实时剪切波超声弹性成像技术评估健康女性肛门括约肌复合体的初步研究

A preliminary study of real-time shear wave ultrasonic elastography to evaluate the anal sphincter complex in healthy women

目的:通过实时剪切波弹性成像(SWE)技术定量分析不同年龄阶段健康成人女性的肛门括约肌复合体(ASC)的硬度,为今后评估ASC的病变奠定基础。方法:选取2022年10月—2023年9月于云南大学附属医院行盆底及经阴道超声检查的健康女性124例,根据年龄分为4组。采用二维超声测量ASC的厚度,SWE测量ASC的弹性模量平均值;比较不同年龄ASC的厚度及弹性模量值的差异,分析二者之间的差异。结果:肛门内括约肌近端平面9点、12点、3点、6点厚度;中部平面9点、12点、3点、6点厚度;远端平面9点、3点、6点厚度与年龄呈微弱正相关(r_(p)=0.279、0.298、0.251、0.321、0.247、0.294、0.311、0.399、0.193、0.218、0.251,P<0.01)。肛门外括约肌远端平面9点、3点、6点厚度与年龄呈微弱正相关(r_(p)=0.202、0.232、0.305,P<0.05)。肛门内括约肌近端平面9点、12点、3点、6点弹性值;中部平面9点、12点、3点、6点弹性值;远端平面9点、12点、3点、6点弹性值与年龄呈负相关(r_(p)=-0.339、-0.157、-0.466、-0.554,-0.413、-0.183、-0.438、-0.548,-0.403、-0.291、-0.465、-0.509,P<0.01)。肛门外括约肌远端平面9点、12点、3点、6点弹性值与年龄呈负相关(r_(p)=-0.422、-0.317、-0.450、-0.540,P<0.01)。双侧耻骨直肠肌弹性值与年龄呈负相关(r_(p)=-0.397、-0.450,P<0.01)。结论:经会阴高频超声能清晰显示ACS的结构,SWE技术可以定量评估ACS的硬度,为临床提供重要参考依据。

Objective:To quantitatively analyze the hardness of anal sphincter complex(ASC)in healthy adult women of different ages by real-time shear wave elastography(SWE),and to lay a foundation for future evaluation of ASC lesions.Methods:A total of 124 healthy women who underwent pelvic floor and transvaginal ultrasonography in the Affiliated Hospital of Yunnan University from October 2022 to September 2023 were selected and divided into 4 groups according to age.The thickness of ASC was measured by two-dimensional ultrasound,and the average elastic modulus of ASC was measured by SWE.The thickness and elastic modulus of ASC at different ages were compared and the differences between them were analyzed.Results:The internal anal sphincter thicknesses of the proximal plane at 9,12,3,6 points,central plane at 9,12,3,6 points and distal plane at 9,3,6 points were positively correlated with age(r_(p)=0.279,0.298,0.251,0.321,0.247,0.294,0.311,0.399,0.193,0.218,0.251,P<0.01).The thicknesses of the distal plane of the external anal sphincter at 9,3 and 6points were positively correlated with age(r_(p)=0.202,0.232,0.305,P<0.05).The elastic values of the internal anal sphincter of proximal plane at 9,12,3,6 points,central plane at 9,12,3,6 points and distal plane at 9,12,3 points were negatively correlated with age(r_(p)=-0.339,-0.157,-0.466,-0.554,-0.413,-0.183,-0.438,-0.548,-0.403,-0.291,-0.465,-0.509,P<0.01).The elastic values at 9,12,3 and 6 points of the distal plane of the external anal sphincter were negatively correlated with age(r_(p)=-0.422,-0.317,-0.450,-0.540,P<0.01).The elasticity of bilateral puborectal muscle was negatively correlated with age(r_(p)=-0.397,-0.450,P<0.01).Conclusion:Perineal high frequency ultrasound can clearly show the structure of ASC,and SWE technique can quantitatively evaluate the hardness of ASC,which provides an important reference for clinical.