盆底超声参数联合应用于剖宫产后压力性尿失禁的预测价值

The value of pelvic floor ultrasound parameters in predicting the risk of stress urinary incontinence after cesarean section

目的探讨盆底超声参数联合应用于剖宫产后压力性尿失禁(stress urinary incontinence,SUI)的预测价值。方法选取抚顺矿务局总医院2016年7月至2017年7月收治的剖宫产产妇120例,根据产后6个月内是否发生SUI分成SUI组(n=16)与非SUI组(n=104)。所有妇女均接受盆底超声检查,明确静息期(resting period,R)与张力期Valsalva动作(Valsalva movement,V)的膀胱尿道后角(posterior urethrovesical angle,PUA)、膀胱颈至耻骨联合下缘水平垂直距离(bladder neck and inferior margin of pubic symphysis,BNS),以及膀胱颈移动度(bladder neck descent,BND)、尿道旋转角度(urethral rotation angle,UR)。记录并比较两组受检者的临床资料,包括年龄、产次、急产史、孕期饮酒史、孕期尿失禁以及盆底超声参数,采用ROC曲线分析超声参数联合预测SUI的价值,利用logistic回归分析明确剖宫产后SUI的独立危险因素。结果 SUI组产次≥2次、有急产史占比分别为75.00%、31.25%,高于非SUI组的23.08%、2.88%,且SUI组R-BNS、V-BNS低于非SUI组,V-PUA、BND、UR高于非SUI组,差异有显著性(P<0.05)。R-BNS、V-PUA、V-BNS、BND、UR单独预测剖宫产后SUI的ROC曲线下面积分别为0.712、0.679、0.809、0.745、0.720,各指标联合预测的ROC曲线下面积为0.858,高于各指标单独检测的结果。Logistic回归分析显示,产次(≥2次)、急产史(有)、R-BNS(<22.598mm)、V-PUA(>146.793°)、V-BNS(<-3.207mm)、BND(>29.216mm)、UR(>81.349°)是剖宫产后SUI的独立危险因素(P<0.05)。结论盆底超声参数联合应用对剖宫产后SUI的预测价值较高,其中R-BNS、V-BNS下降,V-PUA、BND、UR升高与剖宫产后SUI的发生密切相关。

Objective To explore the value of pelvic floor ultrasound parameters in predicting Stress Urinary Incontinence (SUI) after cesarean section. Method 120 cases of cesarean section admitted to our hospital from July 2015 to July 2017 were selected.According to whether the SUI was divided into SUI group (n=16) and non-sui group (n=104) within 6 months after delivery. All parturients were examined by pelvic floor ultrasound, and the posterior urethral posterior angle (PUA), the horizontal vertical distance (BNS), the bladder neck mobility (BND), the urethral rotation angle (UR) of the bladder neck to the symphysis pubis associated with the resting period (R) and the tension phase (Valsalva movement, V) were clearly defined. The clinical data of two groups of women were recorded and compared, including age, parity, history of emergency labor, drinking history during pregnancy, urinary incontinence during pregnancy, and pelvic floor ultrasound parameters.Using ROC curve to analyze the value of joint prediction of SUI with ultrasound parameters. Logistic regression analysis was used to identify the independent risk factors of SUI after cesarean section. Result In group SUI, the incidence was More than 2 times, and the incidence of acute birth history was 75% and 31.25% respectively, higher than those of non SUI group 23.08% and 2.88%. In addition, R-BNS and V-BNS of SUI group were lower than those of non-SUI group, and V-PUA, BND and UR were higher than those of non-SUI group. The difference was statistically significant (P<0.05). The area under the curve of R-BNS, V-PUA, V-BNS, BND and UR separately predicted SUI after cesarean section was 0.712, 0.679, 0.809, 0.745 and 0.720, respectively. The area under the joint prediction of each index was 0.858, and the area under each index was higher than that of each index.Logistic regression analysis showed the independent risk factors of postpartum SUI including cesarean section (≥2 times), history of urgent production, R-BNS(< 22.598mm), V-PUA( >146.793°), V-BNS(<-3.207mm), BND( >29.216mm) and UR( >81.349°)(P<0.05). Conclusion Pelvic floor ultrasound parameters combined prediction has a high value in predicting the risk of SUI after cesarean section. R-BNS, V-BNS decreased, and V-PUA, BND, UR increased are closely related to the occurrence of SUI after cesarean section.