经会阴与经肛门超声诊断产科肛门括约肌损伤的效能比较  

Comparison of the efficacy between transperineal ultrasound and endoanal ultrasound in diagnosing obstetrics anal sphincter injury

作　　者：杨雅麟 赵白桦[1] 卿真真 郭雨阳 周珊 文烈明[1] Yang Yalin;Zhao Baihua;Qing Zhenzhen;Guo Yuyang;Zhou Shan;Wen Lieming(Department of Ultrasound Diagnosis,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院超声科,长沙410011

出　　处：《中华超声影像学杂志》2023年第6期530-536,共7页Chinese Journal of Ultrasonography

摘　　要：目的研究经会阴超声(TPUS)与经肛门超声(EAUS)评估产科肛门括约肌损伤(OASI)的一致性,并分析超声OASI预测肛门失禁(AI)的效能。方法前瞻性纳入2021年1月至2022年5月在中南大学湘雅二医院门诊招募的成年女性217例。采用St Mark肛门失禁评分(SMIS)评估AI症状的严重程度。由同一操作者对每例受检者使用同一设备进行TPUS和EAUS筛查OASI。根据肛门括约肌复合体的损伤程度分为OASI 3a、3b、3c和4级,并测量肛门外括约肌(EAS)缺损角度。当EAS缺损达到其总长度2/3以上并缺损角度达到30°以上为严重EAS缺损。比较两种方法评估结果的一致性,采用Logistic回归分析确定超声OASI对AI的预测效能。结果217例受检者中,28例(12.9%)出现AI症状,SMIS为5~20(11.9±4.5)分。TPUS诊断79例(36.4%)OASI,其中OASI 3a度50例,3b度13例,3c/4度16例;EAUS诊断78例(35.9%)OASI,其中OASI 3a度23例,3b度22例,3c度15例,4度18例。TPUS诊断24例严重EAS缺损,EAUS诊断28例,两种方法诊断严重EAS缺损具有较好的一致性(加权Kappa=0.91,P<0.001)。Logistic回归分析显示,超声OASI与AI相关。ROC曲线分析显示,TPUS OASI 3b及以上、EAUS OASI 3b及以上、TPUS严重EAS损伤和EAUS严重EAS损伤预测AI的曲线下面积(AUC)分别为0.92、0.87、0.89、0.92。结论TPUS和EAUS检测OASI有较好的一致性。TPUS和EAUS诊断严重EAS缺损或OASI 3b及以上对AI有良好的预测效能。Objective To study the agreements between transperineal ultrasound(TPUS)and endoanal ultrasound in assessing obstetrics anal sphincter injury(OASI),and to analyse the diagnostic efficacy of OASI in predicting AI relationship between OASI and anal incontinence(AI).Methods A total of 217 women were prospectively recruited from the clinic in the Second Xiangya Hospital of Central South University from January 2021 to May 2022.Symptoms of AI were determined using the St Mark′s Incontinence Score(SMIS).TPUS and EAUS were performed by the same operator with the same machine on every participant for detecting OASI:OASI grades 3a,3b,3c,and 4 were performed according to the extent of the injuries in the anal sphincter complex.The angle of the defect in the external anal sphincter(EAS)was measured.A"significant EAS defect"was diagnosed as a defect affecting at least 2/3 of the length of the EAS with a defect angle of≥30°in each slice.Ultrasound findings were compared between the two methods.The diagnostic efficacy of"ultrasound OASI"in predicting AI was analysed by logistic regression.Results Of 217 women,twenty-eight(12.9%)suffered from AI with SMIS ranging from 5~20(11.9±4.5).On TPUS,79(36.4%)cases were suspected of OASI,that was 50 OASI 3a,13 OASI 3b,and 16 OASI 3c/4.On EAUS,78(35.9%)cases were suspected of OASI that was 23 OASI 3a,22 OASI 3b,15 OASI 3c,and 18 OASI 4.Twenty-four"significant EAS defects"were diagnosed by TPUS and twenty-eight by EAUS,TPUS had excellent agreement with EAUS(weighted Kappa=0.91,P<0.001).Logistic regression analysis showed that"ultrasound OASI"was associated with AI symptoms.ROC curve analysis showed that the area under the curve(AUC)was 0.92,0.87,0.89,0.92 for TPUS OASI 3b+,EAUS OASI 3b+,TPUS"Significant EAS defect",and EAUS"Significant EAS defect"for predicting AI,respectively.Conclusions TPUS has good agreement with EAUS in detecting OASI.OASI 3b+and"significant EAS defect"on TPUS and EAUS had good performance in predicting AI symptoms.

关 键 词：超声检查 经会阴 经肛门 产科肛门括约肌损伤 肛门外括约肌 

分 类 号：R714.3[医药卫生—妇产科学]