LHap diameter measurement under three conditions(at rest,pelvic floor muscle contraction,and maximal Valsalva maneuver).The percentage of shortening of LHap diameter(PDC%)and the percentage of elongation of LHap diameter(PIV%)were calculated.The differences of PDC%and PIV%were compared between the observation and control groups.The receiver operating curve was used to evaluate the values of PDC%and PIV%in the diagnosis of pelvic floor dysfunction.Results Age,body mass index,the proportion of parturient women among included patients,and the proportion of patients who underwent vaginal delivery were significantly higher in the observation group than those in the control group(all P<0.001).LHap diameters measured when patients were at rest,pelvic floor muscle contraction,and maximal Valsalva maneuver as well as PIV%in the observation group were(45.23±5.74)mm],(37.71±8.44)mm,(51.03±7.41)mm and(11.42±4.79)%,respectively,which were significantly higher than those in the control group[(41.78±4.56)mm,(29.15±4.64)mm,(44.28±4.87)mm,(6.05±2.13)%,t=-4.62,-8.29,-7.26,-9.36,all P<0.001].PDC%in the observation group was significantly lower than that in the control group[(17.52±5.58)%vs.(32.19±4.27)%,t=20.39,P<0.001].MOS was positively correlated with PDC%(r=0.56,P<0.001)and it was negatively correlated with PIV%(r=-0.49,P<0.001).Taking P

关 键 词：骨盆底 肌肉 功能障碍 超声检查 会阴 剖宫产术 自然分娩 肌收缩 

分 类 号：R711.5[医药卫生—妇产科学]