会阴超声结合POP-Q评分在评价重度盆腔脏器脱垂中隐匿性尿失禁的应用分析

发布时间：2018-03-10 04:37

本文选题：隐匿性压力性尿失禁　切入点：重度盆腔脏器脱垂　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的经会阴超声检测女性重度盆腔脏器脱垂(POP)合并隐匿性压力性尿失禁(OSUI)患者以及单纯性重度盆腔脏器脱垂(POP)患者下尿路、膀胱颈及肛提肌的相关超声学参数,结合患者的术前妇科检查进行的盆腔器官脱垂定量评分系统(POP-Q)的相关分析,客观的了解隐匿性尿失禁患者盆底组织形态学改变,评估经会阴超声及术前POP-Q评分在隐匿性尿失禁中的应用及价值,进而为重度POP合并隐匿性尿失禁的术前评估选择提供新的思路及方法。资料与方法1研究对象2014年9月至2016年6月就诊于郑大三附院盆底重建病区79例重度POP患者,尿动力学检查是否合并压力性尿失禁将其分为盆腔脏器脱垂(POP)合并隐匿性尿失禁组(OSUI)组和单纯盆腔脏器脱垂(POP)组。分别记录患者术前盆腔器官脱垂定量分度(POP-Q)评分、年龄、孕产次、脱垂情况等相关信息。2超声参数分析经会阴三维彩超分别测量患者静息状态及Valsalva动作后尿道口形态、尿道倾斜角(UIA)、膀胱颈与耻骨联合下缘的垂直距离(BN-S)及肛提肌裂孔面积(LHA)。计算尿道旋转角度(URA)、膀胱颈移动度(BND)。所有数据均录入EXCEL表格。使用SPSS21.0统计软件处理数据后比较两组患者POP-Q评分及超声各参数的差异性。3统计学方法采用SPSS 21.0统计软件处理数据。计量资料采用均数±标准差表示,即?X±S;计数资料描述其数量及比率,不符合正态性分布的计量资料以四分位间距表示。定量资料组间比较采用独立样本t检验,不符合正态性分布的定量资料组间对比采用独立样本的秩和(Z)检验。定性资料组间对比采用x2检验。检验水准取α=0.05,P值0.05为差异有统计学意义。诊断价值采用受试者工作特征(ROC)曲线分析。结果1.两组的年龄、孕产次、脱垂程度等基本情况对比差异无统计意义2.对比单纯盆腔脏器脱垂患者组,盆腔脏器脱垂合并隐匿性尿失禁的患者组POP-Q评分中Aa、Ba指示点有显著差异,差异有统计学意义(P=0.028、P=0.003)。ROC曲线选取+2.5 cm为Aa指示点预测是否合并OSUI的阈值,ROC曲线下面积为0.642(95%CI为0.519~0.765,P=0.03),敏感度为75.6%,特异度为52.6%;选择+3.5 cm为Ba指示点预测是否合并OSUI的阈值,ROC曲线下面积为0.699(95%CI为0.583~0.815,P=0.002),敏感度为92.7%,特异度为60.5%。3.静息状态下,盆腔脏器脱垂合并隐匿性尿失禁组肛提肌裂孔面积为(21.67±4.90)平方厘米。单纯盆腔器官脱垂组肛提肌裂空面积为(18.97±5.27)平方厘米。两组对比盆腔脏器脱垂合并隐匿性尿失禁组参数明显增大,差异有统计学意义(P=0.021)。ROC曲线选取16.77 cm2为静息状态下肛提肌裂孔面积预测是否合并OSUI的阈值,ROC曲线下面积为0.647(95%CI为0.525~0.770,P=0.024),敏感度为87,8%,特异度为55.3%。4.Valsalva动作后,盆腔脏器脱垂合并隐匿性尿失禁组肛提肌裂空面积为(31.82±7.14)平方厘米,单纯盆腔脏器脱垂组肛提肌裂空面积为(26.32±6.60)平方厘米,两组对比盆腔脏器脱垂合并隐匿性尿失禁组各参数均增大,差异有统计学意义(P=0.010)。ROC曲线选取31.05 cm2为Valsalva动作下肛提肌裂孔面积预测是否合并OSUI的阈值,ROC曲线下面积为0.728(95%CI为0.614~0.841,P=0.000),敏感度为84.2%,特异度为58.3%。5.静息状态转为Valsalva动作后,盆腔脏器脱垂合并隐匿性尿失禁组膀胱颈的移动度、尿道旋转角度分别为(24.54±6.60)毫米、(77.49±19.76)度,单纯盆腔脏器脱垂组膀胱颈的移动度、尿道旋转角度分别为(17.42±5.11)毫米、(67.94±15.91)度,两组参数对比差异有显著统计学意义(P=0.000、P=0.021)。膀胱颈的移动度、尿道旋转角度曲线下面积分别为0.451、0.521,诊断价值很低。6、盆腔器官脱垂合并隐匿性尿失禁组,在静息状态及Valsalva动作漏斗形尿道口发生率为36.6%(15/41)、51.2%(21/41),单纯盆腔脏器脱垂组在静息状态及Valsalva动作后漏斗形尿道口发生率为15.8%(6/38)、23.7%(9/38),两组两种状态下分别对比,差异具有统计学意义(P值均0.05)。结论1.重度盆腔脏器脱垂是否合并隐匿性尿失禁,POP-Q评分中反应前盆腔指示点中Aa、Ba点与其有一定相关性。2.经会阴超声可以清晰、准确的显示盆底解剖学结构形态,同时可动态观查盆底组织由静息状态到Valsalva动作解剖学结构的改变,可以为重度盆腔脏器是否合并OSUI提供影像学基础的解剖学定位。3.肛提肌是盆腔完整支持组织的首要的部分,肛提肌的损伤会导致盆底整体构造的异常,导致重度盆腔脏器合并隐匿性尿失禁的发生,肛提肌裂孔面积可为是否合并隐匿性尿失禁提供依据。4.术前评估重度POP患者中,POP-Q评分结合盆底超声多参数的观察及测量,可以提高隐匿性尿失禁的诊断率及准确性,为术前评估提供新的思路及方法。
[Abstract]:The purpose of transperineal ultrasound detection of female pelvic organ prolapse (POP) with occult stress urinary incontinence (OSUI) patients and simple pelvic organ prolapse (POP) patients with lower urinary tract, related to ultrasonic levator muscle of bladder neck and anus parameters, combined with pelvic organ prolapse quantitative scoring system of patients with gynecological examination before the (POP-Q) correlation analysis, objective understanding of the morphological changes of occult patients with urinary incontinence pelvic tissue, evaluate transperineal ultrasound and preoperative POP-Q score and application value in the occult incontinence, and to evaluate the choice to provide new ideas and methods of severe POP patients with occult urinary incontinence before operation. Materials and methods 1 research objects from September 2014 to June 2016 at the Zheng Dasan hospital in 79 cases of severe pelvic floor reconstruction in patients with POP, urodynamic examination with stress urinary incontinence and pelvic organ will be divided into Vertical (POP) with occult urinary incontinence group (OSUI group) and simple pelvic organ prolapse (POP) group. The patients were recorded before operation of pelvic organ prolapse quantitation (POP-Q) score, age, gravidity, prolapse and other related information.2 to analyse the ultrasonic parameters were measured in patients with resting state and Valsalva action of transperineal three-dimensional ultrasound after urethral mouth shape, urethral angle (UIA), the vertical distance between the bladder neck and the lower edge of the symphysis (BN-S) and levator hiatus area (LHA). The calculation of rotation angle (URA), transurethral resection of the bladder neck mobility (BND). All the data were input into EXCEL table. The difference was.3 methods using SPSS21.0 statistical software to process data of two groups were compared after POP-Q score and ultrasonic parameters using SPSS 21 statistical software to process data. The measurement data expressed by the mean and standard deviation, namely? X + S; count data. The number and ratio, do not accord with normal The measurement data of the said distribution with four points spacing. Comparison between quantitative data were analyzed by independent sample t test, does not meet the normal distribution of the quantitative data between the groups by using independent sample rank sum test (Z). The qualitative data comparison between the two groups by x2 test. Take a =0.05 level test, P value of 0.05 the difference was statistically significant. The diagnostic value of the receiver operating characteristic (ROC) curve analysis. Results 1. two groups of age, gravidity, prolapse degree difference had no statistical significance of the basic situation of 2. compared to pure pelvic organ prolapse patients, pelvic organ prolapse with occult urinary incontinence in patients with POP-Q score in Aa group Ba, indicating there is a significant difference, the difference was statistically significant (P=0.028, P=0.003).ROC +2.5 cm Aa curve indicating point prediction with OSUI threshold, ROC area under the curve was 0.642 (95%CI, 0.519~0.765, P= 0.03), the sensitivity was 75 .6%, the specificity was 52.6%; +3.5 cm Ba selection indicator point prediction with OSUI threshold, ROC area under the curve was 0.699 (95%CI, 0.583~0.815, P=0.002), the sensitivity was 92.7%, specificity of 60.5%.3. in resting state, pelvic organ prolapse with occult urinary incontinence group levator hiatus area (21.67 + 4.90) cm. Simple pelvic organ prolapse group levator hiatus area (18.97 + 5.27) cm. Two groups of pelvic organ prolapse with occult urinary incontinence group parameters increased significantly, the difference was statistically significant (P=0.021).ROC curve 16.77 cm2 levator hiatus area to predict whether the merger the OSUI threshold for the resting state of anus, area under the ROC curve was 0.647 (95%CI, 0.525~0.770, P=0.024), the sensitivity is 87,8%, the specificity of 55.3%.4.Valsalva action, pelvic organ prolapse with occult urinary incontinence group levator hiatus area (31.82 + 7.14) cm, simple pelvic organ prolapse group levator hiatus area (26.32 + 6.60) cm, between the two groups of pelvic organ prolapse with occult urinary incontinence group parameters were increased, the difference was statistically significant (P=0.010).ROC curve 31.05 cm2 levator hiatus area prediction with OSUI threshold is Valsalva under the action of anus, area under the ROC curve was 0.728 (95%CI, 0.614~0.841, P=0.000), the sensitivity was 84.2%, specificity of 58.3%.5. in resting state to Valsalva after operation, pelvic organ prolapse with occult urinary incontinence group of bladder neck mobility, urethral rotation respectively (24.54. 6.60 mm), (77.49 + 19.76), simple group of bladder pelvic organ prolapse neck mobility, urethral rotation angle respectively (17.42 + 5.11) mm, (67.94 + 15.91), the two groups have statistical significance of parameter difference (P=0.000, P=0.02 1). The bladder neck mobility, the area under the curve of urethral rotation angle were 0.451,0.521, the diagnostic value of.6 was very low, pelvic organ prolapse with occult urinary incontinence group in the resting state and Valsalva action funnel-shaped urethra incidence rate was 36.6% (15/41), 51.2% (21/41), simple pelvic organ prolapse group funnel in the resting state and after Valsalva action form urethral mouth occurrence rate was 15.8% (6/38), 23.7% (9/38), the two groups under two different conditions were compared, the difference was statistically significant (P < 0.05). Conclusion: 1. pelvic organ prolapse and whether occult urinary incontinence, pelvic anterior point indication in Aa reaction the score of POP-Q, Ba and.2. have a certain correlation transperineal ultrasound can clearly display the pelvic anatomy structure accurately, at the same time, the dynamic inspection of pelvic tissue from resting state to the Valsalva movement anatomy structure change, can be severe pelvic viscera Anus anatomical location.3. combined with OSUI imaging based on levator muscle is the most important part of the complete pelvic supporting tissue, levator ani muscle injury may lead to abnormal integral structure, leading to severe pelvic organ with occult urinary incontinence, levator hiatus area can be with occult urine provide the basis for.4. incontinence preoperative evaluation in patients with severe POP, POP-Q score of observation and measurement combined with pelvic ultrasound parameters, can improve the diagnostic accuracy rate and occult urinary incontinence, to provide new ideas and methods for preoperative evaluation.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.2;R711.59

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