盆腔器官活动度和肛提肌裂孔面积用于诊断盆腔器官脱垂

Pelvic organ mobility and levator ani hiatus area for diagnosing pelvic organ prolapse

目的观察盆腔器官活动度和肛提肌裂孔面积诊断盆腔器官脱垂(POP)的价值。方法收集疑诊盆底肌功能障碍的343例女性患者,根据POP定量系统(POP-Q)将其分为POP组(n=247)及对照组(n=96);记录其静息态至最大瓦尔萨尔瓦动作时的膀胱颈移动度(BNM)、宫颈移动度(CM)、直肠壶腹移动度(RAM)及最大瓦尔萨尔瓦动作下肛提肌裂孔面积(vHA);比较组间上述指标差异,评价其诊断POP的价值。结果POP组前腔BNM、中腔BNM和CM、后腔RAM与对照组各指标差异均有统计学意义(P均<0.05);其中,POP组中腔CM与对照组的差异较组间BNM差异更为显著(P=0.001 vs.P=0.01)。以BNM诊断前腔POP、以CM诊断中腔POP、以RAM诊断后腔POP的敏感度分别为85.60%、78.10%、88.60%,以vHA诊断前、中及后腔POP的敏感度分别为79.10%、85.60%及75.60%;以BNM+vHA诊断前腔POP的敏感度为94.96%,以CM+vHA诊断中腔POP的敏感度为97.10%,以RAM+vHA诊断后腔POP的敏感度为95.60%。结论盆腔器官活动度联合肛提肌裂孔面积有助于诊断POP。

Objective To observe the value of pelvic organ mobility and levator ani hiatus area for diagnosing pelvic organ prolapse(POP).Methods Totally 343 women with suspected pelvic floor dysfunction were enrolled and divided into POP group(n=247)or control group(n=96)according to POP quantification system(POP-Q).The bladder neck mobility(BNM),cervix mobility(CM)and rectum ampulla mobility(RAM)from resting-state to the maximum Valsalva maneuver were recorded,as well as levator ani hiatus area on the maximum Valsalva maneuver(vHA).Then the above ultrasonic parameters were compared between groups,and the values for diagnosing POP were evaluated.Results Compared with those in control group,BNM of anterior compartment,BNM and CM of apical compartment as well as RAM of posterior compartment in POP group were all significantly different(all P<0.05),and the difference of CM of middle cavity was more obvious than that of BNM between groups(P=0.001 vs.P=0.01).The sensitivity of BNM for diagnosing anterior compartment POP,of CM for diagnosing apical compartment POP,of RAM for diagnosing posterior compartment POP was 85.60%,78.10%and 88.60%,respectively.The sensitivity of vHA for diagnosing anterior,apical and posterior compartment POP was 79.10%,85.60%and 75.60%,respectively.The sensitivity of BNM+vHA for diagnosing anterior compartment POP was 94.96%,of CM+vHA for diagnosing middle compartment was 97.10%,and of RAM+vHA for diagnosing posterior compartment was 95.60%.Conclusion The combination of pelvic organ mobility and levator ani hiatus area was helpful for diagnosing POP.