【摘要】 目的探讨在盆底正中矢状切面上二维超声测量肛提肌裂孔前后径和面积与盆腔器官脱垂病情严重程度的相关性。方法选取2016年3月至2018年9月因下尿路症状或盆腔器官脱垂症状而就诊的155名女性患者作为研究对象。收集患者盆腔脱垂症状(包括特异性脱垂症状及相关排尿、排便、性功能障碍等)、国际尿失禁协会(International Continence Society, ICS)制定的盆腔脏器脱垂POP-Q分期(pelvic organ prolapse quantitation, POP-Q)资料及超声测量肛提肌裂孔前后径与面积;分析超声测量肛提肌裂孔前后径及面积与POP-Q分期和临床症状的相关性;绘制受试者工作曲线(receiver operating characteristic curve,ROC),分析肛提肌裂孔前后径与面积在评估盆腔器官脱垂中的价值。结果①根据POP-Q分期,155例患者中0期64例,1期38例,2期33例,3期18例,4期2例;其中存在临床症状的患者49例,占31.61%;②Spearman线性相关性分析得出,肛提肌裂孔前后径、面积与POP-Q分期呈正相关(ρ=0.634,0.830,P<0.001);③ROC曲线分析显示,肛提肌裂孔前后径在预测POP-Q2期以上的盆腔器官脱垂中的曲线下面积(AUC)=0.799(95%CI:0.725～0.873),截点值为6.25cm,敏感度为71.70%,特异度为80.39%;肛提肌裂孔面积在预测POP-Q2期以上的盆腔器官脱垂中AUC=0.904(95%CI:0.858～0.949),截点值为14.93cm~2,敏感度为84.91%,特异度为81.37%;在脱垂症状方面,肛提肌裂孔前后径AUC=0.785(95%CI:0.714～0.857),截点值为5.95cm,敏感度为87.76%,特异度为80.60%;裂孔面积AUC=0.973(95%CI:0.953～0.993),截点值为21.56cm~2,敏感度为95.92%,特异度为89.62%。结论超声测量肛提肌裂孔前后径和面积在评估盆腔器官脱垂方面具有良好的应用价值,特别是对于基层无法开展三维超声的医院,二维超声测量前后径也是很好的预测指标。更多还原

【Abstract】 Objective To investigate the correlation between the anteroposterior diameter and area of levator ani hiatus and the severity of pelvic organ prolapse(POP). Methods A retrospective analysis of 155 female patients went to hospital due to lower urinary tract or POP symptoms from March 2016 to September 2018 was performed. The POP symptoms(including specific prolapse symptoms and related urination, defecation and sexual dysfunction symptoms, etc.), International Continence Society(ICS) Pelvic Organ Prolapse Quantitation(POP-Q) data and ultrasound measurement of anteroposterior diameter and area of levator ani hiatus were collected. The correlation between anteroposterior diameter and area of levator ani hiatus and POP-Q staging and clinical symptoms was analyzed. The receiver operating characteristic curve(ROC) was drawn and the value of anteroposterior diameter and area of levator ani hiatus in evaluating POP was analyzed. Results ①According to POP-Q staging, there were 64 patients with stage 0, 38 patients with stage 1, 33 patients with stage 2, 18 patients with stage 3, and 2 patients with stage 4 in the 155 patients; 49 patients had clinical symptoms, accounting for 31.61%. ②Spearman linear correlation analysis showed that the anteroposterior diameter and area of levator ani hiatus were positively correlated with POP-Q stage(ρ=0.634, 0.830, P<0.001). ③ ROC curve analysis showed that the area under the curve(AUC) of anteroposterior diameter of levator ani hiatus in predicting POP above POP-Q stage 2 was 0.799(95%CI:0.725～0.873), and the cut-off value was 6.25 cm, sensitivity was 71.70%, specificity was 80.39%; AUC of area of levator ani hiatus in predicting POP-Q stage 2 was 0.904(95%CI:0.858～0.949), the cut-off value was 14.93 cm~2, sensitivity was 84.91%, and specificity was 81.37%. In terms of prolapse symptoms, AUC of the anteroposterior diameter of the levator ani hiatus was 0.785(95% CI:0.714～0.857), the cut-point value was 5.95 cm, the sensitivity was 87.76%, and the specificity was 80.60%; AUC of the area of levator ani hiatus was 0.973(95%CI:0.953～0.993), the cut-off value was 21.56 cm~2, the sensitivity was 95.92%, and the specificity was 89.62%. Conclusions Ultrasound measurement of the anteroposterior diameter and area of the levator ani hiatus has a good application value in the evaluation of POP. Especially for hospitals where three-dimensional ultrasound was unavailable, the anteroposterior diameter of two-dimensional ultrasound measurement is also of high predictive value.更多还原