经会阴超声联合剪切波弹性成像在盆底功能障碍中的诊断价值

doi:10.3760/cma.j.cn441417-20240805-10006

摘要/Abstract

摘要：

目的　探讨经会阴超声联合剪切波弹性成像（SWE）在盆底功能障碍中的诊断价值。方法　采用回顾性研究，选取2021年10月至2023年10月西安交通大学第一附属医院榆林医院收治的120例盆底功能障碍患者作为研究组，另选取同期体检健康的82例女性作为对照组。均接受经会阴超声及SWE检查，收集两组一般资料（年龄、体重指数、产次、文化程度）、不同状态下经会阴超声检查参数［静息与缩肛状态下的裂孔前后径、裂孔左右径、裂孔面积］、SWE检查参数［静息与缩肛状态下的耻骨直肠肌（PR）杨氏模量值］，比较不同检查方法诊断盆底功能障碍的准确率。采用t检验、χ2检验进行统计比较，受试者操作特征曲线（ROC）评估经会阴超声联合SWE对盆底功能障碍的诊断价值。结果　两组研究对象的年龄、体重指数、产次、文化程度比较，差异均无统计学意义（均P>0.05）。不同状态下，研究组肛提肌裂孔前后径、左右径及面积均大于对照组，PR杨氏模量值小于对照组（均P<0.05）。经会阴超声、SWE及两者联合检出盆底功能障碍的准确率分别为86.67%（104/120）、90.83%（109/120）、97.50%（117/120），两者联合的检出准确率明显高于单独应用（均P<0.05）。ROC结果显示，静息与缩肛状态下的裂孔前后径、裂孔左右径、裂孔面积、PR杨氏模量值断盆底功能障碍的曲线下面积（AUC）分别为0.622、0.569、0.676、0.638、0.643、0.586、0.680、0.694（P<0.05），联合诊断的AUC为0.846（均P<0.05）。结论　经会阴超声联合SWE对盆底功能障碍具有较高的诊断价值。

关键词: 剪切波弹性成像； , , 经会阴超声； , , 盆底功能障碍； , , 联合诊断

Abstract:

Objective　To explore the value of transperineal ultrasound combined with shear wave elastography (SWE) in the diagnosis of pelvic floor dysfunction (PFD). Methods　This was a retrospective study. One hundred and twenty patients with PFD treated at Yulin Hospital, The First Affiliated Hospital of Xi'an Jiaotong University from October 2021 to October 2023 were selected as a study group; 82 healthy women who received physical examination during the same period were selected as a control group. All the subjects took transperineal ultrasound and SWE examinations. The general data (age, body mass index, parity, and education level) and parameters of transperineal ultrasound and SWE examinations under different conditions were collected in both groups. The accuracy rates of different examination methods in the diagnosis of PDF were compared. t and χ² tests were use for the statistical comparisons. The receiver operating characteristic curve (ROC) was applied to evaluate the value of transperineal ultrasound combined with SWE in the diagnosis of PFD. Results　There were no statistical differences in age, body mass index, parity, and education level between the two groups (all P>0.05). Under different conditions, the anteroposterior diameter, left-right diameter, and area of anal levator hiatus in the study group were larger than those in the control group, while the Young' s modulus of puborectal muscle (PR) was lower (all P<0.05). The accurate rates of transperineal ultrasound, SWE, and their combination in the detection of PDF were 86.67% (104/120), 90.83% (109/120) , and 97.50% (117/120), respectively; the accurate rate of the combination was higher than those of transperineal ultrasound and SWE (both P<0.05). The ROC results showed that the areas under the curves (AUC) of the anteroposterior diameter, left-right diameter, and area of anal levator hiatus and the Young' s modulus of PR for PFD were 0.622, 0.569, 0.676, 0.638, 0.643, 0.586, 0.680, and 0.694 (all P<0.05), respectively, and the AUC of the combined diagnosis was 0.846 (P<0.05). Conclusion　Transperineal ultrasound combined with SWE has high diagnostic value fir PFD.

Key words: Shear wave elastography, Transperineal ultrasound, Pelvic floor dysfunction, Combined diagnosis

高鑫高晓婷陈欣穆靓薛小梅贺静. 经会阴超声联合剪切波弹性成像在盆底功能障碍中的诊断价值 [J]. 国际医药卫生导报, 2025, 31(10): 1615-1619.

Gao Xin, Gao Xiaoting, Chen Xin, Mu Liang, Xue Xiaomei, He Jing.

Value of transperineal ultrasound combined with shear wave elastography in diagnosis of pelvic floor dysfunction [J]. International Medicine and Health Guidance News, 2025, 31(10): 1615-1619.

参考文献

[1]安春芳,冯晓杰,晋熙梦.宫颈癌根治术后患者发生盆底功能障碍性疾病的危险因素分析[J].实用癌症杂志,2023,38(1):33-35. DOI:10.3969/j.issn.1001-5930.2023.01.008.

[2]Zhou W, Guo H. Curative effect of hydrogen peroxide combined with silver ion disinfection on pelvic floor dysfunction[J]. World J Clin Cases, 2024,12(21):4508-4517. DOI: 10.12998/wjcc.v12.i21.4508.

[3]苑翠翠,高洁,薛秀荣,等.盆底肌力评分联合盆底超声在盆底功能障碍诊断中的应用研究[J].保健医学研究与实践,2023,20(12):38-42. DOI:10.11986/j.issn.1673- 873X. 2023.12.008.

[4]张亚亚,侯佳文,毕晓玄,等.女性盆底功能障碍病人述情障碍现状及影响因素[J].护理研究,2023,37(3):554-559. DOI:10.12102/j.issn.1009-6493.2023.03.033.

[5]何秋,罗婷,元之婷.经会阴盆底三维超声联合直肠超声评价生物肌电刺激治疗盆底功能障碍性疾病[J].中国计划生育学杂志,2022,30(8):1795-1798. DOI:10.3969/j.issn. 1004-8189.2022.08.020.

[6]Yao L, Li F, Wang D, et al. Evaluation of acupuncture treatments of postpartum female pelvic floor dysfunction by four-dimensional transperineal pelvic floor ultrasound[J]. Medicine (Baltimore), 202,100(42):e27236. DOI: 10.1097/MD.0000000000027236.

[7]储华,杜丽君,黄智慧,等.超声剪切波弹性成像评估功能性排便障碍的潜在价值[J].中华消化杂志,2023,43(10):690-695. DOI:10.3760/cma.j.cn311367-20230320- 00135.

[8]Pesce K, Binder F, Chico MJ, et al. Diagnostic performance of shear wave elastography in discriminating malignant and benign breast lesions : our experience with QelaXtoTM software[J]. J Ultrasound, 2020,23(4):575-583. DOI: 10.1007/s40477-020-00481-8.

[9]谢幸,孔北华,段涛.妇产科学[M]. 9版.北京:人民卫生出版社,2018: 278-286.

[10]李萍萍,李旻.老年女性盆底功能障碍性疾病的症状和生活质量调查问卷的临床应用[J].中华老年医学杂志,2024,43(3):410-416. DOI:10.3760/cma.j.issn.0254-9026. 2024.03.026.

[11]尤丛,赵玉娇,张程,等.静动态MRI评估产后不同类型盆底功能障碍性疾病盆底结构改变[J].放射学实践,2022,37(8):1006-1013. DOI:10.13609/j.cnki.1000-0313.2022.08.015.

[12]秦学敏,柏根基,盛文伟,等.三维盆底超声检查联合盆底肌力评估在产后盆底功能中的应用[J].中国超声医学杂志,2019,35(12):1112-1114. DOI:10.3969/j.issn.1002-0101. 2019.12.019.

[13]吴雪辉,刘海凤,李薇,等.社区老年女性盆底功能障碍性疾病调查及盆底形态学[J].中国老年学杂志,2023,43(15):3732-3735. DOI:10.3969/j.issn.1005-9202.2023.15.043.

[14]陶均佳,应涛,陈爱萍,等.断层超声成像技术在分娩时耻骨直肠肌损伤诊断中的应用[J].中国医科大学学报,2023,52(2):179-182. DOI:10.12007/j.issn.0258-4646. 2023.02.016.

[15]金玲,张晓红,王建六,等.盆腔器官脱垂患者盆底支持组织超微结构特征的研究[J].现代妇产科进展,2006,15(8):592-595,封三. DOI:10.3969/j.issn.1004-7379.2006. 08.008.

[16]褚建华,王显芝,关景双.经会阴二维和三维超声对盆底功能障碍性疾病的诊断价值[J].中南医学科学杂志,2022,50(6):915-917. DOI:10.15972/j.cnki.43-1509/r.2022. 06.034.

[17]王化义,武云哲,王红艳,等.基于经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效[J].现代生物医学进展,2024,24(4):778-783. DOI:10.13241/j.cnki.pmb.2024.04.035.

[18]余显梅,黎俊余,谭春梅,等.盆底超声对骨盆环疾病孕产妇经阴道分娩后的盆底功能的评估价值[J].医学影像学杂志,2024,34(9):96-98.

[19]陈艳,陈梅,王竞宇,等.实时剪切波弹性成像技术在评价盆底肌肉功能中的效能初探[J].川北医学院学报,2022,37(12):1591-1595. DOI:10.3969/j.issn.1005-3697. 2022.12.019.

[20]钟婷婷,王丽,李载红,等.声触诊组织定量剪切波弹性成像技术评估女性盆底功能障碍性疾病的应用研究[J].海南医学院学报,2021,27(1):24-29. DOI:10.13210/j.cnki.jhmu. 20200628.003.

[21]钟婷婷,王丽,李载红,等.声触诊组织定量剪切波弹性成像联合盆底超声对阴道分娩者产后盆底功能障碍的诊断价值[J/OL].中华医学超声杂志(电子版),2022,19(3):226-233 [2024-7-5].https://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zhyxcszz202203007.DOI:10.3877/cma.j.issn.1672-6448.2022.03.007.

[22]董丽丽,王冰霜,李晓静,等.超声剪切波弹性成像联合盆底超声检查对阴道分娩产妇盆底功能障碍的诊断效能分析[J].中国医刊,2023,58(10):1130-1134. DOI:10.3969/j.issn.1008-1070.2023.10.022.

[23]刘晓志,孙雪松,吴晨,等.多模态超声对产后女性盆底功能康复疗效的评价[J].同济大学学报(医学版),2021,42(6):809-813. DOI:10.12289/j.issn.1008-0932.21247.

[24]张珍珍,薛梅,李明莉,等.盆底超声联合剪切波弹性成像预测子宫全切术后盆底功能障碍性疾病的临床价值[J].临床超声医学杂志,2024,26(7):583-589. DOI:10.3969/j.issn.1008-6978.2024.07.012.

[25]李宁,阚艳敏,王艺桦,等.多模态超声定量评估高龄产妇产后早期盆底结构和功能变化及诊断压力性尿失禁的价值研究[J].中国全科医学,2022,25(6):706-713. DOI:10.12114/j.issn.1007-9572.2021.