经会阴4D超声对产后压力性尿失禁患者的盆底肌应变率研究

Study of pelvic floor muscle strain rate in postpartum patients with stress urinary incontinence by perineal 4D ultrasound

目的:经会阴4D超声对盆底结构和功能进行研究,为诊断产后早期压力性尿失禁(SUI)提供肛提肌伸缩应变率量化参数及客观依据。方法:收集包头医学院第二附属医院就诊的产后42~100 d有SUI症状患者30例作为病例组(SUI组),同期无SUI症状患者30例为对照组(非SUI组)。测量不同状态下膀胱颈移动度(BNM)、尿道旋转角(URA)、膀胱后角(RVA),计算肛提肌伸缩应变率并进行分析对比。绘制受试者工作特征曲线获得超声诊断截断值。结果:两组一般资料差异无统计学意义(P<0.05)。SUI组和非SUI组的面积收缩应变率(εA1)均和周长收缩应变率(εC1)呈正相关(r=0.617,P<0.01;r=0.457,P<0.05);两组的εC1均和前后径收缩应变率(εL1)呈正相关(r=0.569,P<0.01;r=0.563,P<0.01);两组的面积拉伸应变率(εA2)均和周长拉伸应变率(εC2)(r=0.370,P<0.01;r=0.647,P<0.01)、前后径拉伸应变率(εL2)(r=0.663,P<0.01;r=0.427,P<0.01)呈正相关;两组的εC2均和εL2呈正相关(r=0.785,P<0.01;r=0.542,P<0.01)。ROC曲线结果显示,εA1诊断截止最好,曲线下面积最大(0.9936),灵敏度最高(97.4%)。结论:肛提肌伸缩应变率对产后早期压力性尿失禁患者的诊断具有一定价值。

Objective:To study the structure and function of pelvic floor using 4D perineal ultrasonography,and to provide quantitative parameters and objective basis for the diagnosis of early postpartum stress urinary incontinence(SUI).Methods:A total of 30 women with SUI symptoms 42 to 100 days after dilivery were collected from the Second Affiliated Hospital of Baotou Medical College as the case group(SUI group),and 30 women without SUI symptoms in the same period as the control group(non-SUI group).Bladder neck mobility(BNM),urethral rotation angle(URA)and posterior bladder angle(RVA)were measured under different conditions,and the strain rate of levator ani muscle was calculated for analysis and comparison.The cut-off value of ultrasonic diagnosis was obtained by drawing the receiver operating characteristic curve(ROC).Results:There was no significant difference in general data between the two groups(P<0.05).The area shrinkage strain rate(εA1)in both SUI and non-SUI groups was positively correlated with the perimeter shrinkage strain rate(εC1)(r=0.617,P<0.01;r=0.457,P<0.05).TheεC1 of both groups was positively correlated with the strain rate of diameter shrinkage(εL1)(r=0.569,P<0.01;r=0.563,P<0.01).The average area tensile strain rate(εA2)of the two groups was positively correlated with perimeter tensile strain rate(εC2)(r=0.370,P<0.01;r=0.647,P<0.01)and tensile strain rate(εL2)(r=0.663,P<0.01;r=0.427,P<0.01).εC2 in the two groups was both positively correlated withεL2(r=0.785,P<0.01;r=0.542,P<0.01).The ROC curve showed thatεA1 had the best diagnostic cutoff,the largest area under the curve(0.9936),and the highest sensitivity(97.4%).Conclusion:The strain rate of levator ani muscle contraction is valuable in the diagnosis of early postpartum SUI.