经会阴盆底超声参数联合腹直肌分离度可提高产后压力性尿失禁诊断效能  

Transperineal pelvic floor ultrasound parameters combined with rectus abdominis separation can improve the diagnostic efficacy of postpartum stress urinary incontinence

作　　者：白伟伟 廖凡 阚晓纯 朱美娣 BAI Weiwei;LIAO Fan;KAN Xiaochun;ZHU Meidi(Department of ultrasound,Wuxi Xishan People's Hospital(Wuxi Branch of Southeast University Affiliated Zhongda Hospital),Wuxi 214105,China)

机构地区：[1]无锡市锡山人民医院(东南大学附属中大医院无锡分院)超声医学科,江苏无锡214105

出　　处：《分子影像学杂志》2025年第3期340-346,共7页Journal of Molecular Imaging

基　　金：江苏省卫健委妇幼健康项目(F202103);无锡市卫健委青年科研项目(Q202443)。

摘　　要：目的 探讨经会阴盆底超声参数联合腹直肌分离度对产后压力性尿失禁(PSUI)的评估价值。方法 纳入2022年9月~2024年8月于本院分娩并于产后6~8周进行产后复查的112例产妇。根据是否发生PSUI,将产妇分为PSUI组(n=51)和非PSUI组(n=61)。比较两组产妇经会阴盆底超声参数[静息状态时膀胱颈位置(BSD1)、尿道倾斜角(UIA1)、膀胱尿道后角(PUA1)、肛提肌裂孔面积(LHA1);最大Valsava动作时膀胱颈位置(BSD2)、尿道倾斜角(UIA2)、膀胱尿道后角(PUA2)、肛提肌裂孔面积(LHA2)、尿道内口漏斗形成率、膀胱颈移动度(BND)及尿道旋转角(URA)]及腹直肌分离度,利用Logistic回归分析PSUI发生的独立风险因素,绘制ROC曲线验证各参数单独及联合应用时对PSUI的诊断效能。结果 PSUI组BSD2、UIA2、PUA2、LHA2、尿道内口漏斗形成率、BND及URA均高于非PSUI组(P<0.05)。112例产妇中,28例腹直肌正常,其中7例发生PSUI(25.00%);轻度分离组43例,14例发生PSUI(32.56%);中度分离组27例,19例发生PSUI(70.37%);重度分离组14例,11例发生PSUI(78.57%)。随着腹直肌分离程度加重,PSUI发生率占比逐渐升高(P<0.05)。Logistic回归分析显示:LHA2(OR=3.170)、尿道内口漏斗形成率(OR=2.702)、BND(OR=3.034)、URA(OR=2.854)及腹直肌分离度(OR=3.476)是产妇发生PSUI的独立风险因素(P<0.05)。ROC曲线显示,各参数联合时曲线下面积为0.925,敏感度和特异度分别为84.31%和86.89%。结论 经会阴盆底相关超声参数LHA2、尿道内口漏斗形成率、BND、URA协同腹直肌分离度可进一步提高PSUI诊断效能。Objective To investigate the value of transperineal pelvic floor ultrasound parameters combined with rectus abdominis separation in the evaluation of postpartum stress urinary incontinence(PSUI).Methods The clinical data of 112 parturients who gave birth in our hospital from September 2022 to August 2024 and underwent postpartum reexamination 6-8 weeks after delivery were included.According to the occurrence of PSUI,the postpartum women were divided into PSUI group(n=51)and non-PSUI group(n=61).Transperineal pelvic floor ultrasound parameters[bladder neck position at rest(BSD1),urethral inclination angle(UIA1),posterior vesicourethral angle(PUA1),levator hiatus area(LHA1)]of all postpartum women were collected.Bladder neck position(BSD2),urethral inclination angle(UIA2),posterior vesicourethral angle(PUA2),levator hiatus area(LHA2),funnel formation rate of internal urethral orifice during maximum Valsava maneuver,bladder neck mobility(BND)and urethral rotation angle(URA)]and rectus abdominis separation were measured.Logistic regression was used to analyze the independent risk factors of PSUI,and the ROC curve was drawn to verify the diagnostic efficacy of each parameter alone and in combination for PSUI.Results The BSD2,UIA2,PUA2,LHA2,urethral funnel formation rate,BND and URA in the PSUI group were higher than those in the non-PSUI group(P<0.05).Of the 112 postpartum women,28 had normal rectus abdominis,of which 7 had PSUI(25.00%).In 43 cases of mild separation group,PSUI occurred in 14 cases(32.56%).In the moderate separation group of 27 cases,19 cases had PSUI(70.37%);there were 14 cases in the severe separation group,and 11 cases(78.57%)had PSUI.With the aggravation of rectus abdominis separation,the incidence of PSUI increased gradually(P<0.05).Logistic regression analysis showed that LHA2(OR=3.170),urethral funnel formation rate(OR=2.702),BND(OR=3.034),URA(OR=2.854)and rectus abdominis separation(OR=3.476)were independent risk factors for PSUI(P<0.05).ROC curve showed that the AUC was 0.925 when the paramet

关 键 词：产后压力性尿失禁 经会阴 超声检查 腹直肌分离度 诊断效能 

分 类 号：R47[医药卫生—护理学]