通讯作者: 王美霞, 67614162@qq.com

DOI：10.12201/bmr.202407.00020

Predict risk factors of pelvic floor three-dimensional ultrasound indicators in primiparae ofnaturalchildbirth women with bladder neck funnel formation

• 摘要：目的：对单胎初次经阴道分娩产妇产后6-8周盆底三维超声指标进行分析，探索膀胱颈漏斗形成的危险因素,分析各因素的评估价值。方法：根据盆底超声数据，将40例膀胱颈漏斗形成的研究对象为观察组，同期无膀胱颈漏斗形成的研究对象68例为对照组，对两组临床数据和盆底超声指标进行分组比较。结果：①观察组中，压力性尿失禁（stress urinary incontinence, SUI）和阴道前壁脱垂发生率、膀胱颈移动度（bladder neck distance,BND）、valsalva状态膀胱尿道后角(posterior urethrovesical angle,PUA)、静息状态和valsalva状态盆膈裂孔面积（levator hiatus area，LHA）、盆膈裂孔前后径（levator hiatus length LHL）及LHL变化量（ΔLHL）均高于对照组，P值均＜0.05；②Logistic回归分析发现，SUI和阴道前壁脱垂的发生是膀胱颈漏斗形成的独立危险因素，相对危险度（Oddsratio，OR）值分别为11.255和3.643；静息状态和valsalva状态LHA、LHL及ΔLHL亦是膀胱颈漏斗形成的独立危险因素。③受试者工作曲线(receiver operating characteristic,ROC)分析发现，出现SUI和阴道前壁脱垂症状诊断膀胱颈漏斗形成的曲线下面积(Area under curve,AUC)分别为0.744和0.615；超声指标中，当静息状态LHA＞20.1cm2，valsalva状态LHA＞28.4cm2和valsalva状态LHL＞63.5mm时，AUC分别为0.640、0.637和0.706；联合预测指标1（静息状态LHA+valsalva状态LHA）AUC为0.636,诊断敏感度为95.0%；联合预测指标2（ΔLHL+valsalva状态LHL）AUC为0.751,诊断特异度为80.9%。结论：在单胎初次经阴道分娩产妇中，发生SUI、阴道前壁脱垂、增大的LHA、LHL和ΔLHL是发生膀胱颈漏斗的独立危险因素；联合指标1预测价值敏感度高，联合指标2预测特异度较高。

  关键词： 膀胱颈漏斗；压力性尿失禁；盆底三维超声；盆膈裂孔

   

  Abstract: Objective To investigate value and risk factors of pelvic floor three-dimensional ultrasound parameters in natural childbirth primiparae with bladder neck funnel formation at 6-8weeks after delivery. Methods A total of 108 cases of primiparae were selected as research objects. Then according to three-dimensional ultrasound indexes of pelvic floor，they were assigned into two groups: observation group（40 cases）with bladder neck funnel formation and control group（68 cases）without bladder neck funnel formation. Three-dimensional ultrasound indexes of pelvic floor and clinical symptoms were compared between two groups. Meaningful indicators were analyzed. Results ①The findings showed that the rate of SUI and vaginal anterior wall prolapse 、bladder neck distance (BND)、posterior urethrovesical angle（PUA)in valsalva state、levator hiatus area（LHA）at resting state、LHA under valsalva state、levator hiatus length (LHL) under two states and LHL variation（△LHL）in the observation group were higher than those in the control group，and the differences were statistically significant（P＜0.05）.②Logistic regression analysis showed that the increased rate of SUI and vaginal anterior wall prolapsed were independent risk factors of bladder neck funnel formation，OR were 11.255 and 3.643.LHA and LHL under two states and△LHL were also independent risk factors of urethral funnel formation（P＜0.05）.③ROC curve analysis showed that AUC of SUI and vaginal anterior wall prolapse were 0.744and0.615.When set the critical value of LHA at resting state as 20.1cm2、LHA at valsalva state as 28.4cm2 and LHL at valsalva state as 63.5mm，the area under the ROC curve for diagnosis of bladder neck funnel formationwere0.640、0.637 and 0.706.The area under the curve(AUC) of combination of two state LHA was 0.636,the diagnostic sensitivity for bladder neck funnel formation was 95.0%.The AUC of combination of LHL under valsalva state and LHL variation（△LHL） was 0.751,the diagnostic specificity was 80.9%.ConclusionIn patients of singleton natural childbirth primipara with bladder neck funnel formation, rate of SUI and vaginal anterior wall prolapse、increasedLHA and LHL under two statesand △LHL were independent risk factors. The diagnostic sensitivity of the combination factor one was higher then single index. The diagnostic specificity of the combination factor two was higher.

  Key words: bladder neck funnel；stress urinary incontinence；three-dimensional ultrasound of pelvic floor；levator hiatus

  提交时间：2024-07-11

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• 序号	提交日期	编号	操作
  1	2024-05-16	bmr.202407.00020V1	下载

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