二维盆底超声评估盆膈裂孔前后径与盆腔器官脱垂的关系  

Relationship Between the Anteroposterior Hiatal Diameter and Female Pelvic Organ Prolapse Assessed by Two-Dimensional Pelvic Floor Ultrasound

作　　者：刘丹[1] 赵白桦[1] 文烈明[1] LIU Dan;ZHAO Baihua;WEN Lieming(Department of Ultrasonic Diagnosis,Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院超声诊断科,湖南长沙410011

出　　处：《中国医学影像学杂志》2024年第2期157-161,共5页Chinese Journal of Medical Imaging

摘　　要：目的研究盆底正中矢状切面盆膈裂孔前后径(AP)与盆腔器官脱垂(POP)程度的关系。资料与方法回顾性收集2017年7月—2019年5月中南大学湘雅二医院262例女性的临床资料和经会阴盆底超声(TPUS)数据。在盆底正中矢状切面于最大Valsalva动作下测量AP,通过TPUS和盆腔器官脱垂量化系统(POP-Q)测定POP程度,并分析AP与POP程度的关系,采用受试者工作特征曲线分析AP对POP程度的预测能力。结果共获得237例有效数据,其中POP-Q 0度POP 51例(21.51%),I度57例(24.05%),II度49例(20.67%),III度44例(18.56%),IV度36例(15.18%)。AP为37.10~97.90 mm,平均(61.33±10.71)mm。在TPUS或POP-Q系统诊断的不同程度POP中,AP测值差异均有统计学意义(F=52.00、58.18,P均<0.01)。以AP=6.0 cm为截断值,预测TPUS明显POP的敏感度为81.0%,特异度为75.5%;预测POP-Q II度以上POP的敏感度为74.5%,特异度为76.0%。AP与POP严重程度呈正相关,AP<6.0 cm与0~I度POP相关,6.0 cm≤AP<6.5 cm与II度POP相关,6.5 cm≤AP<7.0 cm与II~III度POP相关,7.0 cm≤AP与IV度POP相关(r=0.61、0.47、0.56、0.41,P均<0.05)。结论AP≥6.0 cm提示盆膈裂孔扩张,可能发生POP;AP越大,器官脱垂程度越严重。Purpose To explore the association between the anteroposterior hiatal diameter(AP)and pelvic organ prolapse(POP).Materials and Methods All clinical and transperineal ultrasound(TPUS)data of 262 women with lower urinary tract symptoms or POP who had presented to Second Xiangya Hospital of Central South University from July 2017 to May 2019 were retrospectively summarized and analyzed.AP was measured in the median sagittal section of the pelvic floor at maximum Valsalva motion.The degree of POP was obtained via international continence society(ICS)pelvic organ prolapse quantification(POP-Q)system and TPUS.The relationship between AP and POP degrees,and the predictive ability of AP on POP degrees were analyzed,respectively.Results A total of 237 patients were finally selected.There were 51(21.51%)women within ICS POP-Q stage 0,57(24.05%)within stage I,49(20.67%)within stage II,44(18.56%)within stage III,36(15.18%)within stage IV.The mean AP on maximal Valsalva was(61.33±10.71)mm(range 37.10-97.90 mm).There was a significant difference in AP measurements based on TPUS or POP-Q(F=52.00,58.18,both P<0.01).A receiver operating characteristic curve analysis proposed a cutoff of 6.0 cm,and the sensitivity and specificity of prediction of obvious POP via TPUS was 81.0%and 75.5%,respectively;the sensitivity and specificity of prediction of POP-Q II or high levels POP was 74.5%and 76.0%,respectively.AP was positively highly related to the POP stages.AP on Valsalva of less than 6.0 cm was related to POP stage 0-I,6.0 to less than 6.5 cm was related to POP stage II,6.5 to less than 7.0 cm to POP stage II-III,7.0 or more to POP stage IV(r=0.61,0.47,0.56,0.41,all P<0.05).Conclusion AP≥6.0 cm indicates an enlarged levator hiatus,with likelihood of POP.The larger the AP,the more severe the POP is.

关 键 词：盆腔器官脱垂 女性 盆膈裂孔 超声检查 盆底 

分 类 号：R711.21[医药卫生—妇产科学] R445.1[医药卫生—临床医学]