Abstract:

Objective  To investigate the value of transperineal 4-dimensional ultrasound imaging in the diagnosis of early postpartum stress urinary incontinence (SUl) in primiparous women. Methods  A total of 110 primiparous women who had vaginal delivery and underwent transperineal 4-dimensional ultrasound 6-10 weeks after delivery at Jieyang People's Hospital were selected for the retrospective analysis. Among them, the 58 cases with SUI were set as a case group (SUI group) who were (29.00±3.88) years old, and the rest 50 cases without SUI as a control group (non-SUI group) who were (28.28±4.37) years old. Both groups underwent perineal 4-dimensional ultrasound examination. The structural parameters of the anal raphe were compared between the two groups at rest, retraction, and maximal Valsalva. The receiver operator characteristic curves (ROC) were drawn to assess the diagnostic efficacy of each parameter for SUI. t test and non-parametric test were used. Results  In the resting state, there were no statistical differences in the area and circumference of the anal raphe fissure, the thickness of the anal raphe at the level of the anal sphincter, and area of the anal raphe between the two groups (all P>0.05). In the contracted state, there were no statistical differences in the area and circumference of the anal raphe fissure between the two groups (both P>0.05). The thickness of the anal raphe at the level of the anal sphincter and area of the anal raphe in the case group were lower than those in the control group [7.5 (7.0, 7.9) mm vs. 8.4 8.0, 8.6) mm and (10.98±1.79) cm² vs. (11.90±2.22) cm²], with statistical differences (Z=-6.064 and t=-2.341; both P<0.05). Under the maximal Valsalva manoeuvre, there was no statistical difference in the anal raphe fissure circumference between the two groups (P>0.05); the anal raphe fissure area in the case group was bigger than that in the control group [23 (20, 28) cm² vs. 17 (15, 20) cm²], with a statistical difference (Z=-6.005, P<0.05); the thickness of the anal raphe at the level of the anal sphincter and area of the anal raphe in the case group were less than those in the control group [6.2 (5.9, 6.4) mm vs. 6.5 (6.3, 6.7) mm and (10.14±3.21) cm² vs. (12.02±2.80) cm²], with statistical differences (Z=-4.264 and t=-3.218; both P< 0.05). The sensitivities of the fissure area of the anal raphe >19.5 cm², the thickness of the anal raphe <6.0 mm, and the area of the anal raphe <8.5 cm² under the maximal Valsalva maneuver and the thickness of the anal raphe <7.5 mm, and the area of the anal raphe <12.5 cm² under the contracted state were 82.8%, 82.8%, 37.9%, 79.3%, and 79.3%, respectively; the specificities were 72.0%, 54.0%, 90.0%, 78.0%, and 46.0%, respectively; the areas under their curves (AUC) were 0.835, 0.738, 0.673, 0.839, and 0.625, respectively; the AUC for the combined analysis of the above five parameters was 0.924, with a sensitivity of 91.4% and a specificity of 80.0%. Conclusions  Transperineal 4-dimensional ultrasound has high application value in the diagnosis of early postpartum SUI in primiparous women. The combined analysis of multiple ultrasound parameters can significantly improve the diagnostic efficacy of SUI.

Key words:

Stress urinary incontinence, Postpartum, Primiparous women, Pelvic floor ultrasound, Levator ani muscle

摘要：

目的　探讨经会阴四维超声成像技术在初产妇产后早期压力性尿失禁（SUl）中的诊断价值。方法　采用回顾性分析，选取2021年8月至2022年10月在揭阳市人民医院经阴道分娩、并于产后6～10周接受经会阴四维超声检查的初产妇108例为研究对象。其中，58例发生SUI者为病例组，年龄（29.00±3.88）岁；50例未发生SUI者为对照组，年龄（28.28±4.37）岁。两组产妇均接受会阴四维超声检查，比较两组产妇在静息、缩肛和最大Valsalva状态下肛提肌结构参数，绘制受试者工作特征曲线（ROC），评估各参数在SUI中的诊断效能。采用t检验、非参数检验。结果　两组产妇在静息状态下的肛提肌裂孔面积、肛提肌裂孔周长与肛提肌在肛门括约肌水平的厚度、肛提肌面积比较，差异均无统计学意义（均P>0.05）。两组产妇在缩肛状态下的肛提肌裂孔面积、肛提肌裂孔周长差异均无统计学意义（均P>0.05）；病例组在缩肛状态下的肛门括约肌水平肛提肌的厚度、肛提肌面积分别为7.5（7.0，7.9）mm、（10.98±1.79）cm²，对照组分别为8.4（8.0，8.6）mm、（11.90±2.22）cm²，差异均有统计学意义（Z=-6.064、t=-2.341，均P<0.05）。两组产妇在最大Valsalva动作下的肛提肌裂孔周长差异无统计学意义（P>0.05）；病例组在最大Valsalva动作下的肛提肌裂孔面积大于对照组［23（20，28）cm²比17（15，20）cm²］，差异有统计学意义（Z=-6.005，P<0.05）；病例组在最大Valsalva动作下肛门括约肌水平肛提肌的厚度、肛提肌面积均低于对照组［6.2（5.9，6.4）mm比6.5（6.3，6.7）mm，（10.14±3.21）cm²比（12.02±2.80）cm²］，差异均有统计学意义（Z=-4.264、t=-3.218，均P<0.05）。最大Valsalva状态下肛提肌裂孔面积>19.5 cm²、肛提肌的厚度<6.0 mm、肛提肌面积<8.5 cm²及缩肛状态下肛提肌的厚度<7.5 mm、肛提肌面积<12.5 cm²灵敏度分别为82.8%、82.8%、37.9%、79.3%、79.3%，特异度分别为72.0%、54.0%、90.0%、78.0%、46.0%。5种参数的曲线下面积（AUC）分别为0.835、0.738、0.673、0.839、0.625，以上5种参数联合分析时AUC为0.924，灵敏度为91.4%，特异度为80.0%。结论　经会阴四维超声在初产妇产后早期SUI的诊断中具有较高应用价值，多个超声参数联合分析能明显提高SUI的诊断效能。

关键词:

压力性尿失禁, 产后, 初产妇, 盆底超声, 肛提肌