三维超声联合剪切波弹性成像评估压力性尿失禁绝经女性耻骨直肠肌功能北大核心CSCD

目的观察三维超声联合剪切波弹性成像(SWE)评估压力性尿失禁(SI)绝经女性耻骨直肠肌功能的价值。方法收集57例SI绝经女性(SI组)和30名查体未见明显异常的绝经女性(对照组),采用经会阴三维超声测量其静息及最大缩肛状态下肛提肌裂孔(LH)参数(面积、前后径、左右径),以高频超声及SWE测量其静息及最大缩肛状态下耻骨直肠肌厚度及杨氏模量平均值(E_(mean)),比较组间各参数差异。结果静息状态下,SI组与对照组LH面积、前后径及左右径差异均无统计学意义(P均>0.05);最大缩肛状态下,SI组LH面积、前后径及左右径均大于对照组(P均<0.05)。SI组双侧耻骨直肠肌厚度及E_(mean)均小于对照组(P均<0.05);最大缩肛状态下,SI组与对照组双侧耻骨直肠肌厚度及E_(mean)均大于静息状态(P均<0.05)。静息状态下,SI组LH面积与双侧耻骨直肠肌E_(mean)均无明显相关(左侧r=-0.182,P=0.108;右侧r=-0.274,P=0.053),最大缩肛状态下,SI组LH面积与双侧耻骨直肠肌E_(mean)均呈低度负相关(左侧r=-0.349,P=0.002;右侧r=-0.329,P=0.003)。结论三维超声联合SWE可通过观察LH形态和耻骨直肠肌厚度及E_(mean)评估绝经女性耻骨直肠肌功能,有助于早期诊断及治疗SI。

Three-dimensional ultrasound combined with shear wave elastography for evaluating function of puborectalis in postmenopausal women with stress incontinence

Objective To observe the value of three-dimensional ultrasound and shear wave elastography (SWE) for evaluating the function of puborectalis in postmenopausal women with stress incontinence (SI).Methods Fifty-seventh postmenopausal women with SI (SI group) and 30 postmenopausal women without obvious abnormalities in physical examination (control group) were enrolled. The parameters of levator hitus (LH), including area, anterior and posterior diameter, left and right diameter were measured with three-dimensional transperineal ultrasound. The thickness and mean Young''s modulus (E_mean) of puborectalis were measured with high frequency ultrasound and SWE. The above parameters were compared between groups.Results There was no significant difference of area, anterior and posterior diameter, nor left and right diameter of LH between groups under resting-state (all P > 0.05). The area, anterior and posterior diameter and left and right diameter of LH of SI group were higher than those of control under the maximum pelvic floor contraction (all P < 0.05). The thickness and E_mean of puborectalis of SI group were lower than those of control group (all P < 0.05). Under the maximum pelvic floor contraction, the thickness and E_mean of puborectalis of SI group and control group were higher than those under resting-state (all P < 0.05). The area of LH was not significantly correlated with E_mean of left and right puborectalis (left r=-0.182, P=0.108; right r=-0.274, P=0.053) at resting-state, but lowly negatively correlated with E_mean of left and right puborectalis (left r=-0.349, P=0.002; right r=-0.329, P=0.003).Conclusion Three-dimensional ultrasound combined with SWE could be used to evaluate the function of puborectalis in postmenopausal women through observation on LH morphology, thickness and E_mean of puborectalis, which was helpful to early diagnosis and treatment of SI.