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Received:February 16, 2022 Published Online:January 20, 2023
Received:February 16, 2022 Published Online:January 20, 2023
中文摘要: 目的探讨四维盆底超声在评估初产妇孕晚期及分娩后盆膈裂孔变化中的作用。
方法选取唐山市妇幼保健院2019年1月至2020年12月182例孕晚期初产妇（观察组）与61例因月经不调就诊的未育女性（对照组）的临床资料进行回顾性研究，均进行四维盆底超声检查，观察盆膈裂孔前后径、左右径及面积;且根据不同分娩方式将观察组182例分为阴道分娩亚组（n=93）和择期剖宫产亚组（n=89）。对比静息、提肛、Valsulva状态下的盆膈裂孔参数变化，用ROC曲线分析该三项参数单独及联合评估盆膈裂孔形态的AUC值、敏感度、特异度。
结果观察组静息状态下盆膈裂孔前后径、左右径及面积高于对照组（P＜0.01）。重复测量方差分析显示，〖JP2〗盆膈裂孔三项参数间存在时间效应、组间效应（P＜0.05）;但时间（检测状态）因素和组间因素不具有交互效应（P＞0.05）;〖JP〗两两比较显示，在静息、提肛、Valsulva状态下，阴道分娩亚组的盆膈裂孔前后径、左右径及面积高于择期剖宫产亚组（P＜0.05）。ROC曲线分析显示，盆膈裂孔前后径、左右径、面积以及三项参数单独和联合评估盆膈裂孔形态的AUC值分别为0.822、0.609、0.782和0.893，联合评估的AUC最高;敏感度分别为82.40%、23.10%、73.10%和78.00%;特异度分别为70.50%、100.00%、75.40%和93.40%。
结论四维盆底超声评估盆膈裂孔具有较高的临床价值，能为孕晚期孕产妇预防产后盆底功能障碍的发生提供指导。
Abstract:ObjectiveToexploretheroleoffour-dimensionalpelvicfloorultrasoundinevaluatingthechangesofpelvicdiaphragmatichiatusinprimiparaeduringthelatepregnancyandafterdelivery.
MethodsTheclinicaldataof182primiparaeinlatepregnancy（observationgroup）and61nulliparouswomenwhovisitedtothehospitalduetoirregularmenstruation（controlgroup）fromJanuary2019toDecember2020inTangshanMaternalandChildHealthHospitalwereselectedforretrospectivestudy.Allofthemwereexaminedwithfour-dimensionalpelvicfloorultrasoundtoobservetheanteroposteriordiameters,leftandrightdiametersandareasofpelvicdiaphragmatichiatus.Accordingtodifferentdeliverymethods,182casesweredividedintovaginaldeliverysubgroup（n=93）andelectivecesareansectionsubgroup（n=89）.Thechangesofparametersofpelvicdiaphragmatichiatusatresting,analliftingandValsulvawerecompared,andtheAUCvalue,sensitivityandspecificityofthesethreeparametersindividuallyandjointlyinevaluatingthemorphologyofpelvicdiaphragmatichiatuswereanalysedbyROCcurve.
ResultsTheanteroposteriordiameter,left-rightdiameterandareaofthepelvicdiaphragmatichiatusintheobservationgroupatrestwerehigherthanthoseinthecontrolgroup（P＜0.05）.Variamceanalysisofrepeatedmeasurementsshowedthatthereweretimeeffectsandintergroupeffectsamongthethreeparametersofpelvicdiaphragmatichiatus（P＜0.05）;however,therewasnointeractionbetweentime（teststate）andintergroupfactors（P＞0.05）;pairwisecomparisonbetweentwogroupsshowedthattheanteroposteriordiameter,left-rightdiameterandareaofpelvicdiaphragmatichiatusinvaginaldeliverysubgroupwerehigherthanthoseinelectivecesareansectionsubgroupatresting,analliflingandValsulava（P＜0.05）.ROCcurveanalysisshowedthattheAUCvaluesofanteroposteriordiameter,left-rightdiameter,areaandthreeparametersindividuallyandjointlyforevaluatingtheshapeofpelvicdiaphragmatichiatuswere0.822,0.609,0.782and0.893respectively,andtheAUCvalueofjointevaluationwasthehighest;andthesensitivitywas82.40%,23.10%,73.10%and78.00%,respectively;thespecificitieswere70.50%,100.00%,75.40%and93.40%,respectively.
ConclusionFour-dimensionalpelvicfloorultrasoundevaluationofpelvicdiaphragmatichiatushasahighclinicalvalue,whichcanprovideguidanceforlatepregnantwomentopreventtheoccurrenceofpostpartumpelvicfloordysfunction.
keywords: Four-dimensionalultrasound Pelvicfloor Latepregnancy Childbirth Hiatusofpelvicdiaphragm Postpartumpelvicfloordysfunction
文章编号： 中图分类号：R714.7 R445.1 文献标志码：B
基金项目:河北省医学科学研究课题（20211407）
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