[1]汪雪莲,丁华.盆底三维超声及Glazer盆底表面肌电评估在产后压力性尿失禁的诊断价值[J].中国医学物理学杂志,2024,41(8):987-991.[doi:DOI:10.3969/j.issn.1005-202X.2024.08.010]
　WANG Xuelian,DING Hua.Diagnostic value of three-dimensional pelvic floor ultrasonography and Glazer pelvic floor surface electromyography in postpartum stress urinary incontinence[J].Chinese Journal of Medical Physics,2024,41(8):987-991.[doi:DOI:10.3969/j.issn.1005-202X.2024.08.010]
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盆底三维超声及Glazer盆底表面肌电评估在产后压力性尿失禁的诊断价值()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
41卷
期数:
2024年第8期
页码:
987-991
栏目:
医学影像物理
出版日期:
2024-08-31

文章信息/Info

Title:
Diagnostic value of three-dimensional pelvic floor ultrasonography and Glazer pelvic floor surface electromyography in postpartum stress urinary incontinence
文章编号:
1005-202X（2024）08-0987-05
作者:
汪雪莲; 丁华
芜湖市第一人民医院超声科， 安徽 芜湖 241000
Author(s):
WANG Xuelian;  DING Hua
Department of Ultrasound, the First Peoples Hospital of Wuhu, Wuhu 241000, China
关键词:
盆底; 三维超声; 肌电生理; 产后压力性尿失禁; 诊断模型
Keywords:
Keywords: pelvic floor three-dimensional ultrasonography muscle electrophysiology postpartum stress urinary incontinence diagnostic model
分类号:
R445.1
DOI:
DOI:10.3969/j.issn.1005-202X.2024.08.010
文献标志码:
A
摘要:
目的：探讨盆底三维超声及Glazer盆底表面肌电评估在产后压力性尿失禁（SUI）的诊断价值。方法：选取2021年8月~2022年12月在芜湖市第一人民医院分娩并在产后6~8周内接受复查的272例产妇作为研究对象，根据其是否发生SUI分为观察组（n=139）与对照组（n=133）。比较两组超声参数指标（尿道近端长度、静息状态下膀胱后角、肛提肌裂孔面积及最大Valsalve动作下膀胱颈移动度、膀胱颈距参考线下距离、膀胱后角、肛提肌裂孔面积），比较两组Glazer盆底表面肌电参数（前静息阶段、快速收缩阶段、紧张收缩阶段、耐力收缩阶段、后静息阶段），建立受试者工作特征（ROC）曲线分析各指标诊断产后SUI的效能。结果：两组尿道近端长度、静息状态下肛提肌裂孔面积、最大Valsalve动作下肛提肌裂孔面积比较差异无统计学意义（P>0.05）；观察组患者静息状态下膀胱后角小于对照组，观察组患者最大Valsalve动作下膀胱颈移动度、膀胱颈距参考线下距离、膀胱后角均大于对照组（P<0.05）。两组前静息阶段、快速收缩阶段、紧张收缩阶段、耐力收缩阶段、后静息阶段各项参数比较，差异均无统计学意义（P>0.05）。盆底多参数联合诊断模型公式为：-0.069×静息状态下膀胱后角+0.038×膀胱颈移动度+0.045×膀胱颈距参考线下距离+0.097×最大Valsalve动作下膀胱后角-10.521。ROC曲线分析显示，静息状态下膀胱后角、最大Valsalve动作下膀胱颈移动度、膀胱颈距参考线下距离、膀胱后角以及4项联合诊断产后SUI的AUC值分别为0.588、0.671、0.643、0.710、0.775，敏感度分别为52.6%、84.2%、73.4%、47.5%、59.0%，特异度分别为65.5%、44.4%、50.4%、82.0%、82.0%。结论：盆底三维超声参数（静息状态下膀胱后角及最大Valsalve动作下膀胱颈移动度、膀胱颈距参考线下距离、膀胱后角）诊断产后SUI具有一定效能，且联合诊断的诊断效能更高。
Abstract:
Abstract: Objective To evaluate the value of three-dimensional pelvic floor ultrasonography and Glazer pelvic floor surface electromyography (EMG) in diagnosing postpartum stress urinary incontinence (SUI). Methods A total of 272 women who gave birth in the First Peoples Hospital of Wuhu from August 2021 to December 2022 and were re-examined within 6-8 weeks after delivery were selected as the study subjects, and divided into observation group (n=139) and control group (n=133) according to whether SUI was occurred. Both ultrasonic parameters (length of proximal urethra posterior bladder angle and size of hiatus in the levator ani muscle at rest bladder neck descent, distance of bladder neck from reference line, posterior bladder angle, and size of hiatus in the levator ani muscle on maximum Valsalve maneuver) and Glazer pelvic floor surface EMG parameters (pre-resting stage, rapid contraction stage, tension contraction stage, endurance contraction stage, post-resting stage) were compared between two groups. Receiver operating characteristic (ROC) curves were established to analyze the efficacy of each index in diagnosing postpartum SUI. Results There were no significant differences between two groups in the length of proximal urethra and the sizes of hiatus in the levator ani muscle at rest and on maximum Valsalve maneuver (P>0.05). Compared with control group, observation group had smaller posterior bladder angle at rest, while larger bladder neck descent, distance of bladder neck from the reference line, and posterior bladder angle on maximum Valsalve maneuver (P<0.05). The differences between two groups in surface EMG parameters at pre-resting stage, rapid contraction stage, tension contraction stage, endurance contraction stage and post-resting stage were trivial (P>0.05). The combined diagnostic model based on 4 parameters of three-dimensional pelvic floor ultrasonography was -0.069×bladder posterior angle at rest+0.038×bladder neck descent+0.045×distance of bladder neck from the reference line +0.097×posterior bladder angle on maximum Valsalve maneuver -10.521. ROC curve analysis revealed that for diagnosing postpartum SUI, the bladder posterior angle at rest bladder neck descent, distance of bladder neck from the reference line, posterior bladder angle on maximum Valsalve maneuver and the combined model had AUC of 0.588, 0.671, 0.775, 0.643 and 0.710, sensitivity of 52.6%, 84.2%, 73.4%, 47.5% and 59.0%, and specificity of 65.5%, 44.4%, 50.4%, 82.0% and 82.0%, respectively. Conclusion Three-dimensional pelvic floor ultrasonic parameters (posterior bladder angle at rest, and bladder neck descent, distance of bladder neck from reference line, posterior bladder angle on maximum Valsalve maneuver) have certain efficacy in diagnosing postpartum SUI, and the combined diagnosis exhibits higher efficacy.

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备注/Memo

备注/Memo:
【收稿日期】2024-03-12 【基金项目】安徽省重点研究与开发计划（2022e07020089） 【作者简介】汪雪莲，主治医师，研究方向：超声医学，E-mail: wangxuelian_w@163.com 【通信作者】丁华，主任医师，研究方向：超声医学，E-mail: h_aolinlin@163.com
更新日期/Last Update: 2024-08-31