經(jīng)會陰超聲評估盆腔臟器脫垂的應(yīng)用研究
發(fā)布時間：2018-12-06 21:06
【摘要】：目的:應(yīng)用經(jīng)會陰超聲技術(shù)探究女性盆腔臟器脫垂(pelvic organ prolapse,POP)患者的盆底解剖結(jié)構(gòu)及功能的改變,了解盆底超聲成像特點,測量、統(tǒng)計、分析各項數(shù)據(jù),量化超聲診斷標準,評估經(jīng)會陰超聲技術(shù)的可行性及臨床應(yīng)用價值。方法:研究對象:2014年5月-2016年12月在南昌大學第一附屬醫(yī)院門診及住院部的POP患者63例,對照組40例。兩組患者均無盆腔巨大腫塊,且近期未接受過盆腔手術(shù)及近期未使用過激素類藥物。檢查項目:觀察兩組研究對象的超聲聲像圖表現(xiàn),分別在靜息期、張力期(Valsalva動作)、縮肛期下測量以下參數(shù):膀胱頸距恥骨聯(lián)合下緣水平線垂直距離(BN-VD)、宮頸距恥骨聯(lián)合下緣水平線垂直距離(C-VD)、直腸壺腹部距恥骨聯(lián)合下緣水平線垂直距離(RA-VD),根據(jù)所測數(shù)據(jù)計算移動范圍。測量肛提肌裂孔的前后徑(LHD)、肛提肌裂孔的左右徑(LHLR)、肛提肌裂孔的周長(LHP)、肛提肌裂孔面積(LHA)、肛提肌厚度(LAT)。統(tǒng)計學分析:應(yīng)用SPSS 19.0軟件對參數(shù)進行統(tǒng)計分析,所測參數(shù)資料以(?)±s表示,采用配對樣本t檢驗,P0.05表示有差異,P0.05表示差異無明顯統(tǒng)計意義。計量資料以±s表示,采用Spearman相關(guān)性分析評估超聲與臨床診斷POP的相關(guān)性。結(jié)果:(1)POP組、對照組在年齡、BMI、生育狀況比較,差異無統(tǒng)計學意義(P0.05)。(2)POP組在靜息期、張力期、縮肛期時RA-VD、C-VD、BN-VD均較對照組小,差異有統(tǒng)計學意義(P0.05),移動度較對照組差異無明顯統(tǒng)計學意義(P0.05)。LAT較對照組小,LHD、LHLR、LHP、LHA均較對照組大,差異均具有統(tǒng)計學意義(P0.05)。(3)POP組肛提肌損傷發(fā)生率57.1%(36/63),對照組肛提肌損傷發(fā)生率12.5%(5/40),兩組發(fā)生率進行對比,差異具有統(tǒng)計學意義(P0.05)。(4)經(jīng)會陰超聲評估I度脫垂與II度脫垂與臨床POP-Q評估的相關(guān)性好,相關(guān)系數(shù)分別為0.46、0.83。(5)POP組與對照組在張力期(Valsalva動作)LHA進行ROC曲線分析,得出曲線下面積為0.97(95%置信區(qū)間0.94,1.00),最佳臨界值為18.25cm2,其敏感度為88.9%,特異性為97.5%。結(jié)論:經(jīng)會陰超聲可以定位、定性、定量評估盆腔臟器脫垂,定量評估盆腔臟器脫垂與臨床POP-Q評估相關(guān)性好,具有輔助應(yīng)用臨床的價值。
[Abstract]:Objective: to investigate the changes of pelvic floor anatomical structure and function in female patients with pelvic organ prolapse (pelvic organ prolapse,POP) by transperineal ultrasound, and to understand the characteristics, measurement, statistics and analysis of pelvic floor ultrasound imaging. To evaluate the feasibility and clinical value of transperineal ultrasound. Methods: from May 2014 to December 2016, 63 patients with POP in outpatient and inpatient department of the first affiliated Hospital of Nanchang University and 40 patients in control group were studied. In both groups, there were no large pelvic masses, no pelvic surgery and no hormone therapy. The following parameters were measured during resting period, tension period (Valsalva action) and anus contraction period: vertical distance from bladder neck to the lower margin of pubic symphysis (BN-VD). The vertical distance from cervix to the lower margin of pubic symphysis (C-VD) and from the rectum ampulla to the lower margin of pubic symphysis (RA-VD) were calculated according to the measured data. Measure the anteroposterior diameter of the levator anal muscle hiatus (LHD), the left and right diameter of the levator ani muscle hiatus (LHLR), the circumference of the levator anal muscle fissure area of the (LHP), levator anal muscle hiatus area (LAT). Of the levator ani muscle Statistical analysis: the parameters were analyzed by SPSS 19.0 software. The parameters were expressed as (?) 鹵s. Using paired sample t test, P0.05 indicated difference, P0.05 showed no statistical significance. The correlation between ultrasound and clinical diagnosis of POP was evaluated by Spearman correlation analysis. Results: (1) there was no significant difference in age and BMI, fertility between POP group and control group (P0.05). (2) RA-VD,C-VD,BN-VD in POP group was lower than that in control group in resting, tension and anal contraction stages. The difference was statistically significant (P0.05), and the mobility was not significantly different from that of the control group (P0.05). LAT was smaller than the control group, LHD,LHLR,LHP,LHA was larger than the control group. The incidence of levator ani muscle injury was 57.1% (36 / 63) in POP group and 12.5% (5 / 40) in control group (P0.05). (3). The difference was statistically significant (P0.05). (4). There was a good correlation between degree I prolapse and II degree prolapse and clinical POP-Q evaluation by perineum ultrasound. (5) ROC curve analysis of LHA in tension phase (Valsalva action) between POP group and control group showed that the area under the curve was 0.97 (95% confidence interval 0.94m1.00), the best critical value was 18.25cm2, and the correlation coefficient was 0.46 鹵0.83.The best critical value was 18.25cm2.The results showed that the area under the curve was 0.97 (95% confidence interval 0.94m1.00). The sensitivity was 88.9 and the specificity was 97.5. Conclusion: transperineal ultrasound can be used to evaluate pelvic visceral prolapse with good correlation with clinical POP-Q evaluation.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.1;R711.2
本文編號：2366658
[Abstract]:Objective: to investigate the changes of pelvic floor anatomical structure and function in female patients with pelvic organ prolapse (pelvic organ prolapse,POP) by transperineal ultrasound, and to understand the characteristics, measurement, statistics and analysis of pelvic floor ultrasound imaging. To evaluate the feasibility and clinical value of transperineal ultrasound. Methods: from May 2014 to December 2016, 63 patients with POP in outpatient and inpatient department of the first affiliated Hospital of Nanchang University and 40 patients in control group were studied. In both groups, there were no large pelvic masses, no pelvic surgery and no hormone therapy. The following parameters were measured during resting period, tension period (Valsalva action) and anus contraction period: vertical distance from bladder neck to the lower margin of pubic symphysis (BN-VD). The vertical distance from cervix to the lower margin of pubic symphysis (C-VD) and from the rectum ampulla to the lower margin of pubic symphysis (RA-VD) were calculated according to the measured data. Measure the anteroposterior diameter of the levator anal muscle hiatus (LHD), the left and right diameter of the levator ani muscle hiatus (LHLR), the circumference of the levator anal muscle fissure area of the (LHP), levator anal muscle hiatus area (LAT). Of the levator ani muscle Statistical analysis: the parameters were analyzed by SPSS 19.0 software. The parameters were expressed as (?) 鹵s. Using paired sample t test, P0.05 indicated difference, P0.05 showed no statistical significance. The correlation between ultrasound and clinical diagnosis of POP was evaluated by Spearman correlation analysis. Results: (1) there was no significant difference in age and BMI, fertility between POP group and control group (P0.05). (2) RA-VD,C-VD,BN-VD in POP group was lower than that in control group in resting, tension and anal contraction stages. The difference was statistically significant (P0.05), and the mobility was not significantly different from that of the control group (P0.05). LAT was smaller than the control group, LHD,LHLR,LHP,LHA was larger than the control group. The incidence of levator ani muscle injury was 57.1% (36 / 63) in POP group and 12.5% (5 / 40) in control group (P0.05). (3). The difference was statistically significant (P0.05). (4). There was a good correlation between degree I prolapse and II degree prolapse and clinical POP-Q evaluation by perineum ultrasound. (5) ROC curve analysis of LHA in tension phase (Valsalva action) between POP group and control group showed that the area under the curve was 0.97 (95% confidence interval 0.94m1.00), the best critical value was 18.25cm2, and the correlation coefficient was 0.46 鹵0.83.The best critical value was 18.25cm2.The results showed that the area under the curve was 0.97 (95% confidence interval 0.94m1.00). The sensitivity was 88.9 and the specificity was 97.5. Conclusion: transperineal ultrasound can be used to evaluate pelvic visceral prolapse with good correlation with clinical POP-Q evaluation.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.1;R711.2
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