肛提肌应变率用于压力性尿失禁患者TVT-O术前评估的价值  

Application value of the strain rate of the levator ani muscle of patients with stress urinary incontinence for the preoperative evaluation of their TVT-O surgery

作　　者：郑洁 朱张茜 ZHENG Jie;ZHU Zhangxi(Wenzhou People's Hospital,The Third Affiliated Hospital of Shanghai University,Wenzhou,Zhejiang Province,325000)

机构地区：[1]浙江省温州市人民医院,上海大学附属第三医院,325000

出　　处：《中国计划生育学杂志》2025年第4期984-987,共4页Chinese Journal of Family Planning

基　　金：温州市基础性医疗卫生科技项目(Y2020817)。

摘　　要：目的:探讨肛提肌应变率用于压力性尿失禁患者经闭孔行无张力尿道中段悬吊术(TVT-O)术前评估的价值。方法:选取因压力性尿失禁来本院就诊的129例患者作为观察对象,需行TVT-O手术的39例设为手术组,行保守治疗的90例设为对照组。经会阴三维超声采集静息状态、缩肛状态及Valsalva状态下肛提肌裂孔图像,并测量肛提肌裂孔面积(A),计算并比较两组肛提肌的收缩应变率及拉伸应变率,通过绘制ROC曲线找出肛提肌应变率在TVT-O术前评估的最佳临界值。结果:手术组肛提肌收缩应变率较对照组小(P<0.05),肛提肌收缩应变率判断是否需行TVT-O术的最佳临界值为12.7%,其灵敏度、特异度、阳性预测值及阴性预测值分别为74.4%、86.7%、70.7%、88.6%。曲线下面积为0.754。手术组肛提肌拉伸应变率较对照组增大(P<0.05),肛提肌拉伸应变率判断是否需行TVT-O术的最佳临界值为19.6%,其灵敏度、特异度、阳性预测值及阴性预测值分别为87.2%、84.4%、70.8%、93.8%,曲线下面积为0.850。结论:肛提肌收缩应变率及拉伸应变率对压力性尿失禁患者评估是否需要行TVT-O术具有一定参考价值。Objective:To investigate the application value of the strain rate of the levator ani muscle of patients with stress urinary incontinence(SUI)for the preoperative evaluation of their TVT-O surgery.Methods:129 patients with SUI who admitted to the hospital were selected as observation objects,including 39 patients who required TVT-O surgery in study group and 90 patients who wanted conservative treatment in control group.The images of the levator ani muscle hiatus of the patients in the two groups at resting state,at contraction state and at Valsalva state fissure were collected by the perineal 3D ultrasound.The area of levator hiatus(A)of the patients in the two groups was measured.The strain rate and the tensile strain rate of the levator ani muscle of the patients were calculated and were compared between the two groups.Receiver operating characteristic(ROC)curve was drawn to find out the best critical value of the strain rate of the levator ani muscle for the evaluation before TVT-O surgery.Results:The contraction strain rate of the levator ani muscle of the patients in the study group was significantly lower than that of the patients in the control group(P<0.05).The best critical value,the sensitivity,the specificity,the positive predictive value,the negative predictive value and the area under the curve of the contraction strain rate of the levator ani muscle of the patients for judging the necessary of their TVT-O surgery were 12.7%,74.4%,86.7%,70.7%,88.6%,and 0.754,respectively.The best critical value,the sensitivity,the specificity,the positive predictive value,the negative predictive value and the area under the curve of the tensile strain rate of the levator ani muscle of the patients for judging the necessary of their TVT-O were 19.6%,87.2%,84.4%,70.8%,93.8%and 0.850,respectively.Conclusion:The contraction strain rate and the tensile strain rate of the levator ani muscle of the patients for judging the necessary of their TVT-O surgery have certain reference value.

关 键 词：压力性尿失禁 经闭孔行无张力尿道中段悬吊术 术前评估 经会阴超声 肛提肌应变率 

分 类 号：R694[医药卫生—泌尿科学]