膀胱颈移动度在产后压力性尿失禁诊断中的应用及与病情严重程度的关系

Application of bladder neck mobility in diagnosis of postpartum stress urinary incontinence and its relation to disease severity

目的探讨经会阴盆底超声测定膀胱颈移动度诊断产后压力性尿失禁（PSUI）的应用及与PSUI严重程度的关系。方法收集产后6~8周PSUI患者151例（PSUI组）及非PSUI产妇124名（对照组）,应用经会阴超声测量静息状态和屏气向下用力至最大状态（瓦氏动作）膀胱颈至耻骨联合下缘的距离（BSD）,计算膀胱颈移动度。比较两组间及PSUI不同严重程度间膀胱颈移动度,评价膀胱颈移动度对PSUI的诊断效能。结果PSUI组膀胱颈移动度[（34.98±7.75）mm]大于对照组[（23.32±7.08）mm],差异有统计学意义（t=7.35,P〈0.05）。膀胱颈移动度ROC曲线下面积为0.90,当截断值为32.50mm时,对PSUI的诊断效能最高,此时敏感度为85.71%,特异度为90.24%,阳性似然比为8.97,阴性似然比为0.14。轻、中、重度PSUI膀胱颈移动度差异有统计学意义（F=24.72,P〈0.05）。结论经会阴超声测定膀胱颈移动度在PSUI的诊断中价值较高;膀胱颈移动度与PSUI严重程度相关。

Objective To investigate the value of bladder neck mobility measured via transperineal ultrasound in the diagnosis of postpartum stress urinary incontinence（PSUI）and its relation to disease severity.Methods A total of 275 women were enrolled after childbirth 6—8weeks,and were divided into PSUI group（n=151）and control group（n=124）.The bladder neck-symphysis pubis distance was measured at rest and on Valsalva state,then the bladder neck mobility was calculated.Bladder neck mobilities of two groups and disease severty were compared.The dignostic efficacy of bladder neck mobility in diagnosing PSUI was evaluated.Results The mobility of the bladder neck of PSUI group was（34.98±7.75）mm,and that of control group was（23.32±7.08）mm.The difference was statistically significant（t=7.35,P〈0.05）.The area under the ROC curve of mobility of the bladder neck was 0.90.The cutoff value of 32.50 mm had the highest dignostic value,in which case the diagnostic sensitivity was 85.71% and the specificity was 90.24%,positive likelihood ratio was 8.97,and negative likelihood ratio was 0.14.Bladder neck mobilities of mild,moderate and severe PSUI were statistically different（F=24.72,P〈0.05）.Conclusion The bladder neck mobility has high value in the diagnosis of PSUI,and it has a significant relation to disease severity.