CAJ | 학술논문

目的：研究实时三维超声评估正常女性盆底结构的重复性和一致性。方法两位不同经验的操作者，分别测量42例正常成年女性Valsalva后的膀胱颈移动度、肛提肌裂孔面积，研究不同操作者组内和组间的重复性。比较各组测值的差异，运用组内相关系数（intraclass correlation coefficient ，ICC）、变异系数（variation coefficient ，CV）和Bland‐Altman分析来评价各组的一致性和重复性。结果经验丰富的操作者1和经验少的操作者2测得正常女性膀胱颈移动度分别为（184．8±58．4）cm和（177．9±54．8）cm ，二者比较差异无统计学意义（ P ＝02．22）；Valsalva 的最大肛提肌裂孔面积分别为（175．3±39．5）cm2和（173．1±43．2）cm2，二者比较差异无统计学意义（ P ＝03．44）。不同操作者之间测量正常女性膀胱颈移动度、Valsalva后的最大肛提肌裂孔面积的ICC分别为08．9和09．0，CV 分别为72．6％和30．3％。经验丰富的操作者重复性（ICC＝09．9、09．4）优于经验较少者（ICC 09．2、08．1）。Bland‐Altman图像分析结果显示两个不同经验操作者之间一致性较好。结论运用实时三维超声技术检测女性盆底结构在不同操作者间总体重复性和一致性较好。同一操作者的检测效能优于不同操作者；经验丰富的操作者检测效能优于经验较少者，加强对低年资医师培训可更进一步提高测量准确性。
목적：연구실시삼유초성평고정상녀성분저결구적중복성화일치성。방법량위불동경험적조작자，분별측량42례정상성년녀성Valsalva후적방광경이동도、항제기렬공면적，연구불동조작자조내화조간적중복성。비교각조측치적차이，운용조내상관계수（intraclass correlation coefficient ，ICC）、변이계수（variation coefficient ，CV）화Bland‐Altman분석래평개각조적일치성화중복성。결과경험봉부적조작자1화경험소적조작자2측득정상녀성방광경이동도분별위（184．8±58．4）cm화（177．9±54．8）cm ，이자비교차이무통계학의의（ P ＝02．22）；Valsalva 적최대항제기렬공면적분별위（175．3±39．5）cm2화（173．1±43．2）cm2，이자비교차이무통계학의의（ P ＝03．44）。불동조작자지간측량정상녀성방광경이동도、Valsalva후적최대항제기렬공면적적ICC분별위08．9화09．0，CV 분별위72．6％화30．3％。경험봉부적조작자중복성（ICC＝09．9、09．4）우우경험교소자（ICC 09．2、08．1）。Bland‐Altman도상분석결과현시량개불동경험조작자지간일치성교호。결론운용실시삼유초성기술검측녀성분저결구재불동조작자간총체중복성화일치성교호。동일조작자적검측효능우우불동조작자；경험봉부적조작자검측효능우우경험교소자，가강대저년자의사배훈가경진일보제고측량준학성。
Objective To study the repeatability and consistency of normal female pelvic floor structure using transperineal real‐time three‐dimensional ultrasound .Methods Forty‐two cases of normal adult female were evaluated by two different experience operator ,using the real‐time three‐dimensional ultrasound diagnostic apparatus .The bladder neck movement degrees and the levator hiatus area were observed after Valsalva condition .Differences between the groups were compared .Intraclass correlation coefficient (ICC) ,the coefficient of variation (CV) and Bland‐Altman analysis of consistency were evaluated . Results The bladder neck movement degrees and the levator hiatus area measured by the experienced operator (operator 1) and less experienced operator(operator 2) were (18 4.8 ± 5 8.4)cm and (17 7.9 ± 5 4.8) cm ,(17 5.3 ± 3 9.5)cm2 and (17 3.1 ± 4 3.2)cm2 ,respectively .There was no significant difference between the two operators ( P > 0 0.5) .The intra‐ICC were 0 8.9 and 0 9.0 ,CV were 7 2.6% and 3 0.3% .Experienced operator repeatability (ICC= 0 9.9 ,0 9.4) was slightly higher than the less experienced researchers (ICC 0 9.2 ,0 8.1) .The analysis results of Bland‐Altman image showed good consistency between two different operators .Conclusions The current study proves real‐time three‐dimensional ultrasound is a reproducible method for female pelvic floor structure assessment ,and the reproducibility is very well .The detection performance of experienced operator slightly better than the one with less experience ,strengthen the training of junior doctors may further improve the accuracy of measurement .