盆底超声检查对宫颈癌全子宫切除术后盆底功能障碍性疾病评估的研究

A clinical study on the assessment of pelvic floor ultrasound for PFD disease after total hysterectomy of cervical cancer

目的:研究盆底超声检查对宫颈癌全子宫切除术后盆底功能障碍性疾病(PFD)的评估价值。方法:选取医院收治的90例行全子宫切除加盆腔淋巴结清扫术术后42 d的宫颈癌患者,均行盆底超声检查,分别测量静息状态和最大Valsalva动作下盆底超声参数[膀胱颈距耻骨联合下缘距离(BSD)、膀胱尿道后角(PUVA)、膀胱颈下降度(BND)、尿道旋转角度(URA)及膀胱颈旋转角度(θ)],统计PFD发生率,比较发生PFD与未发生PFD患者的临床资料,探究宫颈癌全子宫切除术后发生PFD的危险因素;比较不同肌纤维疲劳度PFD患者的最大Valsalva动作训练下盆底超声参数及其与肌纤维疲劳度的相关性;统计PFD患者对症治疗1个月后的疗效,比较不同疗效患者的最大Valsalva动作训练下盆底超声参数。结果:90例宫颈癌患者术后经盆底超声检查46例确诊为PFD,其中29例SUI、17例POP,PFD发生率为51.11%;宫颈癌患者术后年龄、分娩次数及术后尿管留置时间比较,差异有统计学意义(t=9.124,t=11.100,t=5.112;P<0.05);是否绝经、便秘、慢性咳嗽及术后早期康复训练比较,差异有统计学意义(x^(2)=8.879,x^(2)=5.234,x^(2)=12.267,x^(2)=22.585;P<0.05);宫颈癌患者年龄、分娩次数、术后尿管留置时间增加、发生绝经、便秘、慢性咳嗽以及术后早期未进行康复训练,均会增加术后PFD发生风险(OR=3.176,OR=2.691,OR=3.083,OR=3.015,OR=3.070,OR=2.967,OR=0.320;P<0.05);盆底肌纤维疲劳度正常PFD患者的BSD、PUVA、BND、URA及θ均低于盆底肌纤维疲劳度异常者(t=4.430,t=7.190,t=2.604,t=9.313,t=8.163;P<0.05);PFD患者盆底肌纤维疲劳度与BSD、PUVA、BND、URA及θ呈正相关(r=0.593,r=0.682,r=0.504,r=0.739,r=0.705;P<0.05);疗效良好PFD患者BSD、PUVA、BND、URA及θ均低于疗效不佳者(t=4.598,t=8.306,t=3.095,t=10.202,t=8.976;P<0.05);BSD、PUVA、BND、URA及θ联合评估PFD患者疗效的曲线下面积(AUC)为0.900,大于各参数单一评估的AUC(0.751、0.802、0.825、0.838和0.817),联合评估的最佳灵敏度、特异度分别为81.25%和90.00%。结论:宫颈癌全子宫切除术后PFD发生率较高,行盆底超声能准确检出,且盆底超声参数在反映PFD盆底肌纤维疲劳度、评估PFD疗效方面具有良好价值。

Objective:To explore the value of pelvic floor ultrasound in assessing pelvic floor dysfunction(PFD)disease after total hysterectomy of cervical cancer.Methods:90 patients with cervical cancer who underwent total hysterectomy and pelvic lymph node dissection in hospital 42 days after the surgery were selected.All patients underwent pelvic ultrasound examination.The ultrasound parameters of pelvic floor[bladder neck-cymphyseal distance(BSD),posterior urethrovesical angle(PUVA),bladder neck descent(BND),urethral rotation angle(URA),bladder neck rotation angle(θ)]under the resting state and the maximum Valsalva maneuver were measured respectively.The PFD incidence was counted,and the clinical data of patients with and without PFD were compared,and the risk factors of occurring PFD after total hysterectomy of cervical cancer were explored.And the ultrasound parameters of pelvic floor under maximum Valsalva maneuver of PFD patients between different fatigues of muscle fiber were compared.And the correlation between the ultrasound parameters of pelvic floor and the fatigue of muscle fiber under the maximum Valsalva maneuver was explored.And the therapeutic effects of PFD patients were calculated as statistical method after 1 month of symptomatic treatment.The ultrasound parameters of pelvic floor under the maximum Valsalva maneuver among patients with different therapeutic effects were compared,and the value of ultrasound parameters of pelvic floor under the maximum Valsalva maneuver was explored in assessing the therapeutic effect of PFD patients.Results:46 cases of 90 patients with cervical cancer were confirmed as PFD by ultrasound parameters of pelvic floor after surgery,and 29 cases and 17 cases of 46 patients were stress urinary incontinence(SUI)and pelvic organ prolapse(POP),respectively,and the PFD incidence rate was 51.11%.The differences of age,number of deliveries and postoperative urinary catheter indwelling time of patients with cervical cancer were significant(t=9.124,t=11.100,t=5.112,P<0.05).The differences of menopause,constipation,chronic cough and rehabilitation training in early period post operation were significant(x^(2)=8.879,x^(2)=5.234,x^(2)=12.267,x^(2)=22.585,P<0.05).And the age,number of deliveries and the increase of postoperative urinary catheter indwelling time,menopause,constipation,chronic cough and without rehabilitation training in early period post operation of patients with cervical cancer would increase the risk of occurring PFD after surgery(OR=3.176,OR=2.691,OR=3.083,OR=3.015,OR=3.070,OR=2.967,OR=0.320,P<0.05).BSD,PUVA,BND,URA andθof PFD patients with normal fatigue of muscle fiber of pelvic floor were significantly lower than those of patients with normal that(t=4.430,t=7.190,t=2.604,t=9.313,t=8.163,P<0.05).The fatigue of muscle fiber of pelvic floor was positive correlation with BSD,PUVA,BND,URA andθin PFD patients(r=0.593,r=0.682,r=0.504,r=0.739,r=0.705,P<0.05).And BSD,PUVA,BND,URA andθof PFD patients with favorably curative effect were significantly lower than those of PFD patients with poor curative effect(t=4.598,t=8.306,t=3.095,t=10.202,t=8.976,P<0.05).The area under curve(AUC)of the combined assessment of BSD,PUVA,BND,URA andθwas 0.900 for the curative effect of PFD patients,which was larger than that of single assessment of each parameter(0.751,0.802,0.825,0.838 and 0.817),and the best sensitivity and specificity of combined assessment were 81.25%and 90.00%,respectively.Conclusion:The PFD incidence is higher after total hysterectomy of cervical cancer,and it can be accurately detected by pelvic floor ultrasound.And ultrasound parameters of pelvic floor have favorable value in reflecting the fatigue of muscle fiber of PFD pelvic floor and assessing the curative effect of PFD.