智能盆底超声评价盆腔器官脱垂术后患者肛提肌形态及对新发尿失禁的诊断效能分析

Analysis of smart pelvic floor ultrasound in evaluating levator ani morphology and the diagnostic efficacy for new-onset urinary incontinence in postoperative pelvic organ prolapse patients

摘要

目的 探讨智能盆底超声评价盆腔器官脱垂(POP)术后患者肛提肌形态及对新发尿失禁的诊断效能。方法 选取2019年2月至2022年5月于沧州市人民医院诊治的90例POP术后患者为病例组,另选取于同院体检的100例健康产后女性作为对照组.根据是否出现新发尿失禁,将POP术后患者分为出现组(n=46)和未出现组(n=44),采用智能盆底超声对是否出现新发尿失禁的POP术后患者的盆底超声定量参数进行对比;采用智能盆底超声评估有无出现新发尿失禁的POP术后患者肛提肌形态特征;多因素Logistic回归分析影响新发尿失禁发生的危险因素,建立列线图模型并进行验证,利用受试者工作特征(ROC)曲线分析评估各因素对新发尿失禁的诊断效能。结果 病例组患者的尿道旋转角(URA)值、膀胱颈下降距离(BND)值及在静息状态、Valsalva状态下的膀胱尿道后角(RVA)测定值均较对照组患者更高,而膀胱颈到耻骨联合下缘的距离(BSD)值、直肠壶腹最低点距离耻骨联合下缘的距离(RAD)值均更低(t值介于3.562~17.413之间,P<0.05);新发尿失禁患者的URA值、BND及静息状态、Valsalva状态下新发尿失禁患者的RVA值较未出现新发尿失禁患者均更高,而BSD值、RAD值均更低(t值介于3.326~7.320之间,P<0.05);新发尿失禁的POP术后患者在静息状态及最大用力时肛提肌裂孔的宽度(LHW)、H线及M线值均更大,两侧异向分数均更低(t值介于4.128~24.857之间,P<0.05);多因素Logistic回归分析显示,绝经、术前UDS-尿道梗阻,以及最大尿流率、平均尿流率、最大尿道闭合压(MUCP)水平降低均为新发尿失禁发生的危险因素,其OR值及95%CI分别为1.225(1.064~1.720)、1.580(1.194~1.865)、0.458(0.212~0.844)、0.406(0.201~0.742)、0.520(0.144~0.805);ROC曲线评估RVA值、尿道倾斜角(UTA)值、BSD值、RAD值、URA值及BND六个因素联合预测对新发尿失禁的诊断效能最好,曲线下面积为0.889;模型评价结果显示构建的列线图预测模型具有较高的区分度(92.35%)、准确性(90.26%)和临床适用性。结论 相较于健康女性术后,POP术后患者智能盆底超声定量参数发生显著变化,出现新发尿失禁的POP术后患者肛提肌形态发生明显改变,采用智能盆底超声能够准确评估肛提肌形态改变.

Abstract

Objective To explore the evaluation of levator ani morphology using smart pelvic floor ultrasound in postoperative pelvic organ prolapse (POP) patients and its diagnostic efficacy for new-onset urinary incontinence. Methods 90 postoperative POP patients treated at Cangzhou People's Hospital from February 2019 to May 2022 were selected as the case group, and 100 healthy postpartum women who underwent physical examination at the same hospital were selected as the control group. Based on the occurrence of new-onset urinary incontinence, the patients after POP were divided into the occurrence group (n=46) and the non-occurrence group (n=44). Smart pelvic floor ultrasound was used to compare the quantitative parameters between the groups with and without new-onset urinary incontinence. Smart pelvic floor ultrasound was used to evaluate the morphological characteristics of levator ani muscle in postoperative POP patients with and without new-onset urinary incontinence. Multivariate Logistic regression analysis was used to identify risk factors influencing the occurrence of new-onset urinary incontinence, and a nomogram model was established and validated. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of various factors for new-onset urinary incontinence. Results The urethral rotation angle (URA), bladder neck descent (BND), and resting and Valsalva retrovesical angles (RVA) in the case group were significantly higher than those in the control group, while the distance from the bladder neck to the lower edge of the pubic symphysis (BSD) and the distance from the lowest point of the rectal ampulla to the lower edge of the pubic symphysis (RAD) were significantly lower (t values between 3.562 and 17.413, P<0.05). New-onset urinary incontinence patients had higher URA, BND, and RVA values at rest and during Valsalva compared to those without new-onset urinary incontinence, while BSD and RAD values were lower (t values between 3.326 and 7.320, P<0.05). The levator hiatus width (LHW), H-line, and M-line values at rest and during maximum effort were greater in POP postoperative patients with new-onset urinary incontinence, and bilateral asymmetry scores were lower (t values between 4.128 and 24.857, P<0.05). Multivariate Logistic regression analysis indicated that menopause, preoperative UDS-urethral obstruction, and reduced levels of maximum urine flow rate, average urine flow rate, and maximum urethral closure pressure (MUCP) were risk factors for new-onset urinary incontinence, with OR values and 95% CI of 1.225 (1.064-1.720), 1.580 (1.194-1.865), 0.458 (0.212-0.844), 0.406 (0.201-0.742), and 0.520 (0.144-0.805), respectively. ROC curve analysis showed that combined prediction of RVA, urethral tilt angle (UTA), BSD, RAD, URA, and BND had the best diagnostic efficacy for new-onset urinary incontinence, with an area under the curve of 0.889. The model evaluation indicated that the constructed nomogram prediction model had high discrimination (92.35%), accuracy (90.26%), and clinical applicability. Conclusion Compared to healthy postoperative women, postoperative POP patients exhibit significant changes in quantitative parameters of smart pelvic floor ultrasound. Postoperative POP patients with new-onset urinary incontinence show significant changes in levator ani morphology, which can be accurately assessed using intelligent pelvic floor ultrasound.

关键词

盆底超声 / 盆腔器官脱垂 / 肛提肌形态 / 尿失禁 / 诊断效能

Key words

pelvic floor ultrasound / pelvic organ prolapse / levator ani morphology / urinary incontinence / diagnostic efficacy

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基金资助

沧州市重点研发计划自筹项目(204106004)