多模态超声评估阴道分娩后早期压力性尿失禁患者肛提肌复合体变化研究

Study on the changes of levator complex in patients with early postpartum stress urinary incontinence after vaginal delivery by multimodal ultrasonography

目的研究二维、三维盆底超声及剪切波弹性成像(SWE)评估经阴道分娩初产后早期压力性尿失禁(SUI)患者肛提肌复合体的变化情况。方法选取2019年12月至2022年12月该院收治的足月单胎阴道分娩后6~8周临床诊断为SUI的初产妇57例为SUI组,另选取同条件的非SUI初产妇40例为对照组。经二维、三维盆底超声及SWE检查后,计算2组患者肛提肌耻骨直肠支厚度应变率(ΔT)、提肌裂孔应变率(ΔS)及耻骨直肠肌弹性模量变化率(ΔY),并进行对比分析,评估其肛提肌复合体变化。结果SUI组患者肛提肌ΔT、ΔS(ΔSa、ΔSc及ΔSs)及ΔY显著高于非SUI组,差异均有统计学意义(P<0.05);受试者工作特征曲线分析发现,ΔT及ΔY曲线下面积均大于0.600,以ΔT最大,当ΔT、ΔSa、ΔSc、ΔSs、ΔY为76.7%、37.5%、38.2%、37.9%、56.0%时,灵敏度分别为84.2%、82.5%、63.2%、58.0%、86.0%,特异度为92.5%、55.0%、75.0%、80.0%、70.0%。结论二维、三维盆底超声联合SWE在提示肛提肌耻骨直肠支弹性改变、产后SUI肛提肌复合体状态及功能中具有良好的效果。SWE联合盆底超声适合产后SUI的诊断及病情判断。

Objective To explore the changes of levator complex in patients with early postpartum stress urinary incontinence(SUI)after vaginal delivery by two-dimensional,three-dimensional pelvic floor ultrasound and shear wave elasticity(SWE).Methods From December 2019 to December 2022,a total of 57 primiparas who were clinically diagnosed as SUI six to eight weeks after vaginal delivery of full-term singletons admitted to this hospital were selected as the SUI group,and 40 non-SUI primiparas with the same conditions were selected as the control group.All patients received two-dimensional and three-dimensional pelvic floor ultrasound and SWE examinations,the strain rate of levator puborectal branch thickness(ΔT),levator hiatus strain rate(ΔS)and puborectalis elastic modulus change rate(ΔY)were calculated and compared between the two groups to evaluate the changes of levator complex.Results TheΔT,ΔS(ΔSa,ΔSc andΔSs)andΔY in the SUI group were larger than those in the non-SUI group,and the differences were statistically significant(P<0.05).The receiver operating curve(ROC)showed that the under area ofΔT andΔY were all greater than 0.600,andΔT′area was the largest.WhenΔT,ΔSa,ΔSc,ΔSs,ΔY was 76.7%,37.5%,38.2%,37.9%,56.0%,the sensitivity was 84.2%,82.5%,63.2%,58.0%,86.0%,and the specificity was 92.5%,55.0%,75.0%,80.0%,70.0%,respectively.Conclusion Two-dimensional and three-dimensional pelvic floor ultrasound combined with SWE have a good effect in indicating the elastic changes,the status and function of the levator complex in postpartum SUI.SWE combined with pelvic floor ultrasound is suitable for the diagnosis and condition judgment of postpartum SUI.