摘要
目的探讨应用三维盆底超声观测盆腔器官脱垂(POP)患者肛提肌损伤与生殖道裂孔相关性。方法选择2019年5月―2021年4月于本院妇科术前通过POP定量分期系统(POP-Q)分期为Ⅲ-Ⅳ期的220例POP患者作为研究对象,所有患者均行盆底超声检查及盆底断层成像技术,评估肛提肌损伤情况,在盆膈裂孔最小平面测量双侧肛提肌尿道间隙(LUG)。在最大Valsava状态下三维盆底超声轴平面测量盆膈裂孔面积(LHA)。根据盆底超声扫查结果是否存在肛提肌损伤分为损伤组及未损伤组,比较两组生殖道裂孔高度、会阴体长度以及盆膈裂孔面积(LHA)。对肛提肌损伤组进行多因素回归分析。通过受试者工作特征曲线(ROC)计算生殖道裂孔高度截断值来预测肛提肌损伤的诊断性能。结果盆底超声探测肛提肌损伤128例(58.2%),无损伤92例(41.8%)。损伤组生殖道裂孔高度均值为(54.04±3.85)mm,会阴体长度均值为(22.18±1.82)mm,LHA均值(33.70±2.99)cm^(2);无损伤组生殖道裂孔高度均值为(46.77±2.72)mm,会阴体长度均值(22.25±1.76)mm,LHA均值(28.89±1.70)cm^(2)。两组中生殖道裂孔高度均值与LHA均值比较,差异均有统计学意义(P<0.05),会阴体长度均值比较,差异无统计学意义(P>0.05)。Logistic回归分析显示,生殖道裂孔高度与LHA增大均是肛提肌损伤的独立影响因素,差异有统计学意义(OR值分别为1.508、1.905,P值分别为0.004,0.006)。生殖道裂孔高度预测肛提肌损伤的截断值为51.39 mm时,其曲线下面积、截断值的灵敏度、特异性、约登指数及95%CI分别为0.935、79.70%、98.90%、0.786、0.903-0.967。结论生殖道裂孔高度的尺寸是潜在预测肛提肌损伤的标志。当生殖道裂孔高度截断值为51.39 mm时,可以作为临床怀疑肛提肌损伤的初筛指标,辅助预测肛提肌损伤,但最终诊断肛提肌损伤需要结合影像学检查。
Objective To explore the relationship between levator ani muscle injury and genital hiatus observed by applying three-dimensional pelvic floor ultrasound in the patients with pelvic organ prolapse(POP).Methods A total of 220 cases of patients suffered with POP,those ever been admitted to gynecology department of our hospital during May 2019 and April 2021 and were classed into phase Ⅲ to phase Ⅳ according to POP quantified staging system(POP-Q),were retrospectively enrolled in the study.All patients underwent pelvic floor ultrasonography and pelvic floor tomography to evaluate the injury of levator ani muscle.The bilateral levator urethra gap(LUG)was measured at the minimum plane of pelvic diaphragmatic hiatus.The levator ani hiatus area(LHA)was measured by three-dimensional pelvic floor ultrasonic axial plane at the maximum Valsava state.According to the results of pelvic floor ultrasound,the patients with levator ani muscle injury were divided into injury group and the others were enrolled in non injury group.The height of reproductive tract fissure,perineal body length and LHA were compared between the two groups.Multivariate regression analysis was performed in the levator ani muscle injury group.The diagnostic performance of levator ani injury was predicted by calculating the GH cutoff value of genital hiatus through receiver operating characteristic curve(ROC).Results Pelvic floor ultrasound detected 128 cases(58.2%)of levator ani muscle injury and 92 cases(41.8%)of no injury.In the injury group,the mean height of genital tract fissure was(54.04±3.85)mm,the mean length of perineal body was(22.18±1.82)mm,and the mean value of LHA was(33.70±2.99)cm^(2).In the non injury group,the mean height of genital tract fissure was(46.77±2.72)mm,the mean length of perineal body was(22.25±1.76)mm,and the mean LHA was(28.89±1.70)cm^(2).There were significant differences in mean height of genital tract fissure and value of LHA between the two groups(P<0.05),and there was no significant difference in the mean lengt
作者
何丽英
江峰
叶彩虹
朱菲菲
胡国兵
张平洋
He Liying;Jiang Feng;Ye Caihong;Zhu Feifei;Hu Guobing;Zhang Pingyang(Department of Ultrasonography,Nanjing hospital affiliated to Nanjing Medical University(first hospital of Nanjing),Nanjing,Jiangsu,210000,China;Department of Ultrasonography,Yijishan hospital&the first affiliated hospital of Wannan Medical College,Wuhu,Anhui,241000,China)
出处
《齐齐哈尔医学院学报》
2022年第10期948-952,共5页
Journal of Qiqihar Medical University
基金
南京市科技发展资助计划(医学项目)
南京市医学发展重点项目(ZKX17026)。
关键词
三维盆底超声
盆底断层成像
肛提肌损伤
生殖道裂孔
Three-dimensional pelvic floor ultrasound
Pelvic floor tomography
Levator ani muscle injury
Genital hiatus
