盆底超声联合剪切波弹性成像预测子宫全切术后盆底功能障碍性疾病的临床价值

【摘要】目 的 本研究拟运用盆底超声联合剪切波弹性成像（SWE）技术评估子宫全切术对患者肛提肌（LAM）及盆底功能的影响。方 法 选取因子宫良性疾病行子宫全切术中老年女性51例作为病例组,根据术前是否绝经分为绝经及未绝经亚组,同期未行子宫切除已婚已育女性70例作为对照组。测量静息、缩肛及最大Valsalva状态下二维超声参数。后行SWE获得静息及最大Valsalva状态下LAM弹性模量最大值（Emax）、最小值（Emin）、平均值（Emean）,并计算2种状态下弹性模量差值△Emax、△Emin、△Emean。结果 1、与对照组相比,病例组静息状态下膀胱颈与参考线的距离差异无统计学意义（P>0.05）,但最大Valsalva状态下膀胱颈与参考线的距离、膀胱颈移动度较对照组增大,差异有统计学意义（P<0.05）。2、病例组绝经亚组盆底功能障碍性疾病的发生率高于未绝经亚组（P <0.05）。3、二维超声3种状态下病例组两侧LAM厚度均较对照组减小,肛提肌裂孔前后径较对照组增加,差异有统计学意义（P<0.05）;SWE显示静息及Valsalva状态下,病例组肛提肌 Emax、Emin、Emean 中位数均大于对照组,病例组两侧肛提肌附于耻骨下支处、肌腹及尾侧ΔEmax 、ΔEmin及 ΔEmean 均小于对照组,差异均有统计学意义（均P<0.05）;二者结果相呼应。4、绘制最大 Valsalva 状态时LAM弹性模量的 ROC 曲线,结果显示LAM弹性模量△Emax、△Emin、△Emean评价 SUI、POP均优于 Emax、Emin、Emean。其中分别以△Emean=14.25kpa 、△Emean=13.86kpa作为截断值对SUI、POP的诊断性能是最优的,具有一定临床价值。结论：良性妇科病变的子宫全切术对患者的盆底结构及功能有显著的负面影响。经会阴盆底超声联合肛提肌SWE可多维度评估盆底功能。

Pelvic floor ultrasound combined with shear wave elastography to evaluate the effect of total hysterectomy on pelvic floor function

Abstract Objective To evaluate the effect of total hysterectomy on levator ani muscle ( LAM ) and pelvic floor function by pelvic floor ultrasound combined with shear wave elastography ( SWE ). Methods 50 elderly women who received total hysterectomy l due to benign uterine diseases l were selected as the case group, and they were divided into postmenopausal and premenopausal subgroups according to whether they were menopausal before surgery. 70 married women with children who did not undergo hysterectomy during the same period were selected as the control group. Two-dimensional ultrasound parameters at rest, anal contraction and maximum Valsalva state were measured. The Emax , Emin and Emean of LAM elastic modulus at rest and maximum Valsalva state were obtained by SWE, and the difference of elastic modulus △ Emax, △ Emin and △ Emean between the two states was calculated. Results1.Compared with the control group, there was no significant difference in the distance between the bladder neck and the reference line in the resting state of the case group ( P > 0.05 ), but the distance between the bladder neck and the reference line and the mobility of the bladder neck in the maximum Valsalva state were higher than those in the control group. The difference was statistically significant ( P < 0.05 ). 2.The incidence of pelvic floor dysfunction in the postmenopausal subgroup of the case group was higher than that in the premenopausal subgroup ( P < 0.05 ). 3.Under the three conditions of two-dimensional ultrasound, the thickness of LAM on both sides of the case group was lower than that of the control group, and the anteroposterior diameter of the levator hiatus was higher than that of the control group. The difference was statistically significant ( P < 0.05 ) ;SWE showed that the medians of Emax, Emin and Emean of levator ani muscle in the case group were higher than those in the control group at rest and in Valsalva state. The ΔEmax, ΔEmin and ΔEmean of levator ani muscle on both sides of the case group were lower than those in the control group at the inferior pubic branch, muscle belly and tail, and the differences were statistically significant ( all P < 0.05 ). The two results echo each other. 4.The ROC curve of LAM elastic modulus at the maximum Valsalva state was drawn. The results showed that LAM elastic modulus △ Emax, △ Emin and △ Emean were superior to Emax, Emin and Emean in evaluating SUI and POP. Among them, △ Emean = 14.25 kpa and △ Emean = 13.86 kpa as cut-off values are the best for the diagnostic performance of SUI and POP, and have certain clinical value. Conclusion : Total hysterectomy for benign gynecological lesions has a significant negative impact on the pelvic floor structure and function of patients. Transperineal pelvic floor ultrasound combined with levator ani muscle SWE can evaluate pelvic floor function in multiple dimensions.