Multimodal pelvic floor ultrasound can evaluate maternal birth trauma and postpartum stress urinary incontinence
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摘要:
目的 分析多模态盆底超声参数评估产伤与女性压力性尿失禁（SUI）的相关性。 方法 选取2022年1~12月海南省中医院200例产后妇女，将其分为尿控正常组（n=144）与SUI组（n=56），均于产后42 d行经会阴盆底超声检查（即二维、四维、断层超声成像等检查），SUI组则继续于产后3、6月随访行盆底超声检查，比较两组膀胱颈移动度（BND）、尿道旋转角（URA）、膀胱尿道后角（RVA）、盆膈裂孔面积、子宫以及直肠壶腹最大下降位置、尿道漏斗形成情况、肛提肌是否损伤，分析盆底超声参数与SUI的相关性。 结果 两组子宫下降距离、直肠壶腹下降距离比较，差异无统计学意义（P＞0.05）；SUI组BND、URA、RVA、盆膈裂孔面积大于尿控正常组（P＜0.05），尿道漏斗形成率、肛提肌损伤率高于尿控正常组（P＜0.05）；SUI患者不同时间点子宫下降距离、直肠壶腹下降距离差异无统计学意义（P＞0.05），产后3、6月BND、URA、RVA、盆膈裂孔面积、尿道漏斗形成率、肛提肌损伤率呈现降低趋势（P＜0.05）；BND、URA、RVA、盆膈裂孔面积与SUI呈正相关关系（P＜0.05）。 结论 运用多模态经会阴盆底超声测量BND、URA、RVA、盆膈裂孔面积等指标评估产伤与女性SUI密切相关，可为产后女性SUI预防和治疗提供重要指导价值。 Abstract:Objective To analyze the value of multimodal pelvic floor ultrasound parameters in evaluating maternal birth trauma and postpartum stress urinary incontinence (SUI). Methods A total of 200 parturients admitted to Hainan Traditional Chinese Medicine Hospital from January to December 2022 were selected.The parturients were divided into the normal urine control group (n=144) and the SUI group (n=56). All women were examined with transperineal pelvic floor ultrasound on day 42 after delivery. Women in the SUI group were examined with pelvic floor ultrasound at 3 months and 6 months after delivery. The two groups were compared in terms of bladder neck descent (BND), urethral rotation angle (URA), retrovesical angle (RVA), pelvic diaphragmatic hiatal area, the maximum descent of uterus and rectal ampulla, urethral funnel formation, and the presence or absence of levator ani muscle injury. The correlation between pelvic floor ultrasound parameters and SUI was analyzed. Results There was no statistically significant difference in the descent of uterus or rectal ampulla between the groups (P > 0.05). BND, URA, RVA and pelvic diaphragmatic hiatal area in the SUI group were larger than those in the normal urine control group (P < 0.05). The urethral funnel formation rate and the incidence of levator ani muscle injury were higher than those in the normal urine control group (P < 0.05). There was no statistically significant difference in the descent of uterus or rectal ampulla among patients with SUI at different time points (P > 0.05). BND, URA, RVA, pelvic diaphragmatic hiatal area, urethral funnel formation rate, and the incidence of levator ani muscle injury showed a downward trend at 3 months and 6 months after delivery (P < 0.05). BND, URA, RVA and pelvic diaphragmatic hiatal area were positively correlated with SUI (P < 0.05). Conclusion Multimodal pelvic floor ultrasound parameters such as BND, URA, RVA and pelvic diaphragmatic hiatal area are closely related to SUI. They provide important guidance for the prevention and treatment of SUI. -
Key words:
- multimodal /
- pelvic floor ultrasound /
- birth trauma /
- stress urinary incontinence
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图 1 二维经会阴盆底超声
Figure 1. Two-dimensional transperineal pelvic floor ultrasound images. A: Resting phase; B: Strain phase of the Valsalva maneuver.
图 2 TUI模式下无SUI患者肛提肌完整
Figure 2. Complete musculus levator ani in patients without SUI under TUI mode.
图 3 TUI模式下SUI患者肛提肌损伤
Figure 3. Musculus levator ani injury in patients with SUI under TUI mode.
表 1 尿控正常组与SUI组一般资料的比较
Table 1. Comparison of general data between the normal urine control group and the SUI group (Mean±SD)
Group Age（year） BMI（kg/m2） Gravidity（time） Parity（time） Neonatal birth weight（kg） SUI group (n=56) 26.78±4.19 23.42±2.38 2.13±0.38 1.62±0.30 3.40±0.52 Normal urine control group (n=144) 25.63±4.37 23.27±2.36 2.05±0.42 1.54±0.28 3.26±0.57 t 1.690 0.403 1.241 1.778 1.597 P 0.093 0.688 0.216 0.077 0.112 SUI: Stress urinary incontinence. 
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表 2 尿控正常组与SUI组盆底超声参数比较
Table 2. Comparison of pelvic floor ultrasound parameters between the normal urine control group and the SUI group (Mean±SD)
Group BND（mm） URA（°） RVA（°） Descent of the uterus（mm） Descent of the rectal ampulla（mm） Pelvic diaphragmatic hiatal area（cm2） Urethral funnel formation [n(%)] Levator ani muscle injury[n(%)] SUI group（n=56） 25.13±5.04 54.16±8.93 129.47±25.69 19.27±4.82 -5.13±6.92 19.08±3.65 15（26.79） 19（33.93） Normal urine control group（n=144） 21.82±5.28 37.24±6.15 101.78±21.37 18.52±4.96 -5.64±7.13 17.36±3.27 4（2.78） 3（2.08） t/χ2 4.031 15.276 7.762 0.968 0.458 3.231 27.031 41.766 P ＜0.001 ＜0.001 ＜0.001 0.334 0.648 0.001 ＜0.001 ＜0.001 BND: Bladder neck descent; URA: Urethral rotation angle; RVA: Retrovesical angle.
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表 3 SUI患者产后42 d、3月、6月盆底超声参数比较
Table 3. Comparison of pelvic floor ultrasound parameters among patients with SUI 42 d, 3 months and 6 months after delivery (n=56, Mean±SD)
Time after delivery BND（mm） URA（°） RVA（°） Descent of the uterus（mm） Descent of the rectal ampulla（mm） Pelvic diaphragmatic hiatal area（cm2） Urethral funnel formation [n(%)] Levator ani muscle injury [n(%)] 42 d after delivery 25.13±5.04 54.16±8.93 129.47±25.69 19.27±4.82 -5.13±6.92 19.08±3.65 15（26.79） 19（33.93） 3 months after delivery 23.78±4.52 48.13±8.75 121.53±20.78 19.13±4.65 -5.18±6.85 18.26±3.53 6（10.71） 9（16.07） 6 months after delivery 22.14±4.25 41.05±8.04 112.53±18.76 19.08±4.72 -5.20±6.74 17.57±3.42 0（0.00） 1（1.79） F/χ2 9.458 12.369 8.762 3.296 2.178 5.036 18.612 20.338 P ＜0.001 ＜0.001 ＜0.001 0.368 0.427 0.008 ＜0.001 ＜0.001
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表 4 盆底超声参数与SUI相关性
Table 4. Correlation between pelvic floor ultrasound parameters and SUI
Item SUI rs P BND 0.482 ＜0.001 URA 0.503 ＜0.001 RVA 0.418 ＜0.001 Descent of the uterus 0.128 0.087 Descent of the rectal ampulla 0.105 0.235 Pelvic diaphragmatic hiatal area 0.327 0.006
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