Feasibility of four-dimensional ultrasound reconstruction of levator ani muscle hiatus in the evaluation of cystocele
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摘要:
目的 采用四维盆底超声定量分析中老年经产妇肛提肌裂孔形变，探讨其诊断膀胱膨出的可行性。 方法 选取本院2020年1月~2022年6月患有膀胱膨出的57例中老年女性作为病例组，另选同期59例无膀胱膨出的中老年女性作为对照组，两组均采用四维盆底超声检查，观察静息、Valsalva状态下肛提肌裂孔形变并记录裂孔前后径、左右径及面积，分析其与膀胱膨出的关系。 结果 病例组结构松散，内部排列紊乱，肛提肌裂孔明显增大；静息时两组参数差异无统计学意义（P > 0.05），Valsalva状态下病例组各参数均高于对照组（P < 0.05），各参数曲线下面积均 > 0.8，肛提肌裂孔前后径、左右径及面积的最佳截断值分别为4.45 cm、5.25 cm和19.05 cm2，其中面积的曲线下面积最大（0.898），敏感度为0.754，特异性为0.881，优于前后径及横径。 结论 四维超声重建肛提肌裂孔，观察其形变及参数变化，用于评估中老年膀胱膨出，具有较高诊断价值。 Abstract:Objective To quantitatively analyze the deformation of levator ani hiatus in middle-aged and elderly parturients by 4D pelvic floor ultrasound, and to explore the feasibility of diagnosing cystocele. Methods Fifty-seven middle-aged and elderly women with cystocele in our hospital from January 2020 to June 2022 were selected as the experimental group, and 59 middle-aged and elderly women without cystocele in the same period as the control group. 4D pelvic floor ultrasonography was performed in both groups. The deformation of levator ani muscle hiatus at rest and Valsalva was observed, and the anterior and posterior diameter, left and right diameter and area of the hiatus were recorded, and the relationship between hiatus and cystocele was analyzed. Results In the case group, the structure was loose, the internal arrangement was disordered, and the levator hiatus was significantly increased(P < 0.05). There was no significant difference in the parameters between the two groups at rest. Under the condition of Valsalva, the AUC of the case group was significantly higher than that of the control group (P < 0.05). The best cutoff values of the anterior and posterior diameter, left and right diameter and area of levator hiatus were 4.45 cm, 5.25 cm and 19.05 cm2, respectively. The AUC of the area was the largest (AUC=0.898), sensitivity was 0.754 and specificity was 0.881. It was better than front and back diameter and transverse diameter. Conclusion The hiatus of levator ani muscle is reconstructed by four-dimensional ultrasound. Its deformation and parameter changes have high diagnostic value in the evaluation of cystocele in the middle-aged and elderly. -
Key words:
- pelvic floor /
- ultrasonography /
- aged /
- levator hiatus /
- cystocele
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图 1 正常组静息、Valsalva状态下LH超声图像
Figure 1. LH ultrasonographic images of normal group at rest and Valsalva.
图 2 病例组静息、Valsalva状态下LH超声图像
Figure 2. LH ultrasonographic images of resting and Valsalva in case group.
图 3 LH各参数预测中老年经产妇膀胱膨出的ROC曲线
Figure 3. ROC curve of levator ani muscle hiatus for predicting cystocele in middle-aged and elderly multiparturient women.
表 1 不同情况下LH参数比较
Table 1. Comparison of hiatus parameters of levator ani muscle under different conditions (Mean±SD)
组别 静息状态 Valsalva状态 左右径（cm） 前后径（cm） 面积（cm2） 左右径（cm） 前后径（cm） 面积（cm2） 对照组（n＝59） 3.66±0.37 4.63±0.58 12.19±2.16 4.04±0.49 5.20±0.75 15.52±3.59 病例组（n＝57） 3.64±0.63 4.76±0.91 12.91±3.02 4.84±0.80 6.20±1.08 23.13±4.99 t 0.173 0.891 1.425 6.490 5.811 9.454 P 0.863 0.375 0.157 < 0.001 < 0.001 < 0.001 
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表 2 LH各参数对膀胱膨出的诊断价值
Table 2. The value of various parameters of levator ani muscle hiatus in the diagnosis of cystocele
组别 AUC 敏感度 特异性 截断值 P AUC 95% CI 上限 下限 左右径 0.871 0.825 0.797 4.45 < 0.001 0.805 0.936 前后径 0.824 0.947 0.542 5.25 < 0.001 0.750 0.898 面积 0.898 0.754 0.881 19.05 < 0.001 0.844 0.953
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