经会阴三维及四维超声测量肛提肌裂孔面积在盆腔器官脱垂诊断中的应用

目的: 探讨经会阴三维及四维超声测量肛提肌裂孔面积（levator hiatus area,LHA）在盆腔器官脱垂（pelvic organ prolapse,POP）中的诊断价值。方法: 收集我院就诊的POP患者84例为POP组,选取同期无POP健康女性69例为对照组。2组均接受经会阴三维及四维盆底超声检查,分别测量并比较静息状态、最大Valsalva-3D状态、最大Valsalva-4D状态下的LHA,组内分别比较Valsalva-3D和Valsalva-4D的LHA差异。构建静息状态、Valsalva-3D及Valsalva-4D模式的ROC曲线,确定LHA诊断POP的最佳截断值,评估其诊断效能,比较3种状态的差异。结果: POP组在静息状态、Valsalva-3D模式和Valsalva-4D模式下的LHA与对照组比较差异均有统计学意义（均P<0.05）;各组内Valsalva-3D模式和Valsalva-4D模式的LHA比较差异均无统计学意义（均P>0.05）。静息状态、Valsalva-3D与Valsalva-4D模式下LHA诊断POP的最佳截断值分别为14.29 cm²、19.29 cm²和19.90 cm²,曲线下面积（area under the curve,AUC）分别为0.759、0.959和0.956。Valsalva-3D与Valsalva-4D模式AUC与静息状态AUC比较,差异有统计学意义（Z=4.980,P<0.01;Z=4.865和P<0.01）。Valsalva-3D与Valsalva-4D模式AUC比较差异无统计学意义（Z=0.157, P>0.05）。结论: 经会阴三维及四维盆底超声两种模式测量的LHA对POP均有较高的诊断价值,两者诊断效能相似。

Application of Three- and Four-Dimensional Transperineal Ultrasound in Diagnosis of Pelvic Organ Prolapse by Measuring Area of Levator Hiatus

Objective: To investigate the value of three- and four-dimensional transperineal ultrasound in diagnosis of pelvic organ prolapse (POP) by measuring levator hiatus area (LHA). Methods: A total of 84 POP patients were collected as the POP group, and 69 cases of healthy women without POP during the same period were selected as the control group. All subjects in both groups were examined by three- and four-dimensional transperineal ultrasound. LHA in resting, maximum Valsalva-3D and maximum Valsalva-4D states were measured and compared, respectively. The difference of LHA in Valsalva-3D and Valsalva-4D was compared within the group. The ROC curves of the rest, Valsalva-3D and Valsalva-4D were drawn to determine the optimal cut-off value of LHA in diagnosis POP, then to evaluate its diagnostic efficacy and compare the differences between the three states. Results: The LHA in resting, Valsalva-3D and Valsalva-4D state in the POP group were larger than those of the control group, and the differences were statistically significant (all P<0.05). There was no significant difference between the LHA of Valsalva-3D and Valsalva-4D state in each group (all P>0.05). The cut-off value of the LHA to diagnose POP was 14.29 cm ², 19.29 cm², 19.90 cm² in resting, Valsalva-3D and Valsalva-4D state, respectively. The areas under the curve (AUC) were 0.759, 0.959, 0.956, respectively. The difference between the AUC of Valsalva-3D and Valsalva-4D and the AUC of resting state was statistically significant (Z=4.980, P<0.01; Z=4.865, P<0.01), and there was no significant difference in AUC between Valsalva-3D and Valsalva-4D state (Z=0.157, P>0.05). Conclusions: The LHA measured by three- and four-dimensional transperineal pelvic floor ultrasound has high diagnostic value for POP, and there was no difference in diagnostic efficiency between the two.