盆底超声测量角量参数在女性压力性尿失禁中的应用

摘要

Purpose To investigate the diagnostic criteria and value of angle parameters in female stress urinary incontinence (SUI),and to provide an objective basis for clinical diagnosis of SUI.Materials and Methods In retrospective analysis,138 patients with SUI diagnosed by clinic from December 2014 to December 2016 were selected as the study group,while 100 normal females receiving the routine medical examination were selected as the control group.All subjects in both groups were examined by pelvic floor ultrasound to observe the urethral inclination angle,urethral rotation angle (URA) and posterior urethrovesical angle (PUVA) to obtain the standard in diagnosis of female SUI.30 SUI patients from January to February 2017 were prospectively analyzed,and the above results were verified to evaluate their value in the diagnosis of SUI.Results There was no significant difference in age,body mass index,gravidity and parity history and resting state PUVA between the two groups (P＞0.05).There was significant difference in the resting state urethral inclination angle,Valsalva urethral inclination angle,PUVA and URA between the two groups (P＜0.05).The receiver operating characteristic curve was used to find the cut-off value of SUI:urethral inclination angle in resting state ＜14.5°,urethral inclination angle in Valsalva state ＞32.5 °,and URA ＞49.5 °,PUVA ＞154.5 °,with their sensitivity of 62％,73％,67％ and 57％,respectively;the specificity of 61％,84％,82％ and 70％,respectively;and the area under the curve of 0.633,0.809,0.768 and 0.658,respectively.By verification,when the urethral inclination angle was 14.5° in the resting state,the coincidence rate of the diagnosis of SUI was 63％;when the urethral inclination angle of Valsalva was 32.5°,83％;when the URA was 49.5°,77％;when the PUVA was 154.5 °,60％.Conclusion Pelvic floor ultrasound can clearly observe angle parameters of females,the determination of the cut-off value of ultrasound is helpful for clinical diagnosis and evaluation of SUI,and the urethral inclination angle in Valsalva state and URA are of high diagnostic value in the diagnosis of female SUI,providing an objective basis for clinical diagnosis of SUI.%目的 探讨角量参数在女性压力性尿失禁(SUI)中的诊断价值,为临床诊断SUI提供客观依据.资料与方法 收集2014年12月-2016年12月经临床诊断为SUI的女性患者138例为研究组,选取同期100例常规体检的正常女性作为对照组,两组受检者均进行盆底超声检查,观察两组受检者尿道倾斜角、尿道旋转角及膀胱尿道后角情况,得到其在女性SUI的诊断标准,并前瞻性分析2017年1-2月30例SUI患者,对上述结果进行验证,评估其在SUI诊断中的价值.结果 两组受检者年龄、体重指数、孕产次及静息状态膀胱尿道后角差异无统计学意义(P＞0.05).两组患者静息状态尿道倾斜角、Valsalva动作尿道倾斜角及膀胱尿道后角、尿道旋转角差异有统计学意义(P＜0.05).应用受试者工作特性曲线寻找诊断SU1的截断值:静息状态时尿道倾斜角＜14.5°,Valsalva动作时尿道倾斜角＞32.5°,尿道旋转角＞49.5°,膀胱尿道后角＞154.5°,其敏感度分别为62％、73％、67％、57％,特异度分别为61％、84％、82％、70％,曲线下面积分别为0.633、0.809、0.768、0.658.通过验证,当静息状态尿道倾斜角为14.5°时,诊断SUI的符合率为63％;Valsalva动作尿道倾斜角为32.5°时,诊断SUI的符合率为83％;尿道旋转角为49.5°时,诊断SUI的符合率为77％;Valsalva动作膀胱尿道后角为154.5°时,诊断SUI的符合率为60％.结论 盆底超声能清晰观察女性盆底角量参数,其超声诊断截断值的确定有助于临床对SUI患者的诊断及评估,Valsalva动作时尿道倾斜角与尿道旋转角在女性SUI诊断中具有较高的诊断价值,可为临床诊断SUI提供客观依据.