经会阴盆底超声参数对压力性尿失禁的诊断价值及与患者盆底肌力、尿动力学的相关性分析

The diagnostic value of transperineal pelvic floor ultrasound parameters for SUI and their correlation analysis with pelvic floor muscle strength and urodynamics

目的探讨经会阴盆底超声参数对压力性尿失禁(SUI)的诊断价值及与患者盆底肌力、尿动力学的相关性。方法选取2020年1月至2021年4月北京市通州区中西医结合医院收治的90例SUI患者作为研究对象,设为观察组。病情程度:Ⅰ级33例,Ⅱ级30例,Ⅲ级27例。另选取同期的50例健康体检者作为对照组。比较两组经会阴盆底超声参数、盆底肌力评分、尿动力学指标水平,采用Pearson相关性分析经会阴盆底超声参数与盆底肌力、尿动力学指标水平相关性,绘制受试者工作特征(ROC)曲线,评价经会阴盆底超声参数对SUI的诊断价值。结果观察组盆膈裂孔面积、尿道旋转角、膀胱颈移动度、膀胱尿道后角大于对照组,盆底肌力评分、控制面积、最大逼尿肌压力、最大尿道关闭压低于对照组,差异具有统计学意义(P<0.05);Pearson相关性分析结果显示,SUI患者膀胱尿道后角、盆膈裂孔面积、膀胱颈移动度、尿道旋转角均与盆底肌力评分、控制面积、最大逼尿肌压力、最大尿道关闭压呈负相关(P<0.05);绘制经会阴盆底超声参数对SUI的诊断价值的ROC曲线,结果显示,膀胱尿道后角、盆膈裂孔面积、膀胱颈移动度、尿道旋转角联合诊断SUI的曲线下面积为0.892。结论SUI患者盆膈裂孔面积、尿道旋转角、膀胱颈移动度、膀胱尿道后角均明显升高,且与盆底肌力及尿动力学有关,临床可通过经会阴盆底超声检查,对SUI患者进行临床诊断及病情评估,有助于指导临床治疗。

Objective To explore the diagnostic value of transperineal pelvic floor ultrasound parameters for stress urinary incontinence(SUI)and their correlation with pelvic floor muscle strength and urodynamics.Methods 90 patients with SUI admitted to the Tongzhou District Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to April 2021 were selected as the observation group.The severity of the disease:33 cases of gradeⅠ,30 cases of gradeⅡ,and 27 cases of gradeⅢ.Another 50 healthy subjects of the same period were selected as the control group.The levels of transperineal pelvic floor ultrasound parameters,pelvic floor muscle strength score and urodynamic indexes were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between transperineal pelvic floor ultrasound parameters and pelvic floor muscle strength and urodynamic indexes.Receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of transperineal pelvic floor ultrasound parameters in SUI.Results The pelvic diaphragm hiatus area,urethral rotation angle,bladder neck mobility and posterior angle of bladder urethra in the observation group were higher than those in the control group,the pelvic floor muscle strength score,control area,maximum detrusor pressure and maximum urethral closure pressure were lower than those in the control group(P<0.05).Pearson correlation analysis shows that in SUI patients,posterior angle of bladder urethra,pelvic diaphragm hiatus area,bladder neck mobility,and urethral rotation angle were negatively related to the pelvic floor muscle strength score,control area,maximum detrusor pressure,and maximum urethral closure pressure(P<0.05);the ROC curve of the diagnostic value of transperineal pelvic floor ultrasound parameters for SUI was drawn,and the results showed that the combined diagnosis of SUI by the posterior angle of bladder urethra,the AUC of the pelvic diaphragm hiatus area,bladder neck mobility and urethral rotation angle is 0.892.Conclusions Pelvic diaphragm hiatus area,urethral rotation angle,bladder neck mobility and posterior angle of bladder urethral for SUI patients were significantly increased,and were related to pelvic floor muscle strength and urodynamics.Clinically,transperineal pelvic floor ultrasound can be used to diagnose SUI patients.Carrying out clinical diagnosis and condition assessment can help guide clinical treatment.