盆底四维超声对盆腔脏器脱垂患者术后下尿路结构的评估及尿失禁的预测价值  

Evaluation of lower urinary tract structure and predictive value of urinary incontinence in patients with pelvic organ prolapse after operation with four-dimensional ultrasound of pelvic floor

作　　者：张中喜[1] 邹平[2] 唐泽平 栗世兴 曾令红 Zhang Zhongxi;Zou Ping;Tang Zeping;Li Shixing;Zeng Linghong(Changsha Medical College,Changsha 410219,China;Department of Traditional Chinese Medicine,the First Affiliated Hospital of Changsha Medical College,Changsha 410219,China;School of Medical Imaging,Changsha Medical College,Changsha 410219,China;The First Clinical College of Changsha Medical College,Changsha 410219,China;Department of Ultrasound,the First Affiliated Hospital of Changsha Medical College,Changsha 410219,China)

机构地区：[1]长沙医学院,长沙410219 [2]长沙医学院附属第一医院中医科,长沙410219 [3]长沙医学院医学影像学院,长沙410219 [4]长沙医学院第一临床学院,长沙410219 [5]长沙医学院附属第一医院超声科,长沙410219

出　　处：《国际泌尿系统杂志》2024年第5期882-887,共6页International Journal of Urology and Nephrology

基　　金：湖南省科技厅"长沙医学院临床医学类大学生科技创新创业"湘科人([2019]8号(2019RS5005))。

摘　　要：目的分析引起盆腔脏器脱垂(POP)患者术后新发压力性尿失禁(SUI)的危险因素以及盆底四维超声对患者术后下尿路结构的评估及SUI的预测价值。方法选取2018年6月至2020年6月于本院治疗的136例术前无尿失禁诊断的POP患者为研究对象,根据术后是否新发SUI将患者分为术后无新发SUI组(94例)和术后新发SUI组(42例),经盆底四维超声观察患者术前、术后的下尿路结构,采用单因素以及多因素logistic回归分析影响POP患者术后新发SUI的危险因素;构建列线图模型并进行预测。结果术后患者的膀胱颈移动度明显小于术前(P<0.05);在最大Valsalva动作时,术后的肛提肌-尿道间隙和尿道旋转角度与术前相比明显减小(均P<0.05);术后新发SUI组患者的糖尿病史、巨大胎儿分娩史、V-膀胱颈移动度、V-尿道旋转角度、V-肛提肌-尿道间隙均显著高于术后无新发SUI组,盆腔手术史比例低于术后无新发SUI组(均P<0.05);多因素分析结果显示,盆底四维超声的下尿路结构观察指标(V-膀胱颈移动度、V-尿道旋转角度、V-肛提肌-尿道间隙)以及具有巨大胎儿分娩史、糖尿病史和盆腔手术史均是术后新发SUI的危险因素(均P<0.05),4种盆底重建手术方式是术后新发SUI的保护因素(均P<0.05),并且各因素之间无共线性关系;构建的列线图预测模型具有良好的区分度、准确度和有效性。结论利用盆底四维超声可以对患者术后的下尿路结构有更清楚的了解,对术后新发SUI的产生具有十分重要的预测价值,值得临床推广应用。ObjectiveTo analyze the risk factors of post-operative stress urinary incontinence(SUI)in patients with pelvic organ prolapse(POP),and the value of pelvic floor four-dimensional ultrasound in evaluating the structure of lower urinary tract and predicting urinary incontinence.MethodsA total of 136 cases POP patients treated in our hospital from June 2018 to June 2020 with no diagnosis of urinary incontinence before surgery were selected as the study objects.According to whether they had new SUI after operation,the patients were divided into no postoperative SUI group(94 cases)and new postoperative SUI group(42 cases).The lower urinary tract structure of the patients before and after surgery was observed by four-dimensional ultrasound of the pelvic floor,and the risk factors of new postoperative SUI in POP patients were analyzed by univariate and multivariate logistic regression.Build a nomogram model and make predictions.ResultsThe degree of bladder neck movement after operation was significantly lower than that before operation(P<0.05).During maximum Valsalva,the postoperative levator anal space and urethral rotation angle were significantly reduced compared with those before operation(all P<0.05).Patients with a history of diabetes mellitus,giant fetal delivery history,V-bladder neck mobility,V-urethral rotation angle,V-levator anal space and urethral space in the newly diagnosed SUI group were significantly higher than those in the group without new SUI,and the proportion of history of pelvic surgery was lower than that of the group without new SUI(all P<0.05).Multivariate results showed that the lower urinary tract structure observation indexes(V-bladder neck mobility,V-urethral rotation angle,V-levator anal space),as well as the history of giant fetus delivery,diabetes and pelvic surgery were risk factors for new postoperative SUI(all P<0.05).There was no collinearity between the factors.The nomogram prediction model has good differentiation,accuracy and effectiveness.ConclusionsThe use of pelvic floor four-d

关 键 词：盆腔器官脱垂 四维计算机体层摄影术 尿失禁 

分 类 号：R445.1[医药卫生—影像医学与核医学] R713[医药卫生—诊断学]