经会阴三维超声结合应变弹性成像评估 膀胱脱垂的临床研究

李 凌
新疆武警兵团总队医院

摘要

目的：探讨经会阴盆底三维超声结合应变弹性成像诊断膀胱脱垂的价值。资料与方法 选择产后 6-12 周的妇女（产后组）进行经会阴盆底三维超声和应变弹性成像检查。将耻骨联合中轴线作为基线，以与其呈 135 度角的直线作为参考线。测量静息状态下和 Valsalva 动作后膀胱颈距参考线距离、膀胱颈移动度、膀胱后壁距参考线距离以及肛提肌裂孔面积等指标。随后常规经会阴超声分别定位耻骨直肠肌，进行应变弹性成像检查，获得耻骨直肠肌的应变值。与未妊娠成年健康妇女进行对照（对照组），评估妊娠妇女产后膀胱脱垂情况。结果 产后组妇女的膀胱颈移动度、肛提肌裂孔面积以及耻骨直肠肌应变的最大值均大于对照组。单因素分析显示膀胱颈距离参考线的距离、膀胱颈移动度、肛提肌裂孔面积、膀胱后壁距离参考线的距离以及耻骨直肠肌应变的最大值与膀胱脱垂相关。二元 logistics 多因素回归分析显示，膀胱颈距离参考线的距离（Valsalva 动作）和耻骨直肠肌最大应变值与膀胱脱垂相关。根据受试者工作特征曲线，膀胱颈移动度诊断膀胱脱垂的曲线下面积最大，为 0.776（95% CI 67.6% ~ 88.5%）。以膀胱颈移动度 23.65 mm 作为截止值，其诊断膀胱脱垂的敏感性 68.4%，特异性为 83.3%。结论 经会阴盆底三维超声可准确地诊断膀胱脱垂，膀胱颈距参考线的距离（Valsalva 动作）可以作为预测膀胱脱垂的可靠指标。

关键词

经会阴;三维超声;应变弹性成像;膀胱脱垂

参考

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