经会阴超声评估盆腔脏器脱垂的应用研究

发布时间：2018-12-06 21:06

【摘要】：目的:应用经会阴超声技术探究女性盆腔脏器脱垂(pelvic organ prolapse,POP)患者的盆底解剖结构及功能的改变,了解盆底超声成像特点,测量、统计、分析各项数据,量化超声诊断标准,评估经会阴超声技术的可行性及临床应用价值。方法:研究对象:2014年5月-2016年12月在南昌大学第一附属医院门诊及住院部的POP患者63例,对照组40例。两组患者均无盆腔巨大肿块,且近期未接受过盆腔手术及近期未使用过激素类药物。检查项目:观察两组研究对象的超声声像图表现,分别在静息期、张力期(Valsalva动作)、缩肛期下测量以下参数:膀胱颈距耻骨联合下缘水平线垂直距离(BN-VD)、宫颈距耻骨联合下缘水平线垂直距离(C-VD)、直肠壶腹部距耻骨联合下缘水平线垂直距离(RA-VD),根据所测数据计算移动范围。测量肛提肌裂孔的前后径(LHD)、肛提肌裂孔的左右径(LHLR)、肛提肌裂孔的周长(LHP)、肛提肌裂孔面积(LHA)、肛提肌厚度(LAT)。统计学分析:应用SPSS 19.0软件对参数进行统计分析,所测参数资料以(?)±s表示,采用配对样本t检验,P0.05表示有差异,P0.05表示差异无明显统计意义。计量资料以±s表示,采用Spearman相关性分析评估超声与临床诊断POP的相关性。结果:(1)POP组、对照组在年龄、BMI、生育状况比较,差异无统计学意义(P0.05)。(2)POP组在静息期、张力期、缩肛期时RA-VD、C-VD、BN-VD均较对照组小,差异有统计学意义(P0.05),移动度较对照组差异无明显统计学意义(P0.05)。LAT较对照组小,LHD、LHLR、LHP、LHA均较对照组大,差异均具有统计学意义(P0.05)。(3)POP组肛提肌损伤发生率57.1%(36/63),对照组肛提肌损伤发生率12.5%(5/40),两组发生率进行对比,差异具有统计学意义(P0.05)。(4)经会阴超声评估I度脱垂与II度脱垂与临床POP-Q评估的相关性好,相关系数分别为0.46、0.83。(5)POP组与对照组在张力期(Valsalva动作)LHA进行ROC曲线分析,得出曲线下面积为0.97(95%置信区间0.94,1.00),最佳临界值为18.25cm2,其敏感度为88.9%,特异性为97.5%。结论:经会阴超声可以定位、定性、定量评估盆腔脏器脱垂,定量评估盆腔脏器脱垂与临床POP-Q评估相关性好,具有辅助应用临床的价值。
[Abstract]:Objective: to investigate the changes of pelvic floor anatomical structure and function in female patients with pelvic organ prolapse (pelvic organ prolapse,POP) by transperineal ultrasound, and to understand the characteristics, measurement, statistics and analysis of pelvic floor ultrasound imaging. To evaluate the feasibility and clinical value of transperineal ultrasound. Methods: from May 2014 to December 2016, 63 patients with POP in outpatient and inpatient department of the first affiliated Hospital of Nanchang University and 40 patients in control group were studied. In both groups, there were no large pelvic masses, no pelvic surgery and no hormone therapy. The following parameters were measured during resting period, tension period (Valsalva action) and anus contraction period: vertical distance from bladder neck to the lower margin of pubic symphysis (BN-VD). The vertical distance from cervix to the lower margin of pubic symphysis (C-VD) and from the rectum ampulla to the lower margin of pubic symphysis (RA-VD) were calculated according to the measured data. Measure the anteroposterior diameter of the levator anal muscle hiatus (LHD), the left and right diameter of the levator ani muscle hiatus (LHLR), the circumference of the levator anal muscle fissure area of the (LHP), levator anal muscle hiatus area (LAT). Of the levator ani muscle Statistical analysis: the parameters were analyzed by SPSS 19.0 software. The parameters were expressed as (?) 卤s. Using paired sample t test, P0.05 indicated difference, P0.05 showed no statistical significance. The correlation between ultrasound and clinical diagnosis of POP was evaluated by Spearman correlation analysis. Results: (1) there was no significant difference in age and BMI, fertility between POP group and control group (P0.05). (2) RA-VD,C-VD,BN-VD in POP group was lower than that in control group in resting, tension and anal contraction stages. The difference was statistically significant (P0.05), and the mobility was not significantly different from that of the control group (P0.05). LAT was smaller than the control group, LHD,LHLR,LHP,LHA was larger than the control group. The incidence of levator ani muscle injury was 57.1% (36 / 63) in POP group and 12.5% (5 / 40) in control group (P0.05). (3). The difference was statistically significant (P0.05). (4). There was a good correlation between degree I prolapse and II degree prolapse and clinical POP-Q evaluation by perineum ultrasound. (5) ROC curve analysis of LHA in tension phase (Valsalva action) between POP group and control group showed that the area under the curve was 0.97 (95% confidence interval 0.94m1.00), the best critical value was 18.25cm2, and the correlation coefficient was 0.46 卤0.83.The best critical value was 18.25cm2.The results showed that the area under the curve was 0.97 (95% confidence interval 0.94m1.00). The sensitivity was 88.9 and the specificity was 97.5. Conclusion: transperineal ultrasound can be used to evaluate pelvic visceral prolapse with good correlation with clinical POP-Q evaluation.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R711.2

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