超声测量肛提肌裂孔面积在子宫脱垂诊断中的应用

Application of ultrasound in diagnosis of uterine prolapse by measuring area of levator hiatus

目的探讨肛提肌裂孔面积在子宫脱垂中的诊断价值。方法选取2017年9月至2018年12月中南大学湘雅医院妇科门诊及住院部诊断为子宫脱垂患者80例为病例组,选取同期无子宫脱垂健康女性80例为对照组。两组接受经会阴三维超声检查,分别测量在静息、最大Valsalva状态下肛提肌裂孔的前后径、左右径及面积,比较两组不同状态肛提肌裂孔形态变化。绘制受试者工作特性曲线(ROC),确定肛提肌裂孔面积诊断子宫脱垂的最佳截断值,评估其准确性。结果静息、最大Valsalva状态下病例组肛提肌裂孔前后径、左右径及面积均大于对照组,差异均有统计学意义(均P<0.05)。最大Valsalva动作时,两组测值均大于同组静息状态测值,差异均无统计学意义(均P>0.05)。最大Valsalva动作时,肛提肌裂孔面积最佳截断值为22.09 cm2,曲线下面积为0.893,诊断子宫脱垂的敏感度、特异度及准确度分别为90.0%、95.0%及92.5%。结论经会阴三维超声能评估子宫脱垂患者肛提肌裂孔的形态变化,肛提肌裂孔面积对子宫脱垂具较高诊断价值。

Objective To investigate the value of the area of levator hiatusin diagnosis of uterine prolapse. Methods From September 2017 to December 2018, 80 patients diagnosed with uterine prolapse by Department of Gynecology, Xiangya Hospital of Central South University were selected as the case group, and 80 cases of normal women in the same period were selected as the control group. All subjects in both groups were examined by transperineal three-dimensional ultrasound. The anteroposterior and transverse diameters and the area of levator hiatus were measured at rest and during maximum Valsalva maneuver respectively. The ROC curve was drawn to determine the cut-off value of area of levator hiatus in diagnosis of uterine prolapse and to evaluate its diagnostic value. Results At rest and during maximum Valsalva maneuver, the anteroposterior and transverse diameters and the area of levator hiatus in study group were larger than those in control group, the difference was statistically significant (P<0.05). During maximum Valsalva maneuver, the above values in both groups were greater than those of the same group at rest state, but there was no significant difference between the two groups (P>0.05). During maximum Valsalva maneuver, the best cut-off value of area of levator hiatus for the diagnosis of uterine prolapse was 22.09 cm2, the area under curve was 0.893. The sensitivity, specificity and accuracy were 90.0%, 95.0% and 92.5%, respectively. Conclusion Transperineal three-dimensional ultrasound can evaluate the morphological changes of levator hiatus in patients with uterine prolapse, and the area of levator hiatus has high diagnostic value for uterine prolapse.