中国医科大学学报
中國醫科大學學報
중국의과대학학보
JOURNAL OF CHINA MEDICAL UNIVERSITY
2015年
2期
156-159
,共4页
会阴超声%妊娠晚期女性%压力性尿失禁%ROC曲线
會陰超聲%妊娠晚期女性%壓力性尿失禁%ROC麯線
회음초성%임신만기녀성%압력성뇨실금%ROC곡선
transperineal ultrasound%women in late pregnancy%SUI%ROC curve
目的：探讨会阴超声对妊娠晚期压力性尿失禁（SUI）患者的临床诊断价值。方法应用会阴超声分别观察妊娠晚期患SUI 66例（Ⅰ组）、未患SUI 54例（Ⅱ组）及健康未育女性63例（Ⅲ组）盆底结构，记录各超声参数：静息期及张力期膀胱颈在X轴、Y轴的位置（Djx、Dzx；Djy、Dzy），膀胱尿道后角（αj、αz），膀胱角度（βj、βz）；计算膀胱颈在X轴、Y轴的移动度（ΔDx、ΔDy），膀胱旋转角度（Δβ），测量膀胱颈的移动度（ΔD），进行对比分析；通过受试者工作特征曲线（ROC曲线）分析，寻找各参数的超声诊断临界值。结果3组研究对象膀胱颈在张力状态下均向后下移位；Ⅰ组、Ⅱ组ΔDy、Djx、Dzx值均明显小于Ⅲ组，βj、βz、αj值均明显大于Ⅲ组，Ⅱ组ΔDx值明显大于Ⅲ组，差异有统计学意义（P<0.05）；3组间Djy、Dzy、ΔD、Δβ、αz比较差异有统计学意义（P<0.05）；通过ROC曲线分析Djy、Dzy、ΔDy、ΔD、αz、Δβ临界值为-1.75 cm、-1.71 cm、0.25 cm、0.29 cm、131.5°、3.5°时，敏感度分别为88.9%、88.9%、72.2%、83.3%、88.9%、72.2%，特异度分别为72.2%、81.8%、72.7%、95.5%、86.3%、68.2%。结论会阴超声可以清晰显示妊娠晚期女性盆底结构，患有SUI的妊娠晚期女性膀胱尿道周围支持结构的损伤或缺陷更为严重，各超声参数临界值的确定有助于妊娠晚期女性SUI的筛查。
目的：探討會陰超聲對妊娠晚期壓力性尿失禁（SUI）患者的臨床診斷價值。方法應用會陰超聲分彆觀察妊娠晚期患SUI 66例（Ⅰ組）、未患SUI 54例（Ⅱ組）及健康未育女性63例（Ⅲ組）盆底結構，記錄各超聲參數：靜息期及張力期膀胱頸在X軸、Y軸的位置（Djx、Dzx；Djy、Dzy），膀胱尿道後角（αj、αz），膀胱角度（βj、βz）；計算膀胱頸在X軸、Y軸的移動度（ΔDx、ΔDy），膀胱鏇轉角度（Δβ），測量膀胱頸的移動度（ΔD），進行對比分析；通過受試者工作特徵麯線（ROC麯線）分析，尋找各參數的超聲診斷臨界值。結果3組研究對象膀胱頸在張力狀態下均嚮後下移位；Ⅰ組、Ⅱ組ΔDy、Djx、Dzx值均明顯小于Ⅲ組，βj、βz、αj值均明顯大于Ⅲ組，Ⅱ組ΔDx值明顯大于Ⅲ組，差異有統計學意義（P<0.05）；3組間Djy、Dzy、ΔD、Δβ、αz比較差異有統計學意義（P<0.05）；通過ROC麯線分析Djy、Dzy、ΔDy、ΔD、αz、Δβ臨界值為-1.75 cm、-1.71 cm、0.25 cm、0.29 cm、131.5°、3.5°時，敏感度分彆為88.9%、88.9%、72.2%、83.3%、88.9%、72.2%，特異度分彆為72.2%、81.8%、72.7%、95.5%、86.3%、68.2%。結論會陰超聲可以清晰顯示妊娠晚期女性盆底結構，患有SUI的妊娠晚期女性膀胱尿道週圍支持結構的損傷或缺陷更為嚴重，各超聲參數臨界值的確定有助于妊娠晚期女性SUI的篩查。
목적：탐토회음초성대임신만기압력성뇨실금（SUI）환자적림상진단개치。방법응용회음초성분별관찰임신만기환SUI 66례（Ⅰ조）、미환SUI 54례（Ⅱ조）급건강미육녀성63례（Ⅲ조）분저결구，기록각초성삼수：정식기급장력기방광경재X축、Y축적위치（Djx、Dzx；Djy、Dzy），방광뇨도후각（αj、αz），방광각도（βj、βz）；계산방광경재X축、Y축적이동도（ΔDx、ΔDy），방광선전각도（Δβ），측량방광경적이동도（ΔD），진행대비분석；통과수시자공작특정곡선（ROC곡선）분석，심조각삼수적초성진단림계치。결과3조연구대상방광경재장력상태하균향후하이위；Ⅰ조、Ⅱ조ΔDy、Djx、Dzx치균명현소우Ⅲ조，βj、βz、αj치균명현대우Ⅲ조，Ⅱ조ΔDx치명현대우Ⅲ조，차이유통계학의의（P<0.05）；3조간Djy、Dzy、ΔD、Δβ、αz비교차이유통계학의의（P<0.05）；통과ROC곡선분석Djy、Dzy、ΔDy、ΔD、αz、Δβ림계치위-1.75 cm、-1.71 cm、0.25 cm、0.29 cm、131.5°、3.5°시，민감도분별위88.9%、88.9%、72.2%、83.3%、88.9%、72.2%，특이도분별위72.2%、81.8%、72.7%、95.5%、86.3%、68.2%。결론회음초성가이청석현시임신만기녀성분저결구，환유SUI적임신만기녀성방광뇨도주위지지결구적손상혹결함경위엄중，각초성삼수림계치적학정유조우임신만기녀성SUI적사사。
Objective To investigate the clinical diagnostic value of transperineal ultrasound in women in late pregnancy with stress urinary inconti?nence. Method Totally 66 cases of women in late pregnancy were selected,who did not suffer from SUI(groupⅠ),and 54 cases of women in late pregnancy who suffered from SUI(groupⅡ). Another 63 cases of healthy childless women were used as normal control(groupⅢ). Transperineal ultrasound was used to dynamically observe their pelvic floor structure,and the ultrasonic parameters were recorded and analyzed,including the posi?tion of bladder neck in X axis and Y axis((Djx,Dzx,Djy,Dzy)during resting period and tension period,the vesicourethral angle(αj,αz),the Bladder angle(βj,βz). The moving of the bladder neck in X axis(ΔDx=Dzx-Djx)and Y axis(ΔDy=Dzy-Djy),as well as the bladder rotation an?gle(Δβ=βz-βj)were calculated and the movement of the bladder neck(ΔD)was measured,followed by comparative analysis. The threshold val?ues of all ultrasonic parameters were determined by the ROC curve analysis. Results The bladder neck of all three groups were backward during tension period. Compared with groupⅢ,ΔDy,Djx,Dzx obviously decreased in groupⅠand groupⅡ,whileβj,βz,αj increased significantly.ΔDx of groupⅡwas significantly larger than that of groupⅢ(P<0.05);There was significant difference in Djy,Dzy,ΔD,Δβandαz among the three groups(P<0.05);In ROC curve analysis,when the critical value of Djy,Dzy,ΔDy,ΔD,αz andΔβwas-1.75 cm,-1.71 cm,0.25 cm,0.29 cm,131.5° and 3.5° ,their sensitivity was 88.9%,88.9%,72.2%,83.3%,88.9%and 72.2%,and the specificity was 72.2%,81.8%,72.7%, 95.5%,86.3%and 68.2%,respectively. Conclusions The transperineal ultrasound could clearly show the pelvic floor of the women in late preg?nancy,the bladder urethral support structure damage or defect was more serious in the women in late pregnancy who were suffering from SUI,and the determination of the critical values of all ultrasonic parameters helped the screening of SUI in women in late pregnancy.
