经会阴超声对女性盆底功能障碍性疾病的临床应用观察

Clinical application of transperineal ultrasound in female pelvic floor dysfunction

目的分析经会阴超声在女性盆底功能障碍性疾病诊断中的应用价值。方法选取2014年6月至2016年6月深圳市南山区人民医院收治的48例女性盆底功能障碍性疾病患者(观察组)及30例盆底正常女性(对照组)为研究对象。比较两组经会阴超声检查各指标(膀胱颈下降距离、尿道旋转角度等)。将经会阴二维、三维超声检查结果与女性盆底功能障碍性疾病诊断"金标准"结果进行对照分析,比较经会阴二维、三维超声检测方法对其诊断的敏感性、特异性、阳性预测值、阴性预测值及诊断符合率。结果观察组患者尿道倾斜角、膀胱颈到耻骨联合下缘距离、宫颈到耻骨联合下缘距离、直肠壶腹部最低点至耻骨联合下缘距离、肛提肌尿道间隙均<对照组,膀胱颈下降距离等其他指标>对照组,差异均有统计学意义(P<0.05)。经会阴三维超声检查对女性盆底功能障碍性疾病的诊断准确率92.3%,显著高于二维超声检查的78.2%(P<0.05)。经会阴二维超声检查对女性盆底功能障碍性疾病诊断的敏感性、特异性、阳性预测值、阴性预测值分别为72.9%、53.3%、71.4%、41.0%;三维检查分别为91.7%、93.3%、95.7%、87.5%,三维检查优于二维检查(P<0.05)。结论在女性盆底功能障碍性疾病的临床诊断中,经会阴超声检查能够清晰地显示盆底结构,提高诊断准确性,具有重要的应用价值。

Objective To analyze the clinical application value of transperineal ultrasound in the diagnosis of female pelvic floor dysfunction. Methods 48 cases of female pelvic floor dysfunction （ the observation group） and 30 cases of female with normal pelvic floor （the control group） treated in People＇s Hospital of Nanshan District of Shenzhen City from June 2014 to June 2016 were included and observed by transperineal ultrasound. Indexes including the bladder neck descending distance, urethral rotation angle, etc. , were compared. The test results of transperineal two - dimensional, three - dimensional ultrasound examination and female pelvic floor dysfunction disease diagnosis ＂ gold standard＂ results were comparatively analyzed in order to show the diagnostic sensitivity, specificity, positive predictive value, negative predictive value and diagnostic coincidence rate of transperineal ultrasound to female pelvic floor dysfunction. Results In the observation group, the urethral tilt angle, the distance from the bladder neck to the lower edge of the pubic symphysis, the distance from the lower edge of the cervix to the pubic symphysis, the lowest point of the rectum ampulla to the lower edge of the pubic symphysis, and anal sphincter urethral space were less than in the control group. The distance of bladder neck descent and other indexes in the observation group were higher than in the control group. The differences were statistically significant （ P 〈 0. 05 ）. The diagnosis accuracy rate of transperineal three - dimensional ultrasound examination was 92. 3 %, which was significantly higher than 78. 2% by transperineal two- dimensional ultrasound examination（P 〈 0.05 ）. The diagnostic sensitivity, specificity,positive predictive value and negative predictive value by transperineal two -dimensional uhrasound examination were 72. 9%, 53.3%, 71.4%, and 41.0% respectively, while by transperineal three - dimensional ultrasound examination were 91.7%, 93.3%, 95.7% and 87.5% respectively. The diagnostic sensitivity and specificity of three - dimensional examination were significantly higher than those of two - dimensional examination （P 〈 0. 05）. Conclusion In the clinical diagnosis of female pelvic floor dysfunction disease, the pelvic floor structure can be clearly displayed by ultrasound examination. It has important application value to improve the accuracy of diagnosis.