盆底超声参数与剖宫产后盆底功能的关系及对压力性尿失禁的预测研究

Relationship between pelvic floor ultrasound parameters and pelvic floor function after cesarean section and prediction of stress urinary incontinence

目的分析盆底超声参数与剖宫产后盆底功能的关系及对压力性尿失禁的预测价值。方法选取2016年1月至2021年1月浙江中医药大学附属温州中医院收治的256例规律产检并行剖宫产术的产妇作为研究对象。根据术后6个月内是否发生压力性尿失禁分为病例组(n=36)和对照组(n=220)。所有产妇均于产后6~8周进行盆底超声和肌电生理检查,通过受试者工作特征(ROC)曲线评价盆底超声参数对压力性尿失禁的预测效能。结果两组静息状态下尿道倾斜角、裂孔面积及Valsalva动作下盆底超声指标、盆底肌功能指标比较,差异具有统计学意义(P<0.05);经Pearson相关性分析,剖宫产后静息状态下尿道倾斜角、裂孔面积及Valsalva动作下膀胱颈位置、膀胱位置、膀胱颈移动度、尿道倾斜角、尿道旋转角、膀胱尿道后角、裂孔面积均与阴道指诊盆底肌力、盆底Ⅰ类肌、Ⅱ类肌肌力具有相关性(P<0.05);经ROC曲线分析,Valsalva动作下膀胱颈移动度预测压力性尿失禁的效能最佳,Valsalva动作下膀胱颈位置次之。结论剖宫产产妇产后盆底超声参数异常明显,与盆底功能存在一定关联性,预测压力性尿失禁的效能较好,值得临床予以重视。

Objective To analyze the relationship between pelvic floor ultrasound parameters and pelvic floor function after cesarean section and the predictive value of stress urinary incontinence.Methods From January 2016 to January 2021,a total of 256 parturients who underwent regular obstetrical examination and cesarean section in Wenzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University were selected as the research subjects.According to whether stress urinary incontinence occurred within 6 months after surgery,they were divided into case group(n=36)and control group(n=220).Pelvic floor ultrasound and electromyography were performed on all parturients 6 to 8 weeks after delivery.The predictive efficacy of pelvic floor ultrasound parameters for stress urinary incontinence was evaluated by receiver operating characteristic(ROC)curve.Results There are statistically significant differences between the case group and the control group in urethral inclination angle,hiatus area,pelvic floor ultrasound index and pelvic floor muscle function index under Valsalva operation in resting state(P<0.05).Pearson correlation analysis showed that the urethral inclination angle and hiatus area in resting state after cesarean section,bladder neck position,bladder position,bladder neck mobility,urethral inclination angle,urethral rotation angle,bladder posterior urethral angle and hiatus area under Valsalva operation are correlated with pelvic floor muscle strength,pelvic floor muscle strength classⅠand classⅡ(P<0.05).ROC curve analysis showed that bladder neck mobility under Valsalva operation is the best in predicting stress urinary incontinence,followed by bladder neck position under Valsalva position.Conclusions Postpartum pelvic floor ultrasound parameters of cesarean delivery women are obviously abnormal,have a certain correlation with pelvic floor function,which is good in predicting stress urinary incontinence and worthy of clinical attention.