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    经会阴实时三维超声测定valsalva动作盆膈裂孔面积对FPFD诊断及术后疗效预测价值

    Value of real-time three-dimensional perineal ultrasound measurement of valsalva diaphragmatic hiatal area in the diagnosis of FPFD and prediction of postoperative outcomes

      摘要
    • 摘要:
      目的探讨经会阴实时三维超声测定valsalva动作盆膈裂孔面积对女性盆底功能障碍（female pelvic floor dysfunction，FPFD）病人的诊断及对病人术后疗效的预测价值。
      方法选取行Prolift手术治疗的62例FPFD病人为研究对象，同时以60例无FPFD症状的阴道三维超声检查者作为对照组。对所有研究对象进行经会阴实时三维超声探查其子宫位置形态、膀胱颈移动度（BND）、valsalva动作盆膈裂孔面积，采用受试者工作特征曲线（ROC）分析三维超声对FPFD病人的诊断价值。比较FPFD组病人手术前后最大Valsalva状态下盆膈裂孔面积、周长、前后径、左右径，探讨会阴实时三维超声对手术疗效的评估和预测价值。
      结果FPFD组病人子宫后位比例、BND、valsalva动作盆膈裂孔面积均高于对照组（P < 0.01）。以病人是否诊断为FPFD作为二分类变量（否=0，是=1），对BND、valsalva动作盆膈裂孔面积诊断FPFD价值进行ROC曲线分析，结果显示BND诊断截断值为21.65 mm，预后诊断曲线下面积为0.814（95%CI：0.766~0.862），灵敏度为70.97%，特异度为75.00%；valsalva动作盆膈裂孔面积截断值为20.25 cm2，预后诊断曲线下面积为0.867（95%CI：0.829~0.906），灵敏度为82.26%，特异度为70.00%，具有更高的诊断效能。FPFD组病人行Prolift手术3个月后的治愈率为91.94%（57/62），复发率为8.06%（5/62）。且病人术后3个月的盆膈裂孔面积、周长、前后径、左右径相较于术前均明显降低（P < 0.01）。
      结论经会阴实时三维超声可以提供valsalva动作盆膈裂孔面积等盆底解剖信息，在诊断FPFD方面具有重要价值；同时可以帮助医生掌握病人盆底恢复情况，可应用于病人术后疗效预测。

       

      Abstract:
      ObjectiveTo explore the value of real-time three-dimensional perineal ultrasound measurement of valsalva maneuver pelvic diaphragm hole area in the diagnosis of female pelvic floor dysfunction(FPFD) and prediction of postoperative efficacy of patients.
      MethodsSixty-two FPFD patients treated with Prolift operation were selected as the research subjects, while 60 non-FPFD patients with three-dimensional vaginal ultrasound examination were set as the control group.The position and shape of uterus, bladder neck descen(BND) and valsalva maneuver area of pelvic diaphragm in two goups were detected using real-time three-dimensional perineal ultrasound.The receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of three-dimensional ultrasound in patients with FPFD.The pelvic diaphragm hole area, perimeter, anteroposterior diameter and left and right diameters in the maximum valsalva state between before and after surgery in the FPFD group were compared, and the evaluation and predictive value of real-time three-dimensional perineal ultrasound on surgical effects were investigated.
      ResultsThe ratio of posterior uterus, BND and valsalva maneuver pelvic diaphragm area in FPFD group were higher than those in non-FPFD group(P < 0.01).Taking whether patients with FPFD as the dichotomous variable(no=0, yes=1), the ROC curve analysis of the value of BND and valsalva diaphragmatic hiatal area in diagnosing FPFD was performed.The results of ROC curve analysis showed that the diagnostic cutoff value, area under the prognosis diagnosis curve, sensitivity and specificity of BND were 21.65 mm, 0.814(95%CI: 0.766-0.862), 70.97% and 75.00%, respectively, and the diagnostic cutoff value, area under the prognosis diagnosis curve, sensitivity and specificity of valsalva maneuver pelvic diaphragm hole area were 20.25 cm2, 0.867(95%CI: 0.829-0.906), 82.26% and 70.00%, respectively, the diagnostic efficiency of which was higher.The cure rate and recurrence rate of patients in the FPFD group after 3 months of Prolift surgery were 91.94%(57/62) and 8.06%(5/62), respectively.The area, perimeter, anteroposterior diameter and left-right diameter of the pelvic diaphragm hole after 3 months of operation were significantly lower than those before operation(P < 0.01).
      ConclusionsThe real-time three-dimensional perineal ultrasound can provide the pelvic floor anatomical information of valsalva maneuver pelvic diaphragm area, which has great value in diagnosing FPFD.At the same time, it can help doctors grasp the recovery of pelvic floor of patients and can be used to predict the postoperative efficacy of patients.

       

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