会阴盆底超声测定膀胱角度对经产妇盆腔脏器脱垂术后压力性尿失禁发生的预测价值

The predictive value of bladder angle measured by perineum pelvic floor ultrasound in the occurrence of stress urinary incontinence after pelvic organ prolapse surgery

目的探讨会阴盆底超声测定膀胱角度对经产妇盆腔脏器脱垂术后压力性尿失禁(SUI)发生的预测价值。方法回顾性分析2020年9月至2021年9月于辽宁省朝阳市第二医院妇科行盆腔脏器脱垂术的116例经产的POP患者为研究对象。按照是否发生SUI,分为SUI组(n=43)和非SUI组(n=73)。对比两组经产妇的一般资料,通过多因素Cox回归分析盆腔脏器脱垂术后SUI的独立影响因素。通过曲线拟合和阈值效应分析确定膀胱角度和膀胱颈旋转角度的阈值效应,构建列线图预测模型并对模型进行验证。结果手术时间、膀胱角度、膀胱颈旋转角度、hs-CRP是经产妇盆腔脏器脱垂术后SUI的独立危险因素(P<0.05),膀胱充盈感是保护因素(P<0.05)。曲线拟合发现随着膀胱角度和膀胱颈旋转角度的升高,盆腔脏器脱垂术后SUI的概率呈上升趋势。根据独立影响因素构建预测模型,模型的AUC为0.835(95%CI:0.802~0.876,P<0.001),校准曲线及临床临床决策曲线评价结果提示模型准确性及有效性均较好。结论膀胱角度和膀胱颈旋转角度对经产妇盆腔脏器脱垂术后SUI的发生具有一定的预测价值,是SUI发生的独立危险因素。术前会阴盆底超声监测膀胱角度和膀胱颈旋转角度有助于预测SUI的发生。

Objective To explore the predictive value of perineum pelvic floor ultrasound to bladder angle in patients with stress urinary incontinence(SUI)after pelvic organ prolapse surgery.Methods A retrospective analysis was made on 116cases of post parturient pop patients who underwent pelvic organ prolapse surgery in the Department of Gynecology,the Second Hospital of Chaoyang City of Liaoning Province from September 2020 to September 2021.Patients were divided into SUI group(n=43)and non SUI group(n=73)according to whether SUI occurred or not.The general data of the two groups were compared,and the independent influencing factors of SUI after pelvic organ prolapse were analyzed by multivariate Cox regression.The threshold effects of bladder angle and bladder neck rotation angle were determined by curve fitting and threshold effect analysis.The nomogram prediction model was constructed and verified.Results Operation time,bladder angle,bladder neck rotation angle,hs-CRP and bladder filling feeling were the independent influencing factors of SUI after pelvic organ prolapse surgery(P<0.05).Curve fitting showed that the probability of SUI after pelvic organ prolapse increased with the increase of bladder angle and bladder neck rotation angle.The prediction model was constructed according to independent influencing factors.The AUC of the model was 0.835(95%CI:0.802~0.876,P<0.001).The evaluation results of calibration curve and clinical decision curve showed that the accuracy and effectiveness of the model were good.Conclusion Bladder angle and bladder neck rotation angle have certain predictive value for the occurrence of SUI after pelvic organ prolapse surgery,and are independent risk factors for the occurrence of SUI Preoperative perineal pelvic floor ultrasound monitoring of bladder angle and bladder neck rotation angle is helpful to predict the occurrence of SUI.