隐匿性尿失禁患者盆底超声检查价值  

Preliminary Study on the Value of Pelvic Floor Ultrasonography in Occult Stress Urinary Incontinence

作　　者：张红彬[1] 孟欣雨 申朵朵 魏亚楠 栗河舟[1] Zhang Hongbin;Meng Xinyu;Shen Duoduo;Wei Ya’nan;Li Hezhou(Department of Ultrasound,The Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Jiaxing Maternal and Child Health Hospital Special Inspection Department,Jiaxing,Zhejiang 314001,China)

机构地区：[1]郑州大学第三附属医院超声科,郑州市450000 [2]嘉兴市妇幼保健院特检科,浙江省嘉兴市314001

出　　处：《中国超声医学杂志》2024年第2期202-205,共4页Chinese Journal of Ultrasound in Medicine

基　　金：河南省医学科技攻关计划项目(No.LHGJ20190378)。

摘　　要：目的评价经会阴盆底超声在隐匿性尿失禁诊断中的价值。方法回顾性分析盆底重建病区Ⅲ~Ⅳ度子宫脱垂患者405例,术前1周常规行经会阴盆底超声检查并留存图像,放置子宫托后行尿垫实验,根据尿垫实验结果将患者分为隐匿性尿失禁(+)和隐匿性尿失禁(-),分析两组患者盆底超声检查结果。结果两组患者静息状态下膀胱颈位置、最大瓦氏动作时膀胱颈移动度、膀胱脱垂及肛提肌裂孔面积测值变化均无统计学意义(P>0.05);隐匿性尿失禁(+)患者最大瓦氏动作时尿道旋转角、膀胱后角、尿道内口漏斗长度较隐匿性尿失禁(-)显著增高(P<0.05);根据受试者工作特征(ROC)曲线下面积得出最大瓦氏动作时尿道旋转角、膀胱后角、尿道内口漏斗长度的截断值分别为45.2°、139.5°及0.61 mm。结论最大瓦氏动作时,膀胱后角、近端尿道角度和漏斗长度的显著增大与隐匿性尿失禁(+)的发生关系密切,经会阴盆底超声有望为隐匿性尿失禁的诊断提供价值。Objective To evaluate the diagnostic value of transperineal pelvic floor ultrasound(TPFUS)in patients with occult stress urinary incontinence.Methods A total of 405 patients withⅢ-Ⅳuterine prolapse were retrospectively selected in our hospital.TPFUS examination was performed routinely one week before surgery and the images were recorded.Urodynamic examination was performed at the same time and a urinary pad test was performed after placing a pessary.The patients were divided into occult stress urinary incontinence(OSUI)(+)and OSUI(-)groups according to the urodynamics and urinary pad test results,and the TPFUS examination results of the two groups were retrospectively analyzed.Results There were no significant differences in the bladder neck position at rest,bladder neck mobility at the Valsalva maneuver,bladder prolapse,and levator ani muscle hiatus area between the two groups(P>0.05);the urethral rotation angle with the Valsalva maneuver,the posterior angle of the bladder,and the length of the funnel of the internal urethra were significantly higher in the OSUI(+)group than in the OSUI(-)group(P<0.05).According to the area under the receiver operating charactersitic(ROC)curve,the cut-off values of the urethral rotation angle,the posterior angle of the bladder,and the length of the funnel of the internal urethra in the maximum Valsalva maneuver were 45.2°,139.5°and 0.61 mm,respectively.Conclusions With the Valsalva maneuver,the significant increase of the posterior angle of the bladder,the angle of the proximal urethra,and the length of the funnel are closely related to the occurrence of OSUI;TPFUS is expected to be an objective preoperative screening to check for occult stress urinary incontinence.

关 键 词：盆底超声 隐匿性尿失禁 重度子宫脱垂 尿垫实验 

分 类 号：R445.1[医药卫生—影像医学与核医学] R711.59[医药卫生—诊断学]