三维盆底超声评价肛提肌裂孔形态改变诊断盆腔器官脱垂的临床价值

Clinical value of three-dimensional pelvic ultrasonography in the diagnosis of pelvic organ prolapse by evaluating the morphologic and structural changes of the levator hiatus

目的探讨三维盆底超声通过评价肛提肌裂孔形态与结构改变诊断盆腔器官脱垂的临床价值。方法选择2016年1月至2017年8月在宝鸡市妇幼保健院就诊的盆腔器官脱垂患者142例(脱垂组),同期的健康女性142例(正常组)。两组受检者均采用三维盆底超声检查,测量静息状态下及瓦氏动作时矢状面肛提肌裂孔长度、宽度及面积。结果脱垂组患者的静息、缩肛、瓦氏动作下前后径、左右径和面积与正常组比较明显升高,差异均有统计学意义(P<0.05);面积瓦氏动作(Va)诊断盆腔器官脱垂的灵敏度、特异度、约登指数、曲线下面积(AUC)分别为0.9859、0.9859、0.9718、0.998,均高于其余检查指标。结论三维盆底超声评价肛提肌裂孔可为盆腔脱垂的临床诊断、预防、治疗提供帮助,值得临床推广应用。

Objective To investigate the clinical value of three-dimensional pelvic ultrasonography in the diagnosis of pelvic organ prolapse by evaluating the morphologic and structural changes of the levator hiatus.Methods A total of 142 patients of pelvic organ prolapse in Baoji Maternal and Child Health Hospital from January 2016 to August2017 were selected as the prolapse group,and 142 healthy women in the same period were selected as the control group.Three-dimensional pelvic ultrasonography was used to measure the length,width,and area of the sagittal levator sac in the resting state and under Valsalva maneuver.Results The anteroposterior diameter,left and right diameter,and area during resting,under anal contraction,and under Valsalva maneuver in the prolapse group were significantly increased as compared with the normal group(P<0.05).The sensitivity,specificity,Yoden index,and area under the curve(AUC)for the diagnosis of pelvic organ prolapse by area Valsalva(Va)were 0.9859,0.9859,0.9718,and 0.998,respectively,which were higher than those of other indicators.Conclusion Evaluation of the levator ani muscle by three-dimensional pelvic ultrasonography can provide help for the clinical diagnosis,prevention and treatment of pelvic prolapse,which is worthy of clinical application.