盆底超声测量肛提肌耻骨联合间距预测产后早期盆腔器官脱垂的价值

The value of pelvic floor ultrasound measurement of the distance between the levator ani muscle and pubic symphysis in predicting early postpartum pelvic organ prolapse

目的探讨盆底超声测量肛提肌耻骨联合间距(肛耻间距)预测产后早期盆腔器官脱垂(POP)的价值。方法选取本院超声科行盆底超声检查的221例产后6~8周产妇为研究对象,所有产妇均行二维及三维盆底超声检查,分别测量静息状态、最大Valsalva状态及缩肛状态下肛耻间距,并测量膀胱、子宫、直肠与耻骨联合后下缘水平线的距离,分析不同状态下肛耻间距与POP的关系,绘制静息状态及Valsalva状态下的肛耻间距预测POP的受试者工作特征曲线(ROC)。结果221例产妇中,150例POP,占67.9%(150/221),57例存在2种或2种以上POP,71例未见明显POP:其中膀胱膨出132例(轻度80例,明显52例),占59.7%(132/221),56例可见尿道内口漏斗形成;子宫脱垂44例(轻度43例,明显1例),占19.9%(44/221);直肠膨出38例(轻度35例,明显3例),占17.2%(38/221)。221例产妇静息状态下肛耻间距范围32~65mm,平均(48.8土7.3)mm;最大Valsalva状态下肛耻间距向足背侧移位,且肛耻间距增大,范围40~85mm,平均(61.2土8.0)mm;缩肛状态下肛耻间距向头腹侧移位,肛耻间距变小,范围27~54mm,平均(40.2土5.2)mm。POP组肛耻间距在静息状态、最大Valsalva状态及缩肛状态下均大于无POP组(P<0.05)。有膀胱膨出组静息状态及最大Valsalva状态下肛耻间距大于无膀胱膨出组(P<0.05);子宫脱垂组、直肠膨出组最大Valsalva状态下肛耻间距大于无子宫脱垂组、无直肠膨出组(P<0.05)。绘制肛耻间距在静息状态及最大Valsalva状态下预测POP的ROC,静息状态及最大Valsalva状态下AUC分别为0.657、0.784,95%CI为0.578~0.735、0.725~0.844,最佳截断值为45.5mm、62.5mm,敏感度为77.3%、56.0%,特异度为49.3%、85.9%。结论盆底超声测量肛耻间距简单方便,能够很好预测产后早期POP,具有显著的临床应用价值。

Objective To explore the value of pelvic floor ultrasound measurement of the distance between the pubic symphysis and the levator ani muscle in predicting early postpartum pelvic organ prolapse(POP).Methods 221 postpartum women who underwent pelvic floor ultrasound examination in the ultrasound department of our hospital at 6-8 weeks postpartum were selected as the research subjects.All women underwent two-dimensional and three-dimensional pelvic floor ultrasound examination,and the anal pubic distance was measured in the resting state,maximum valsalva state,and anal contraction state,respectively.The distance between the bladder,uterus,rectum,and the posterior lower edge of the pubic symphysis was measured,and the relationship between the anal pubic distance and POP under different states was analyzed.The receiver operating characteristic(ROC)curves of the anal pubic distance in the resting state and valsalva state were plotted to predict POP,Results Among 221 parturients,150 had POP,accounting for 67.9%(150/221),57 had two or more types of POP,71 had no obvious POP:132 of them had cystocele(80 mild cases,52 obvious cases),accounting for 59.7%(132/221),and 56 had infundibulation of internal urethral opening.There were 44 cases of uterine prolapse(mild 43 cases,obvious 1 case),accounting for 19.9%(44/221).There were 38 cases of proctocele(35 mild cases,3 obvious cases),accounting for 17.2%(38/221).The spacing between the anal and pubic areas in 221 cases at rest ranged from 32 to 65 mm,with an average of(48.8±7.3)mm.In the maximum Valsalva state,the anopubic distance shifted to the dorsal side of the foot,and the anopubic distance increased,ranging from 40 to 85 mm,with an average of(61.2±8.0)mm.In the condition of retraction,the spacing between the anopubic and the anal was shifted to the ventral side of the head,and the spacing between the anopubic and the anal became smaller,ranging from 27 to 54 mm,with an average of(40.2±5.2)mm.The anal pubic distance in POP group was higher than that in no POP group at resting state,maximum Valsalva state and anal retraction state(P<0.05).The anopubic distance at rest and maximum Valsalva in the group with cystocele was greater than that in the group without cystocele(P<0.05).The maximum Valsalva distance between the anopubic area and the anal area in the prolapse group and the proctocele group was greater than that in the non-prolapse group and the non-proctocele group(P<0.05).The ROC of POP predicted by anopubic distance at resting state and maximum Valsalva state was plotted.AUC at resting state and maximum Valsalva state were 0.657 and 0.784,95%CI was 0.578~0.735 and 0.725~0.844,respectively.The optimal cut-off values were 45.5mm and 62.5mm,the sensitivity were 77.3%and 56.0%,and the specificity was 49.3%and 85.9%.Conclusion Pelvic floor ultrasound measurement of anal pubic distance is simple and convenient,and can effectively predict early postpartum POP,with significant clinical application value.