经会阴三维盆底超声在女性压力性尿失禁诊断及病情程度评估中的应用

Application of transperineal three-dimensional pelvic floor ultrasound in the diagnosis and evaluation of female stress urinary incontinence

目的:探究经会阴三维盆底超声在女性压力性尿失禁(stress urinary incontinence,SUI)诊断及病情程度评估的应用。方法:选取2020年7月至2021年12月于武汉市中医医院诊疗的120例SUI患者为SUI组,再按病情分级分为轻度组(n=28)、中度组(n=56)、重度组(n=36);另选取同期行体检的健康女性40例为对照组。收集所有受试者一般资料及Valsalva状态超声检查参数膀胱颈移动度(bladder neck descent,BND)、尿道旋转角、膀胱后角。采用单因素、Pearson相关系数法分析相关指标与SUI的关系,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析经会阴三维盆底超声对SUI诊断及病情评估的效能。结果:SUI组超声检查参数BND、尿道旋转角、膀胱后角均明显大于对照组(均P<0.05)。轻度组、中度组、重度组的BND、尿道旋转角、膀胱后角均依次增大,组间比较差异均有统计学意义(均P<0.05)。ROC曲线分析显示,BND、尿道旋转角、膀胱后角对女性SUI诊断及病情评估均具一定价值,且以三者联合的应用价值最大。诊断SUI:曲线下面积(area under the curve,AUC)为0.991,敏感度为94.17%,特异度为100.00%。评估中度SUI:AUC为0.914,敏感度为92.86%,特异度为71.43%。评估重度SUI:AUC为0.937,敏感度为94.44%,特异度为87.50%。结论:经会阴三维盆底超声对女性SUI具有较高诊断价值,且可用于评估SUI病情程度,为临床诊疗提供客观、科学的依据。

Objective: To explore the application of transperineal three-dimensional pelvic floor ultrasound in the diagnosis and evaluation of female stress urinary incontinence(SUI). Methods: A total of 120 patients with SUI who were treated in our hospital from July 2020 to December 2021 were selected as SUI group, and they were divided into mild group(n=28), moderate group(n=56) and severe group(n=36) according to the disease classification. Another 40 healthy women who underwent physical examination in the same period were selected as the control group. The general information of all subjects and the ultrasonographic parameters of Valsalva status [bladder neck descent(BND), urethral rotation angle, and bladder posterior angle] were collected. Univariate analysis and Pearson correlation coefficient were used to analyze the relationship between related indicators and SUI. Receiver operating characteristic(ROC) curve was used to analyze the efficacy of transperineal three-dimensional pelvic floor ultrasound in the diagnosis and evaluation of SUI. Results: The ultrasonic parameters BND, urethral rotation angle and bladder posterior angle in the SUI group were significantly higher than those in the control group(all P<0.05). The BND, urethral rotation angle and posterior bladder angle of mild group, moderate group and severe group increased in turn, and the differences between the groups were statistically significant(all P<0.05). ROC curve analysis showed that BND, urethral rotation angle and bladder posterior angle had certain value for the diagnosis and disease evaluation of female SUI, and the application value of combination of the three was the highest. Diagnostic SUI: area under the curve(AUC) was 0.991, sensitivity was 94.17%, specificity was 100.00%. Moderate SUI: AUC was 0.914, sensitivity was 92.86%, specificity was 71.43%. Evaluation of severe SUI: AUC was 0.937, sensitivity was 94.44%, specificity was 87.50%. Conclusion: Transperineal threedimensional pelvic ultrasound has high diagnostic value for female SUI, and can be used to evaluate the severity of SUI, providing objective and scientific basis for clinical diagnosis and treatment.