超声检查腹直肌分离度及肛提肌裂孔长度和面积对初产妇盆腔器官脱垂的评估作用  

Value of ultrasound examination of diastasis recti abdominis and the length and area of levator hiatus in evaluating the pelvic organ prolapse in primipara

作　　者：郭晓晗 谢瑜娟[1] 秦博[1] 陈胜江[1] GUO Xiaohan;XIE Yujuan;QIN Bo;CHEN Shengjiang(Department of Ultrasonography,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,Henan Province,China)

机构地区：[1]河南科技大学第一附属医院超声科,河南洛阳471000

出　　处：《新乡医学院学报》2023年第3期238-242,共5页Journal of Xinxiang Medical University

摘　　要：目的探讨超声检查腹直肌分离度(DRA)、肛提肌裂孔长度(LHL)及肛提肌裂孔面积(LHA)对初产妇盆腔器官脱垂(POP)的评估作用。方法选择2021年4月至2022年5月于河南科技大学第一附属医院分娩后6~12周入院检查盆底肌恢复情况的初产妇110例为研究对象,所有产妇入院后接受超声检查,测量DRA、LHL及LHA;比较不同盆腔器官脱垂定量(POP-Q)分期初产妇的DRA、LHL及LHA,采用Spearman相关分析DRA、LHL及LHA与POP-Q分期的相关性,采用受试者操作特征(ROC)曲线评价DRA、LHL及LHA对初产妇POP的预测价值。结果不同POP-Q分期初产妇的脐上3 cm、脐部及脐下3 cm处的DRA比较差异均有统计学意义(P<0.05),Ⅲ、Ⅳ期初产妇各个位置的DRA显著大于Ⅱ期初产妇(P<0.05),Ⅳ期初产妇各个位置的DRA显著大于Ⅲ期初产妇(P<0.05)。不同POP-Q分期初产妇静息状态、Vasalva动作、肛提肌收缩时的LHL、LHA比较差异均有统计学意义(P<0.05),Ⅲ、Ⅳ期初产妇各个状态下的LHL、LHA显著大于Ⅱ期初产妇(P<0.05),Ⅳ期初产妇各个状态下的LHL、LHA显著大于Ⅲ期初产妇(P<0.05)。Spearman相关分析结果显示,初产妇的DRA、LHL及LHA与POP-Q分期均呈正相关(r=0.437、0.512、0.483,P<0.05)。ROC曲线分析结果显示,单独测量DRA、LHL和LHA预测初产妇POP的曲线下面积比较差异无统计学意义(Z=0.958,P>0.05);DRA、LHL、LHA联合预测初产妇POP的曲线下面积显著高于三者单独测量(Z=5.325、3.867、4.312,P<0.05)。DRA、LHL、LHA联合预测初产妇POP的敏感度显著高于三者单独测量(Z=5.764、5.108、3.423,P<0.05);DRA、LHL、LHA联合预测初产妇POP的特异度显著高于三者单独测量(Z=4.231、4.021、3.020,P<0.05);DRA、LHL、LHA联合预测初产妇POP的准确度显著高于三者单独测量(Z=4.325、4.464、3.337,P<0.05)。单独测量DRA、LHL、LHA预测初产妇POP的敏感度、特异度、准确度比较差异无统计学意义(Z=1.021、0.876、1.144,P>0.05)。�Objective To investigate the value of ultrasound examination of the diastasis recti abdominis(DRA),levator hiatus length(LHL)and levator hiatus area(LHA)in evaluating the pelvic organ prolapse(POP)of primipara.Methods A total of 110 primipara admitted to the First Affiliated Hospital of Henan University of Science and Technology from April 2021 to May 2022 to check the recovery of pelvic floor muscles at 6-12 weeks after delivery were selected as the study subjects.All puerpera received ultrasound examination and the DRA,LHL and LHA were measured after admission.The DRA,LHL and LHA of primipara with different pelvic organ prolapse quantitation(POP-Q)stages were compared.The correlation between DRA,LHL,LHA and POP-Q stage was analyzed by Spearman correlation.The predictive value of DRA,LHL and LHA on the POP of primipara was evaluated by the receiver operator characteristic(ROC)curve.Results There were significant differences in DRA at 3 cm above the umbilicus,umbilical part and 3 cm below the umbilicus of primipara in different POP-Q stages(P<0.05).The DRA at each position of primipara in stageⅢandⅣwas significantly higher than that of pri mipara in stageⅡ(P<0.05).The DRA at each position of primipara in stageⅣwas significantly higher than that of primipara in stageⅢ(P<0.05).There were significant differences in LHL and LHA of primipara in different POP-Q stages under resting state,Vasalva action and musculi levator ani contraction(P<0.05).The LHL and LHA at each position of primipara in stageⅢandⅣwere significantly higher than those of primipara in stageⅡ(P<0.05).The LHL and LHA at each position of primipara in stageⅣwere significantly higher than those of primipara in stageⅢ(P<0.05).The Spearman correlation analysis showed that the DRA,LHL and LHA of primipara were positively correlated with POP-Q stage(r=0.437,0.512,0.483;P<0.05).The ROC curve analysis showed that there was no significant difference in the area under curve of the separate measurement of DRA,LHL and LHA in predicting POP of

关 键 词：超声检查 初产妇 腹直肌分离度 肛提肌裂孔长度 肛提肌裂孔面积 盆腔器官脱垂 

分 类 号：R445.1[医药卫生—影像医学与核医学]