经会阴盆底超声联合剪切波弹性成像对阴道分娩产妇盆腔器官脱垂的诊断价值  

Value of transperineal pelvic floor ultrasound combined with shear wave elastography in the diagnosis of pelvic organ prolapse in puerpera with vaginal delivery

作　　者：李刚[1] 徐华勤 薛超 吴小云[1] LI Gang;XU Huaqin;XUE Chao;WU Xiaoyun(Department of Ultrasound,Yixing People’s Hospital,Jiangsu 214200,China)

机构地区：[1]江苏省宜兴市人民医院超声科,江苏省宜兴市214200

出　　处：《临床超声医学杂志》2023年第9期713-717,共5页Journal of Clinical Ultrasound in Medicine

基　　金：2022年度无锡市卫生健康委妇幼健康适宜技术推广项目(FYTG202209)。

摘　　要：目的探讨经会阴盆底超声联合剪切波弹性成像在诊断阴道分娩产妇盆腔器官脱垂(POP)中的临床应用价值。方法选取于我院行阴道分娩且于产后42 d接受复查的初产妇91例,其中发生POP者44例(观察组),未发生POP者47例(对照组),两组均行经会阴盆底超声和剪切波弹性成像检查,获取静息状态和Valsalva状态下尿道倾斜角(UTA)、膀胱尿道后角(PUA)、耻骨联合与膀胱颈距离(BNS)及尿道旋转角(RUA),以及肛提肌杨氏模量最大值(Emax)和平均值(Emean),并计算两种状态下Emax和Emean的差值(ΔEmax和ΔEmean),比较两组上述参数的差异。绘制受试者工作特征(ROC)曲线分析经会阴盆底超声、剪切波弹性成像及两者联合应用对阴道分娩产妇发生POP的诊断效能。结果观察组静息状态下UTA、BNS均小于对照组,PUA大于对照组,差异均有统计学意义(均P<0.05);观察组Valsalva状态下UTA、PUA均大于对照组,BNS小于对照组,差异均有统计学意义(均P<0.05);观察组RUA大于对照组,差异有统计学意义(P<0.05)。观察组两侧肛提肌附于耻骨下支处、肌腹及后下方的ΔEmax和ΔEmean均小于对照组,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,经会阴盆底超声、剪切波弹性成像及两者联合应用诊断阴道分娩产妇发生POP的曲线下面积分别为0.713、0.748、0.895,联合应用的曲线下面积高于单一方法,差异均有统计学意义(Z=3.277、2.894,均P<0.05)。结论经会阴盆底超声联合剪切波弹性成像有助于临床诊断阴道分娩产妇POP的发生,具有较好的应用价值。Objective To explore the clinical value of transperineal pelvic floor ultrasound combined with shear wave elastography in the diagnosis of pelvic organ prolapse(POP)in puerpera with vaginal delivery.Methods A total of 91 primiparas who underwent vaginal delivery in our hospital and were reexamined 42 d after delivery were selected,including 44 cases with POP(observation group)and 47 cases without POP(control group).All underwent transperineal pelvic floor ultrasound and shear wave elastography to obtain urethral tilt angle(UTA),posterior vesicourethral angle(PUA),bladder neck and inferior margin of pubic symphysis(BNS),rotated urethral angle(RUA)in resting and Valsalva states.The maximum value(Emax)and average value(Emean)of Young’s modulus of the levator anal muscle were obtained,and the differences of Emax and Emean(ΔEmax andΔEmean)were calculated.The differences of above parameters between the two groups were compared.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of perineal pelvic floor ultrasound,shear wave elastography,and their combination in the diagnosis of POP in puerpera with vaginal delivery.Results Under rest state,UTA and BNS in observation group were lower than those in control group,while PUA was higher than that in control group(all P<0.05).Under Valsalva state,UTA and PUA in observation group were higher than those in control group,while BNS was lower than that in control group(all P<0.05).RUA in observation group was higher than that in control group,and the difference was statistically significant(P<0.05).ΔEmax andΔEmean of the lateral anal levator muscle attached to the inferior ramus of pubis,muscular abdomen and the posterior underside in the observation group were lower than those in control group,and the differences were statistically significant(all P<0.05).ROC curves analysis showed that area under the curve of transperineal pelvic floor ultrasound,shear wave elastography and combined application in the diagnosis of POP in puerpera with v

关 键 词：超声检查 盆底 剪切波弹性成像 盆腔器官脱垂 肛提肌 

分 类 号：R445.1[医药卫生—影像医学与核医学]