盆底实时三维超声检测尿道内口漏斗在女性压力性尿失禁中的诊断价值
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摘要
目的探讨应用盆底实时三维超声检测尿道内口漏斗在女性压力性尿失禁(SUI)中的诊断价值。方法选取SUI患者60例为SUI组,正常女性70例为对照组,分别行盆底实时三维超声检查,比较两组最大Valsalva动作时尿道内口漏斗形成情况,应用受试者工作特性曲线(ROC)分析尿道内口深度及宽度在SUI中的诊断价值。结果 SUI组有91.7%患者在最大Valsalva动作时尿道内口开放呈漏斗型,明显多于对照组(P<0.01);尿道内口漏斗深度和宽度测量值均大于对照组(P<0.05)。ROC曲线分析示:诊断SUI的尿道内口漏斗深度、宽度最佳截断值分别为3.2、2.3 mm,曲线下面积分别为0.903、0.871,灵敏度分别为76.7%、81.7%,特异度分别为97.1%、81.4%。结论应用盆底实时三维超声检测尿道内口漏斗在女性压力性尿失禁中有较高的诊断价值,值得推广。
Objective To investigate the value of the observation of internal urethral orifice funnel with pelvic floor ultrasonography in the diagnosis of female stress urinary incontinence(SUI). Methods A total of 60 patients who had been diagnosed with SUI were selected as the SUI Group while 70 normal female volunteers were selected as the Control Group.Pelvic floor real-time three-dimensional ultrasonography was performed to observe the internal urethral orifice funnel formation of the SUI Group and the Control Group during Valsalva action. The ROC curve of subjects was used to analyze the value of the depth and width of internal urethral orifice funnel in the diagnosis of SUI. Results During Valsalva action, 91.7%of the SUI Group had the internal urethral orifice funnel formation, which was more than that in the Control Group(P<0.01).The SUI Group had the depth and width of internal urethral orifice funnel all greater than those of the Control Group(P<0.05).ROC curve showed that the optimum cut-off value of the depth and width of internal urethral orifice funnel for the diagnosis of SUI was 3.2 mm and 2.3 mm, the area under the curve(AUC) was 0.903 and 0.871, respectively, the sensitivity was 76.7%and 81.7%, and the specificity was 97.1% and 81.4%, respectively. Conclusions The observation of internal urethral orifice funnel with pelvic floor ultrasonography can be of great value in the diagnosis of female stress urinary incontinence. It is worth promoting.
Objective To investigate the value of the observation of internal urethral orifice funnel with pelvic floor ultrasonography in the diagnosis of female stress urinary incontinence(SUI). Methods A total of 60 patients who had been diagnosed with SUI were selected as the SUI Group while 70 normal female volunteers were selected as the Control Group.Pelvic floor real-time three-dimensional ultrasonography was performed to observe the internal urethral orifice funnel formation of the SUI Group and the Control Group during Valsalva action. The ROC curve of subjects was used to analyze the value of the depth and width of internal urethral orifice funnel in the diagnosis of SUI. Results During Valsalva action, 91.7%of the SUI Group had the internal urethral orifice funnel formation, which was more than that in the Control Group(P<0.01).The SUI Group had the depth and width of internal urethral orifice funnel all greater than those of the Control Group(P<0.05).ROC curve showed that the optimum cut-off value of the depth and width of internal urethral orifice funnel for the diagnosis of SUI was 3.2 mm and 2.3 mm, the area under the curve(AUC) was 0.903 and 0.871, respectively, the sensitivity was 76.7%and 81.7%, and the specificity was 97.1% and 81.4%, respectively. Conclusions The observation of internal urethral orifice funnel with pelvic floor ultrasonography can be of great value in the diagnosis of female stress urinary incontinence. It is worth promoting.
引文
[1]中华医学会妇产科学分会妇科盆底学组.女性压力性尿失禁诊断和治疗指南(2017)[J].中华妇产科杂志, 2017,52(5):289-293.
[2]徐净,张新玲,毛永江,等.尿道内口漏斗形成对女性压力性尿失禁患者的诊断价值[J].中国超声医学杂志, 2016,32(3):252-253.
[3]黄淑卿,张新玲,郑志娟,等.盆底超声在产后早期压力性尿失禁中的应用[J].中国超声医学杂志, 2015, 31(5):433-435.
[4]徐娆,史铁梅,林琳,等.超声评价女性压力性尿失禁患者盆膈裂孔形态[J].中国医学影像技术, 2015, 31(5):433-435.
[5] DEL VESCOVO R, PICCOLO CL, DELLA VECCHIA N,et al. MRI role in morphological and functional assessment of the levator ani muscle:use in patients affected by stress urinary incontinence(SUI)before and after pelvic floor rehabilitation[J]. Eur J Radiol, 2014, 83(3):479-486.
[6]毛永江,张红君,张新玲,等.盆底超声在女性压力性尿失禁分级中的初步应用[J].中华腔镜泌尿外科杂志(电子版),2015, 9(6):12-14.
[7]肖汀,张新玲,毛永江,等.盆底超声在压力性尿失禁诊断中的应用研究[J].中华超声影像学杂志, 2017, 26(7):618-621.
[8] HUANG I S, FAN Y H, LIN A T, et al. Correlation between bladder neck mobility and voiding phase urodynamic parameters in female patients with stress urinary incontinence[J]. Low Urin Tract Symptoms, 2016, 8(1):44-48.
[9]兰俊,钟文斌,张双好.盆底康复干预对压力性尿失禁产妇膀胱颈活动度和尿道旋转角度的影响[J].广东医科大学学报, 2019, 37(2):215-217.
[2]徐净,张新玲,毛永江,等.尿道内口漏斗形成对女性压力性尿失禁患者的诊断价值[J].中国超声医学杂志, 2016,32(3):252-253.
[3]黄淑卿,张新玲,郑志娟,等.盆底超声在产后早期压力性尿失禁中的应用[J].中国超声医学杂志, 2015, 31(5):433-435.
[4]徐娆,史铁梅,林琳,等.超声评价女性压力性尿失禁患者盆膈裂孔形态[J].中国医学影像技术, 2015, 31(5):433-435.
[5] DEL VESCOVO R, PICCOLO CL, DELLA VECCHIA N,et al. MRI role in morphological and functional assessment of the levator ani muscle:use in patients affected by stress urinary incontinence(SUI)before and after pelvic floor rehabilitation[J]. Eur J Radiol, 2014, 83(3):479-486.
[6]毛永江,张红君,张新玲,等.盆底超声在女性压力性尿失禁分级中的初步应用[J].中华腔镜泌尿外科杂志(电子版),2015, 9(6):12-14.
[7]肖汀,张新玲,毛永江,等.盆底超声在压力性尿失禁诊断中的应用研究[J].中华超声影像学杂志, 2017, 26(7):618-621.
[8] HUANG I S, FAN Y H, LIN A T, et al. Correlation between bladder neck mobility and voiding phase urodynamic parameters in female patients with stress urinary incontinence[J]. Low Urin Tract Symptoms, 2016, 8(1):44-48.
[9]兰俊,钟文斌,张双好.盆底康复干预对压力性尿失禁产妇膀胱颈活动度和尿道旋转角度的影响[J].广东医科大学学报, 2019, 37(2):215-217.