盆底超声泌尿裂孔相关参数联合POP-Q评分诊断产后盆腔脏器脱垂效果

Effect of the pelvic ultrasound parameters related to urinary hiatus combined with the pelvic organ prolapse score of women for diagnosing their postpartum pelvic organ prolapse

目的:探讨使用盆底超声泌尿裂孔相关参数联合盆腔器官脱垂定量分析法(POP-Q评分)对产后盆腔脏器脱垂(POP)的发生与严重程度的诊断价值。方法:选取2022年4月-2023年4月本院收治的130例POP患者为POP组,体检健康女性130例为对照组。使用盆底三维超声进行检查,比较各组泌尿裂孔在静息状态、瓦尔萨尔瓦(Valsalva)状态和缩肛状态下的左右径、前后径和面积,并记录不同时期、不同脱垂严重程度POP患者泌尿生殖裂孔参数,分析泌尿裂孔相关参数与产后POP严重程度的相关性。绘制各诊断方法的受试者工作特征(ROC)曲线诊断效能。结果:POP组静息状态、Valsalva状态和缩肛状态下泌尿生殖裂孔各指标均高于对照组,静息-缩肛和Valsalva-静息时期泌尿生殖裂孔各指标均高于对照组,POP组中重度组各检测状态的泌尿生殖裂孔参数均高于中轻度组(均P<0.05),POP患者泌尿裂孔的左右径、前后径和面积与脱垂的严重程度成正比(均P<0.05),ROC曲线分析,盆底超声泌尿裂孔相关参数联合POP-Q评分诊断POP的严重程度的曲线下面积(0.931)、灵敏度(0.910)、特异度(0.952)均高于单独指标诊断(均P<0.05)。结论:盆底超声泌尿裂孔相关参数联合POP-Q评分可用于诊断产后POP情况,泌尿裂孔相关参数越高,出现产后POP可能性越大、程度越严重。

Objective:To investigate the value of pelvic floor ultrasound parameters associated with urinary hiatus combined with the pelvic organ prolapse quantitation(POP-Q)score of women for diagnosing their postpartum pelvic organ prolapse(POP).Methods:130 women with POP admitted to the hospital were selected in study group and 130 healthy women who were given physical examination in the hospital were selected in control group from April 2022 to April 2023.The women in the two groups were examined by the pelvic floor three-dimensional ultrasound.The transverse diameter,the anteroposterior diameter and the area of the urogenital hiatus of the women at resting state,at Valsalva state and at the anal contraction state were compared between the two groups.The parameters of the urogenital hiatus of the women in the study group in the different periods and in the different POP severity were recorded to analyze the correlation between the urogenital hiatus related parameters of the women with POP and their postpartum POP severity.Receiver operator characteristic(ROC)curve were drawn to evaluate the diagnostic efficacy of the pelvic floor ultrasound parameters associated with the urinary hiatus and the POP-Q score of the women for diagnosing their postpartum POP.Results:All the indicators of the urogenital hiatus of the women in the study group at the resting state,at Valsalva state and at the anal contraction state were significantly higher than those of the women in the control group.And all the indicators of the urogenital hiatus of the women in the study group from resting to anal contraction and from Valsalva to resting were significantly higher than those of the women in the control group.In the study group,the parameters of the urogenital hiatus of the women with severe POP were significantly higher than those of the women with moderate or mild POP(all P<0.05).The transverse diameter,the anteroposterior diameter and the area of the urinary hiatus of the women with POP were directly proportional to their severity of prolapse(all P<0.05).ROC analysis showed that the area under the curve(0.931),the sensitivity(0.910)and the specificity(0.952)of the urinary hiatus related parameters by pelvic floor ultrasound combined with the POP-Q score of the women for diagnosing their severity of POP were all significantly higher than those of the urinary hiatus related parameters by pelvic floor ultrasound or the POP-Q score alone(all P<0.05).Conclusion:The urinary hiatus related parameters by pelvic ultrasound combined with the POP-Q score of the women can be used to diagnosing their situation of postpartum POP.The higher values of the urinary hiatus related parameters,the greater the possibility of the postpartum POP and the more severe of the POP of the women.