经会阴三维超声检查对子宫全切术后盆底功能障碍的诊断价值

Diagnostic value of three dimensional perineal ultrasound in pelvic floor dysfunction after total hysterectomy

目的探讨经会阴三维超声检查在子宫全切术后盆底功能障碍中的诊断价值。方法选取90例子宫全切术后患者,将术后无发生盆底功能障碍分为对照组30例,诊断为盆腔器官脱垂患者分为盆腔器官脱垂组总计30例,诊断为尿失禁患者分为尿失禁组30例。经会阴三维超声检查,分析静息状态和Valsalva状态尿道倾斜角(urethral angle,UIA)、膀胱尿道后角(posterior urethrovesical angle,PUVA)、肛提肌裂孔面积(levator hiatus area,LHA)对盆腔器官脱垂和压力性尿失禁的诊断价值。结果Valsalva状态LHA对盆腔器官脱垂诊断的临界值为27.5 cm2,敏感度为70.0%,特异度为93.3%,阳性预测值为76.7%,阴性预测值为70.0%,说明Valsalva状态LHA对盆腔器官脱垂诊断价值较好;Valsalva状态UIA对压力性尿失禁的诊断临界值为40.5°,敏感度为80.0%,特异度为96.7%,阳性预测值为80.0%,阴性预测值为93.3%,说明Valsalva状态UIA对压力性尿失禁诊断价值较好。结论Valsalva状态LHA和UIA对盆腔器官脱垂和压力性尿失禁诊断价值较高。

Objective To discus the diagnostic value of transperineal three-dimensional ultrasound in pelvic floor dysfunction after total hysterectomy.Methods We found 90 cases of total hysterectomy,among them,30 cases with outdiagnosed with pelvic floor dysfunction were divided into control group,30 diagnosed with pelvic organ prolapse were divided into pelvic organ prolapse group,30 diagnosed with urinary incontinence were divided into urinary incontinence group.We measured UIA,PUVA and LHA of the cases in resting state and Valsalva state were analyzed by transperineal three-dimensional ultrasound in the diagnosis of uterine prolapse and stress incontinence.Results The cut-off value of LHA for the diagnosis of pelvic organ prolapse in Valsalva state was 27.5 cm~2,sensitivity was 70.0%,specificity was 93.3%,positive predictive value was 76.7%,negative predictive value was 70.0%.It was suggested that the measurement of LHA in Valsalva state was better diagnostic value for pelvic organ prolapse.The cut-off value of UIA for the diagnosis of stress incontinence in Valsalva state was 40.5°,sensitivity was 80.0%,specificity was 96.7%,positive predictive value was 80.0%,negative predictive value was 93.3%.It was suggested that the measurement of UIA in Valsalva state was better diagnostic value for stress incontinence.Conclusion The value of LHA and UIA in Valsalva state is better diagnostic value for pelvic organ prolapse and stress incontinence.