基于盆底超声的多参数联合用于自然分娩产妇盆底器官脱垂筛查中的临床价值

Clinical Value of Multi-parameter Combination Based on Pelvic Floor Ultrasound in Screening Pelvic Organ Prolapse in Puerperae Undergoing Natural Delivery

目的:探究基于盆底超声的多参数联合用于自然分娩产妇盆底器官脱垂(POP)筛查中的临床价值。方法:选取2022年1月—2023年1月乐平市人民医院医技科收治的自然分娩产妇100例作为生产组,根据POP-Q分期法将生产组患者分为未脱垂组(0期,n=36)、脱垂组A组(Ⅰ、Ⅱ期,n=34)、脱垂组B组(Ⅲ、Ⅳ期,n=30)。于产妇于产后6~8周行盆底超声检查。选取同期体检健康未生产女性43例为未生产组。观察各组Valsalva动作时肛提肌裂孔形态及相关盆底超声参数。采用受试者操作特征(ROC)曲线及曲线下面积(AUC)评价盆底超声参数对筛查自然分娩产妇产后POP及其程度的敏感度和特异度。结果:生产组膀胱颈移动度(BND)、尿道旋转角度(URA)及肛提肌裂孔的面积(HA)均大于未生产组,差异均有统计学意义(P<0.05);脱垂组BND、URA及HA均大于未脱垂组,差异均有统计学意义(P<0.05);BND、URA、HA筛查盆底器官脱垂最佳截断值分别为29.19 mm、48.05°、22.54 cm2,三者联合筛查AUC面积为0.918,高于BND、URA、HA(0.811、0.740、0.853),三者联合筛查特异度为75.61%,高于BND、URA、HA(77.78%、60.47%、63.27%),三者联合筛查敏感度为91.53%,高于BND、URA、HA(78.13%%、82.46%、90.20%);脱垂组A组BND、URA及HA均小于脱垂组B组(P<0.05);BND、URA、HA各指标筛查盆底器官脱垂程度最佳截断值分别为29.88 mm、49.68°、24.12 cm^(2),三者联合筛查AUC面积为0.958,高于BND、URA、HA(0.794、0.820、0.914),三者联合筛查特异度为96.67%,高于BND、URA、HA(86.67%、86.67%、90.32%),三者联合筛查敏感度为82.35%,高于BND、URA(61.76%、67.65%),与HA(82.35%)一致。结论:盆底超声检查能够筛查自然分娩产妇的盆腔器官脱垂及脱垂程度,是筛查产后盆底功能障碍性疾病的有效方法。

Objective:To explore the clinical value of multi-parameter combination based on pelvic floor ultrasound in screening pelvic organ prolapse(POP)in puerperae undergoing natural delivery.Method:A total of 100 puerperae undergoing natural delivery in Leping People's Hospital were enrolled as the delivery group from January 2022 to January 2023.According to POP-Q staging,they were divided into non-prolapse group(stage 0,n=36),prolapse group A(stageⅠ+Ⅱ,n=34)and prolapse group B(stageⅢ+Ⅳ,n=30).At 6-8 weeks after delivery,all underwent ultrasound examination.A total of 43 healthy women not undergoing delivery during the same period were enrolled as non-delivery group.The morphology of levator ani hiatus under Valsalva's maneuver(Valsalva)and related pelvic floor ultrasound parameters were observed.The screening value of pelvic floor ultrasound parameters for postpartum POP and their screening sensitivity and specificity for POP and severity were evaluated by receiver operating characteristic(ROC)curves and area under the curve(AUC).Result:Bladder neck descent(BND),urethral rotation angle(URA)and HA in delivery group were higher than those in non-delivery group,and the differences were statistically significant(P<0.05),and those were higher in prolapse group than those in non-prolapse group,and the differences were statistically significant(P<0.05).The best cut-off values of BND,URA and HA for screening POP were 29.19 mm,48.05°and 22.54 cm^(2),respectively.AUC of combined detection was 0.918,greater than 0.811,0.740,0.853 of BND,URA and HA alone.The screening specificity and sensitivity of combined detection were 75.61%and 91.53%,greater than those of BND,URA and HA alone(specificity=77.78%,60.47%,63.27%;sensitivity=78.13%,82.46%,90.20%).BND,URA and HA in prolapse group A were lower than those in prolapse group B(P<0.05).The best cut-off values of BND,URA and HA for screening POP severity were 29.88 mm,49.68°and 24.12 cm2,respectively.AUC of combined detection was 0.958,greater than 0.794,0.820,0.914 of BND,URA and HA alone.The screening specificity of combined detection was 96.67%,higher than 86.67%,86.67%and 90.32%of BND,URA and HA alone.The screening sensitivity of combined detection was 82.35%,higher than 61.76%and 67.65%of BND and URA alone,and which was consistent with that of HA(82.35%).Conclusion:Pelvic floor ultrasound can screen POP and its severity in puerperae undergoing natural delivery,which is an effective method to screen postpartum pelvic floor dysfunction.