经会阴盆底超声在前盆腔器官脱垂合并压力性尿失禁诊断中的应用

Application of Transperineal Pelvic Floor Ultrasound in the Diagnosis of Anterior Pelvic Organ Prolapse Combined with Stress Urinary Incontinence

目的:探讨经会阴盆底超声在前盆腔器官脱垂合并压力性尿失禁(stress urinary incontinence,SUI)患者中的诊断价值。方法:选择2018年3月-2022年1月于郑州大学第三附属医院诊断为前盆腔器官脱垂合并SUI的56例患者设为脱垂+SUI组,选取同时期就诊于本院诊断为前盆腔器官脱垂并排除SUI的56例患者设为脱垂组,同时选取因妇科良性疾病且排除盆底及泌尿系统疾病的51例住院患者设为对照组。各组均行经会阴盆底超声检查并记录超声参数:静息状态下膀胱颈位置,最大Valsalva状态下膀胱颈位置、膀胱颈移动度(BND)、尿道旋转角(URA)、膀胱尿道后角(PUA)、肛提肌裂孔面积(LHA)及膀胱颈漏斗形成情况,比较各组受检者有无膀胱膨出及膀胱膨出分型情况。构建ROC曲线,得出各超声参数诊断前盆腔器官脱垂合并SUI的最佳截断值。结果:组间比较,脱垂+SUI组、脱垂组最大Valsalva状态下BND、URA、PUA、LHA均高于对照组,而膀胱颈位置均低于对照组(P<0.05);脱垂+SUI组最大Valsalva状态下BND、PUA、LHA均高于脱垂组,而URA低于脱垂组(P<0.05)。脱垂+SUI组以Ⅱ型膀胱膨出为主,而脱垂组以Ⅲ型膀胱膨出为主,两组膀胱膨出分型比较,差异有统计学意义(Z=-2.161,P<0.05),三组膀胱膨出分型比较,差异有统计学意义(χ^(2)=91.132,P<0.01)。与脱垂组相比,脱垂组+SUI组膀胱颈漏斗形成率较高,差异有统计学意义(χ^(2)=54.053,P=0.000);脱垂组膀胱颈漏斗形成率明显高于对照组,差异有统计学意义(χ^(2)=53.317,P<0.001)。ROC曲线结果显示,最大Valsalva状态下各超声参数诊断前盆腔器官脱垂合并SUI的截断值,BND为25.50 mm,URA为76.50°,PUA为138.50°,LHA为21.50 cm^(2),以及有膀胱颈漏斗形成。其敏感度分别为87.50%、44.64%、64.29%、94.64%、94.64%,特异度分别为53.60%、80.36%、66.07%、17.86%、73.21%,曲线下面积(AUC)分别为0.739、0.610、0.693、0.617、0.839。结论:经会阴盆底超声检查可以为前盆腔脏器脱垂合并SUI的诊断提供参考价值。

Objective:To explore the diagnostic value of transperineal pelvic floor ultrasound in patients with anterior pelvic organ prolapse combined with stress urinary incontinence(SUI).Method:Fifty-six patients diagnosed with anterior pelvic organ prolapse complicated with SUI in the Third Affiliated Hospital of Zhengzhou University from March 2018 to January 2022 were selected as the prolapse+SUI group,and 56 patients diagnosed with anterior pelvic organ prolapse and excluded from SUI were selected as the prolapse group,at the same time,51 hospitalized patients with gynecological benign diseases and pelvic floor and urinary system diseases were selected as the control group.Each group underwent transperineal pelvic floor ultrasound examination and recorded ultrasonic parameters:bladder neck location at resting state,bladder neck mobility(BND),urethral rotation angle(URA),posterior urethrovesical angle(PUA),levator hiatus area(LHA)in maximum Valsalva state were compared,and infundibulum of bladder neck,and the presence or absence of cystocele and the classification of cystocele were compared in each group.ROC curve was constructed to obtain the optimal cut-off value of each ultrasonic parameter before diagnosis of pelvic organ prolapse complicated with SUI.Result:Compared with each other,BND,URA,PUA,LHA and bladder neck funnel formation rate in prolapse+SUI and prolapse groups were higher than those in control group under maximum Valsalva condition,while the position of bladder neck was lower than that in control group(P<0.05).The maximum Valsalva BND,PUA and LHA in prolapse+SUI group were higher than those in prolapse group,but URA was lower than that in prolapse+SUI group(P<0.05).TypeⅡbladder bulging was predominant in prolapse+SUI group,while typeⅢbladder bulging was predominant in prolapse group.The cystocele typeⅡwas dominant in prolapse+SUI group,while the cystocele typeⅢwas dominant in prolapse+SUI group,and the difference of cystocele type between the two groups was statistically significant(Z=-2.161,P<0.05).The difference of cystocele type between the three groups was statistically significant(χ^(2)=91.132,P<0.01).Compared with prolapse group,the rate of bladder neck funnel formation in prolapse+SUI group was higher,the difference was statistically significant(χ^(2)=54.053,P=0.000);the rate of bladder neck funnel formation in prolapse group was significantly higher than that in control group,the difference was statistically significant(χ^(2)=53.317,P<0.001).ROC curve results showed that the truncation value of each ultrasonic parameter before diagnosis of pelvic organ prolapsion with SUI under the maximum Valsalva condition,BND was 25.50 mm,URA was 76.50°,PUA was 138.50°,LHA was 21.50 cm^(2),and bladder neck infundibulum formation.Its sensitivity were 87.50%,44.64%,64.29%,94.64%,94.64%,and its specificity were 53.60%,80.36%,66.07%,17.86%,73.21%,the area under the curve(AUC)were 0.739,0.610,0.693,0.617,0.839 respectively.Conclusion:Transperineal pelvic floor ultrasound can provide reference value for the diagnosis of anterior pelvic organ prolapse complicated with SUI.