经会阴三维超声评价肛提肌裂孔在产后早期盆腔器官脱垂中的应用

Application of levator hiatus evaluated by three-dimensional transperineal ultrasound in diagnosis of pelvic organ prolapse in early post partum period

目的探讨经会阴三维超声评价肛提肌裂孔(LH)在盆腔器官脱垂(POP)中的诊断价值。方法选取2020年1月至2021年12月在该院超声科行盆底超声检查的产后6~8周产妇232例,均行二维及三维超声检查,分别测量并比较静息、最大Valsalva动作、缩肛状态LH前后径、横径及面积的差异;绘制静息、最大Valsalva动作状态受试者工作特征曲线,确定LH前后径及面积诊断POP的最佳截断值。结果232例产妇中发生POP 140例(60.3%),其中膀胱膨出120例(51.7%),子宫脱垂42例(18.1%),直肠膨出40例(17.2%)。未见明显POP 92例。POP组产妇静息、缩肛、最大Valsalva动作状态LH前后径、横径、面积均明显大于无POP组,差异均有统计学意义(P<0.05)。LH面积在静息、最大Valsalva动作状态受试者工作特征曲线下面积分别为0.679、0.822,最佳截断值为12.75、22.60 cm 2时灵敏度分别为77.1%、65.0%,特异度分别为53.3%、87.0%;LH前后径在静息、最大Valsalva动作状态受试者工作特征曲线下面积分别为0.657、0.804,最佳截断值为4.75、6.25 cm时灵敏度分别为67.1%、57.9%,特异度分别为63.0%、88.0%。结论经会阴三维超声评估LH大小形态变化可有效诊断POP,最大Valsalva动作状态LH前后径及面积对POP均具有较高的诊断效能。

Objective To investigate the diagnostic value of levator hiatus(LH)evaluated by three-dimensional transperineal ultrasound in diagnosis of pelvic organ prolapse(POP).Methods A total of 232 puerpera who underwent pelvic floor ultrasound examination in the Department of Ultrasound of this hospital from January 2020 to December 2021 at 6 to 8 weeks postpartum were selected.All patients underwent two-dimensional and three-dimensional ultrasound examination.The differences of anterior and posterior diameter,transverse diameter and area of LH in resting state,maximum Valsalva state and anal contraction state were measured and compared.ROC curves of resting state and Valsalva state were drawn to determine the optimal cut-off value of anterior and posterior diameter and area of levator ANI hiatus in the diagnosis of POP.Results Among the 232 patients,140(60.3%)had POP,including 120(51.7%)cystocele,42(18.1%)uterine prolapse and 40(17.2%)rectal bulge.There was no obvious POP in 92 patients.The anteriorposterior diameter,transverse diameter and area of LH in the POP group were significantly larger than those in the non-POP group at rest,contraction and maximum Valsalva state,and the differences between the two groups were statistically significant(P<0.05).The area of LH in resting state and maximum Valsalva state,the area under the curve was 0.679 and 0.822,respectively,the optimal cut-off values were 12.75 cm 2 and 22.60 cm 2,the sensitivity was 77.1%and 65.0%,the specificity was 53.3%and 87.0%respectively.In the resting state and the maximum Valsalva state,the area under the curve was 0.657 and 0.804,the best cut-off values were 4.75 cm and 6.25 cm,the sensitivity was 67.1%and 57.9%,the specificity was 63.0%and 88.0%.Conclusion The changes in size and morphology of LH measured by three-dimensional transperineal pelvic floor ultrasound can effectively diagnose POP.Both the anterior and posterior diameter and area of LH in Valsalva state have high diagnostic value for POP.