经阴道二维联合三维超声评估不同位置盆腔器官脱垂患者盆底结构的价值

Value of transvaginal two-dimensional combined with three-dimensional ultrasound in the evaluation of pelvic floor structure in different position of pelvic organ prolapse

目的探讨经阴道二维联合三维超声在不同位置盆腔器官脱垂(POP)患者盆底结构评估中的临床应用价值。方法选取于我院就诊的78例POP患者,根据脱垂位置分为前盆腔脱垂34例(A组),中盆腔脱垂18例(B组),后盆腔脱垂26例(C组),另选同期非POP患者30例为对照组,应用经阴道二维超声观察并比较各组静息状态和Valsalva状态下耻骨联合与膀胱底距离、耻骨联合与会阴体距离、耻骨联合与膀胱颈距离、生殖道裂孔前后径、膀胱后角、尿道倾斜角、尿道长度、直肠前凸距离、肛直角及会阴体移动度、尿道移动度的差异;经阴道三维超声观察并比较各组肛提肌裂孔前后径、横径和面积、肛提肌直径和面积、阴道旁间隙面积、肛提肌损伤评分的差异。结果经阴道二维超声检查显示,静息及Valsalva状态下各组耻骨联合与膀胱底距离、耻骨联合与会阴体距离、膀胱后角、尿道倾斜角、直肠前凸距离比较差异均有统计学意义(均P<0.05),静息状态下各组尿道长度和肛直角比较差异均有统计学意义(均P<0.05),Valsalva状态下各组生殖道裂孔前后径比较差异有统计学意义(P<0.05)。各组会阴体移动度和尿道移动度比较差异均有统计学意义(均P<0.05)。经阴道三维超声检查显示,各组肛提肌裂孔前后径、横径、右侧径及双侧阴道旁间隙面积、肛提肌损伤评分、髂骨尾骨肌损伤评分、耻骨尾骨肌损伤评分比较差异均有统计学意义(均P<0.05)。结论经阴道二维联合三维超声可全面评估不同位置POP患者盆底结构,为临床制定治疗方案提供参考,具有较好的应用价值。

Objective To investigate the clinical application value of transvaginal two-dimensional combined with three-dimensional ultrasound in the evaluation of pelvic floor structure in different position of pelvic organ prolapse(POP).Methods A total of 78 patients with POP in our hospital were selected,including 34 patients with anterior pelvic prolapse(group A),18 patients with middle pelvic prolapse(group B),26 patients with posterior pelvic prolapse(group C),and 30patients with gynaecological outpatients without POP during the same period were selected as the control group.The differences of distance between pubic symphysis and bladder floor,pubic symphysis and pudendal body,pubic symphysis and bladder neck,anterior and posterior diameter of genital hiatus,posterior angle of bladder,urethral inclination angle,urethral length,rectocele distance,anorectal angle and perineal body mobility,urethral mobility were observed and compared by transvaginal twodimensional ultrasound under resting and Valsalva conditions.The differences of anterior and posterior diameter,transverse diameter and area of levator ani muscle hiatus,diameter and area of levator anus muscle,area of paravaginal space and injury score of levator anus muscle were observed and compared by transvaginal three-dimensional ultrasound.Results Transvaginal two-dimensional ultrasound showed that the distance between pubic symphysis and bladder floor,pubic symphysis and perineal body,urethral inclination angle,posterior bladder angle and rectocle distance were significantly different among the groups under resting and Valsalva conditions(all P<0.05).There were significant differences in urethral length and anorectal angle among the groups in resting condition(all P<0.05),and there was significant difference in anterior and posterior diameter of genital hiatus among the groups in Valsalva condition(P<0.05).There were significant difference in perineal body mobility and urethral mobility among the groups(both P<0.05).Transvaginal three-dimensional ultrasound showed that the anterior and posterior diameters,transverse diameters,right diameters of levator ani hiatus,and bilateral paravaginal space area were significantly different among groups(all P<0.05),and the injury scores of levator muscle,iliac coccygeus muscle,and pubococcygeus muscle were significantly different among groups(all P<0.05).Conclusion Transvaginal two-dimensional combined with threedimensional ultrasound can assess the changes of pelvic floor structure in patients with POP in different positions,and provide a reference for clinical treatment plan,which has good application value.