盆底超声检查和Green分型诊断产妇产后早期盆底结构及压力性尿失禁

Diagnostic value of the pelvic floor ultrasound and Green classification for the postpartum early pelvic floor structure and stress urinary incontinence of puerperae

目的:探究盆底超声检查和Green分型在产妇产后早期盆底结构及压力性尿失禁(SUI)诊断中的价值。方法:选取2021年3月-2023年3月本院就诊经产妇204例,根据产后早期(6~8周)SUI发生情况分为SUI组(82例)和非SUI组(122例)。检查产妇静息和Valsalva动作状态下膀胱颈距耻骨联合下缘的距离(BSD)、膀胱尿道后角(PUA)、膀胱颈移动度(BND)和尿道旋转角(UR),对比Green分型;采用受试者工作特征(ROC)曲线分析相关参数诊断SUI价值。结果:静息状态下,两组盆底超声参数无差异(P>0.05);SUI组Valsalva动作状态下的BSD、PUA、BND和UR值均大于非SUI组,Green分型Ι型占比(25.6%)低于非SUI组(59.8%)(均P<0.05)。ROC曲线分析,Green分型曲线下面积(AUC)0.579,对SUI诊断价值不佳(P=0.057),Valsalva动作状态下BSD(AUC=0.758)、PUA(AUC=0.743)、BND(AUC=0.769)和UR(AUC=0.705)对SUI诊断价值良好(均P<0.05)。结论:盆底超声检查和Green分型能有效评估经产妇早期盆底结构状况,前者可诊断SUI。

Objective:To explore the diagnostic value of the pelvic floor ultrasound and Green classification for the postpartum early pelvic floor structure and stress urinary incontinence(SUI)of puerperae.Methods:A total of 204 puerperae were enrolled in this study between March 2021 and March 2023.According to the occurrence of the postpartum early SUI,these puerperae were divided into group A(82 cases with SUI)and group B(122 cases without SUI).The values of bladder neck-symphyseal distance(BSD),posterior urethrovesical angle(PUA),bladder neck descent(BND)and urethral rotation angle(UR)under rest and Valsalva manoeuvre states of the puerperae were detected and were compared between the pelvic floor ultrasound and Green classification.The diagnostic value of the relevant parameters of the pelvic floor ultrasound and Green classification for the SUI of the puerperae was analyzed by receiver operator characteristic(ROC)curves.Results:Under rest state,there was no significant difference in the pelvic floor ultrasound parameters of the puerperae between the two groups(P>0.05).Under Valsalva manoeuvre state,the values of BSD,PUA,BND and UR of the puerperae in group A were significantly higher than those of the puerperae in group B,and the proportion of the type I of Green classification(25.6%)of the puerperae in group A was significantly lower than that(59.8%)of the puerperae in group B(all P<0.05).The results of ROC curves analysis showed that the diagnostic value of Green classification(AUC=0.579)was poor for SUI of the puerperae(P=0.057).Under Valsalva manoeuvre state,the AUC of the BSD value,PUA value,BND value and UR value of Green classification of the puerperae for their SUI occurrence were 0.758,0.743,0.769 and 0.705,respectively,and which had good diagnostic value for SUI(P<0.05).Conclusion:The pelvic floor ultrasound and Green classification of the puerperae can effectively evaluate the postpartum early pelvic floor structure,and the pelvic floor ultrasound can diagnose the SUI occurrence of the puerperae.