盆底三维超声对顺产初产妇膀胱颈漏斗形成的危险因素分析  

Analysis of risk factors for bladder neck funnel formation in spontaneous delivery primipara by pelvic floor three-dimensional ultrasound

作　　者：吴丽群 赵慧燕 王美霞 高洁 姚锐 许群 WU Liqun;ZHAO Huiyan;WANG Meixia;GAO Jie;YAO Rui;XU Qun(Department of Obstetricsand Gynecology,Wenzhou Hospital of Integrated Traitionanl Chinese and Western Medicine,Wenzhou 325000,Zhejiang,China;Department of Ultrasound,Wenzhou Hospital of Integrated Traitionanl Chinese and Western Medicine,Wenzhou 325000,Zhejiang,China)

机构地区：[1]温州市中西医结合医院妇产科,浙江温州325000 [2]温州市中西医结合医院超声科,浙江温州325000

出　　处：《中国现代医生》2024年第27期26-30,共5页China Modern Doctor

基　　金：浙江省温州市基础性科研项目(Y20211140)。

摘　　要：目的对单胎顺产初产妇产后6~8周盆底三维超声指标进行分析,探索膀胱颈漏斗形成的危险因素,分析各因素的评估价值。方法选取2021年7月至2024年4月于温州市中西医结合医院产后就诊的单胎顺产初产妇108例,根据有无膀胱颈漏斗形成分为观察组(膀胱颈漏斗形成,n=40)和对照组(无膀胱颈漏斗形成,n=68),比较两组单胎顺产初产妇的临床数据和盆底超声指标。结果观察组单胎顺产初产妇的压力性尿失禁(stress urinary incontinence,SUI)和阴道前壁脱垂发生率、膀胱颈移动度(bladder neck distance,BND)、Valsalva状态膀胱尿道后角(posterior urethrovesical angle,PUA)、静息状态和Valsalva状态盆膈裂孔面积(levator hiatus area,LHA)、盆膈裂孔前后径(levator hiatus length,LHL)及LHL变化量(ΔLHL)均高于对照组(P<0.05)。Logistic回归分析发现,SUI和阴道前壁脱垂是膀胱颈漏斗形成的独立危险因素,校正后OR分别为11.255和3.643;静息状态和Valsalva状态LHA、LHL及ΔLHL也是膀胱颈漏斗形成的独立危险因素(P<0.05)。受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析发现,SUI和阴道前壁脱垂诊断膀胱颈漏斗形成的曲线下面积(area under the curve,AUC)分别为0.744和0.615;超声指标中,当Valsalva状态LHL>63.5mm时,AUC为0.706;联合指标1(静息状态LHA+Valsalva状态LHA)诊断敏感度为95.0%;联合指标2(Valsalva状态LHL+ΔLHL)诊断特异性为80.9%。结论在单胎顺产初产妇中,SUI、阴道前壁脱垂的发生和增大的LHA、LHL和ΔLHL是形成膀胱颈漏斗的独立危险因素;联合指标1预测价值敏感度高,联合指标2预测特异性较高。Objective To investigate value and risk factors of pelvic floor three-dimensional ultrasound parameters in single spontaneous delivery primipara with bladder neck funnel formation at 6-8weeks after delivery.Methods A total of 108 cases of single spontaneous delivery primipara were selected as research objects according to three-dimensional ultrasound indexes of pelvic floor,they were assigned into two groups:Observation group(40 cases)with bladder neck funnel formation and control group(68 cases)without bladder neck funnel formation.Three-dimensional ultrasound indexes of pelvic floor and clinical symptoms were compared between two groups.Results The incidence of stress urinary incontinence(SUI),anterior vaginal wall prolapse,bladder neck distance(BND),posterior urethrovesical angle(PUA)in Valsalva state,levator hiatus area(LHA)in resting and Valsalva states,levator hiatus length(LHL),and changes in LHL(ΔLHL)in observation group were all higher than those in control group(P<0.05).Logistic regression analysis revealed that SUI and anterior vaginal wall prolapse are independent risk factors for bladder neck funnel formation,adjusted OR were 11.255 and 3.643;Resting state and Valsalva state LHA,LHL,andΔLHL were also independent risk factors for bladder neck funnel formation(P<0.05).Receiver operating characteristic(ROC)curve analysis revealed that area under the curve(AUC)for diagnosing bladder neck funnel formation in SUI and anterior vaginal wall prolapse were 0.744 and 0.615,respectively;In ultrasound indicators,when the LHL of Valsalva state is>63.5mm,the AUC is 0.706;The diagnostic sensitivity of the combination factor 1(resting state LHA+Valsalva state LHA)is 95.0%;The diagnostic specificity of the combination factor 2(Valsalva state LHL+ΔLHL)is 80.9%.Conclusion In patients of single spontaneous deliveryprimipara with bladder neck funnel formation,occurrence of SUI and vaginal anterior wall prolapse,increased LHA and LHL under two states and△LHL were independent risk factors.The diagnostic sensitivity of

关 键 词：膀胱颈漏斗 压力性尿失禁 盆底三维超声 盆膈裂孔 

分 类 号：R714[医药卫生—妇产科学]