[摘 要]目的 探討智能盆底超聲評價(jià)盆腔器官脫垂(POP)術(shù)后患者肛提肌形態(tài)及對新發(fā)尿失禁的診斷效能。方法 選取2019年2月至2022年5月于滄州市人民醫(yī)院診治的90例POP術(shù)后患者為病例組,另選取于同院體檢的100例健康產(chǎn)后女性作為對照組。根據(jù)是否出現(xiàn)新發(fā)尿失禁,將POP術(shù)后患者分為出現(xiàn)組(n=46)和未出現(xiàn)組(n=44),采用智能盆底超聲對是否出現(xiàn)新發(fā)尿失禁的POP術(shù)后患者的盆底超聲定量參數(shù)進(jìn)行對比;采用智能盆底超聲評估有無出現(xiàn)新發(fā)尿失禁的POP術(shù)后患者肛提肌形態(tài)特征;多因素Logistic回歸分析影響新發(fā)尿失禁發(fā)生的危險(xiǎn)因素,建立列線圖模型并進(jìn)行驗(yàn)證,利用受試者工作特征(ROC)曲線分析評估各因素對新發(fā)尿失禁的診斷效能。結(jié)果 病例組患者的尿道旋轉(zhuǎn)角(URA)值、膀胱頸下降距離(BND)值及在靜息狀態(tài)、Valsalva狀態(tài)下的膀胱尿道后角(RVA)測定值均較對照組患者更高,而膀胱頸到恥骨聯(lián)合下緣的距離(BSD)值、直腸壺腹最低點(diǎn)距離恥骨聯(lián)合下緣的距離(RAD)值均更低(t值介于3.562~17.413之間,P<0.05);新發(fā)尿失禁患者的URA值、BND及靜息狀態(tài)、Valsalva狀態(tài)下新發(fā)尿失禁患者的RVA值較未出現(xiàn)新發(fā)尿失禁患者均更高,而BSD值、RAD值均更低(t值介于3.326~7.320之間,P<0.05);新發(fā)尿失禁的POP術(shù)后患者在靜息狀態(tài)及最大用力時(shí)肛提肌裂孔的寬度(LHW)、H線及M線值均更大,兩側(cè)異向分?jǐn)?shù)均更低(t值介于4.128~24.857之間,P<0.05);多因素Logistic回歸分析顯示,絕經(jīng)、術(shù)前UDS-尿道梗阻,以及最大尿流率、平均尿流率、最大尿道閉合壓(MUCP)水平降低均為新發(fā)尿失禁發(fā)生的危險(xiǎn)因素,其OR值及95%CI分別為1.225(1.064~1.720)、1.580(1.194~1.865)、0.458(0.212~0.844)、0.406(0.201~0.742)、0.520(0.144~0.805);ROC曲線評估RVA值、尿道傾斜角(UTA)值、BSD值、RAD值、URA值及BND六個(gè)因素聯(lián)合預(yù)測對新發(fā)尿失禁的診斷效能最好,曲線下面積為0.889;模型評價(jià)結(jié)果顯示構(gòu)建的列線圖預(yù)測模型具有較高的區(qū)分度(92.35%)、準(zhǔn)確性(90.26%)和臨床適用性。結(jié)論 相較于健康女性術(shù)后,POP術(shù)后患者智能盆底超聲定量參數(shù)發(fā)生顯著變化,出現(xiàn)新發(fā)尿失禁的POP術(shù)后患者肛提肌形態(tài)發(fā)生明顯改變,采用智能盆底超聲能夠準(zhǔn)確評估肛提肌形態(tài)改變。
[關(guān)鍵詞]盆底超聲;盆腔器官脫垂;肛提肌形態(tài);尿失禁;診斷效能
Doi:10.3969/j.issn.1673-5293.2024.09.006
[中圖分類號]R173""" [文獻(xiàn)標(biāo)識碼]A
[文章編號]1673-5293(2024)09-0033-10
Analysis of smart pelvic floor ultrasound in evaluating levator ani morphology and the diagnostic
efficacy for new-onset urinary incontinence in postoperative pelvic organ prolapse patients
[Abstract] Objective To explore the evaluation of levator ani morphology using smart pelvic floor ultrasound in postoperative pelvic organ prolapse (POP) patients and its diagnostic efficacy for new-onset urinary incontinence. Methods 90 postoperative POP patients treated at Cangzhou Peoples Hospital from February 2019 to May 2022 were selected as the case group,and 100 healthy postpartum women who underwent physical examination at the same hospital were selected as the control group.Based on the occurrence of new-onset urinary incontinence,the patients after POP were divided into the occurrence group (n=46) and the non-occurrence group (n=44).Smart pelvic floor ultrasound was used to compare the quantitative parameters between the groups with and without new-onset urinary incontinence.Smart pelvic floor ultrasound was used to evaluate the morphological characteristics of levator ani muscle in postoperative POP patients with and without new-onset urinary incontinence.Multivariate Logistic regression analysis was used to identify risk factors influencing the occurrence of new-onset urinary incontinence,and a nomogram model was established and validated.The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of various factors for new-onset urinary incontinence. Results The urethral rotation angle (URA),bladder neck descent (BND),and resting and Valsalva retrovesical angles (RVA) in the case group were significantly higher than those in the control group,while the distance from the bladder neck to the lower edge of the pubic symphysis (BSD) and the distance from the lowest point of the rectal ampulla to the lower edge of the pubic symphysis (RAD) were significantly lower (t values between 3.562 and 17.413,P<0.05).New-onset urinary incontinence patients had higher URA,BND,and RVA values at rest and during Valsalva compared to those without new-onset urinary incontinence,while BSD and RAD values were lower (t values between 3.326 and 7.320,P<0.05).The levator hiatus width (LHW),H-line,and M-line values at rest and during maximum effort were greater in POP postoperative patients with new-onset urinary incontinence,and bilateral asymmetry scores were lower (t values between 4.128 and 24.857,P<0.05).Multivariate Logistic regression analysis indicated that menopause,preoperative UDS-urethral obstruction,and reduced levels of maximum urine flow rate,average urine flow rate,and maximum urethral closure pressure (MUCP) were risk factors for new-onset urinary incontinence,with OR values and 95%CI of 1.225 (1.064-1.720),1.580 (1.194-1.865),0.458 (0.212-0.844),0.406 (0.201-0.742),and 0.520 (0.144-0.805),respectively.ROC curve analysis showed that combined prediction of RVA,urethral tilt angle (UTA),BSD,RAD,URA,and BND had the best diagnostic efficacy for new-onset urinary incontinence,with an area under the curve of 0.889.The model evaluation indicated that the constructed nomogram prediction model had high discrimination (92.35%),accuracy (90.26%),and clinical applicability. Conclusion Compared to healthy postoperative women,postoperative POP patients exhibit significant changes in quantitative parameters of smart pelvic floor ultrasound.Postoperative POP patients with new-onset urinary incontinence show significant changes in levator ani morphology,which can be accurately assessed using intelligent pelvic floor ultrasound.
[Key words] pelvic floor ultrasound;pelvic organ prolapse;levator ani morphology;urinary incontinence;diagnostic efficacy
盆腔器官脫垂(pelvic organ prolapse,POP)主要由于患者盆底支持結(jié)構(gòu)出現(xiàn)異常使得盆腔器官移位而導(dǎo)致[1]。POP的發(fā)生率在8%~41%之間,影響患者的生活質(zhì)量[2]。下尿路癥狀是POP患者的常見并發(fā)癥,而壓力性尿失禁(stress urinary incontinence,SUI)是其中最為常見的一種[3]。盆底重建手術(shù)能夠有效糾正脫垂、改善術(shù)前存在的尿失禁,但術(shù)后仍有部分重度POP患者出現(xiàn)新發(fā)尿失禁[4]。術(shù)后新發(fā)尿失禁的發(fā)生率為16%~51%[5]。臨床上通常會(huì)在手術(shù)中同時(shí)行抗尿失禁手術(shù),但會(huì)增加與之相關(guān)的并發(fā)癥。作為診斷尿失禁的常用方法,尿動(dòng)力學(xué)檢查操作繁瑣且有創(chuàng)[6]。近年來,臨床上多采取無創(chuàng)的、便利的盆底超聲等影像學(xué)方法對尿失禁進(jìn)行評估,具有其他檢查方法不可超越的優(yōu)勢。
肛提肌是由恥尾肌、恥骨直腸肌和髂尾肌共同組成的向前中傾斜的立體結(jié)構(gòu),肛提肌裂孔則由兩側(cè)恥骨支與恥骨直腸肌組成,尿道、陰道、直腸通過其中,肛提肌具有穩(wěn)定盆腔器官的作用[7]。由于肛提肌受損,對盆底支持作用降低,從而引起盆腔器官脫垂,其嚴(yán)重程度由肛提肌受損程度決定[8]。因此通過肛提肌裂孔的形態(tài)結(jié)構(gòu)變化,能夠判斷肛提肌的功能改變。隨著自動(dòng)化盆底超聲的不斷發(fā)展,對于盆底結(jié)構(gòu)狀態(tài)的動(dòng)態(tài)變化,臨床上常采用盆底超聲檢查,進(jìn)而觀察肛提肌裂孔的形態(tài)改變,為評估POP提供一定的參考價(jià)值[9]?;诖耍狙芯恐饕治隽酥悄芘璧壮曉u價(jià)POP術(shù)后患者肛提肌形態(tài)及對新發(fā)尿失禁的診斷效能,以期為臨床應(yīng)用提供更可靠的依據(jù)。
1資料與方法
1.1研究對象
選取2019年2月至2022年5月于滄州市人民醫(yī)院診治的90例POP術(shù)后患者為病例組,另選取于同院體檢的100例健康產(chǎn)后女性作為對照組。年齡30~45歲,平均(35.54±4.65)歲。另外根據(jù)是否出現(xiàn)新發(fā)尿失禁,將病例組患者分為出現(xiàn)組(n=46)和未出現(xiàn)組(n=44)。納入標(biāo)準(zhǔn):①根據(jù)國際尿控協(xié)會(huì)制定的POP-Q分期測量法評估脫垂程度[10];②患者均有過相關(guān)治療;③能有效完成Valsalva動(dòng)作。排除標(biāo)準(zhǔn):①精神異?;颊?;②泌尿系統(tǒng)器質(zhì)性病變;③腹腔手術(shù)病史;④尿路感染。本研究經(jīng)我院醫(yī)學(xué)倫理委員會(huì)審核批準(zhǔn)(批準(zhǔn)號:201805672),患者及家屬均簽署知情同意書。
1.2資料收集
通過一般資料調(diào)查表及查閱患者管理檔案的方式收集研究對象一般資料,指標(biāo)包括年齡、脫垂病程、體質(zhì)量指數(shù)(body mass index,BMI)、吸煙史、飲酒史、妊娠期高血壓疾病、妊娠期糖尿病、孕次、產(chǎn)次、絕經(jīng)、子宮切除手術(shù)。
1.3觀察指標(biāo)
采用UDS-600尿動(dòng)力學(xué)分析儀(萊博瑞公司)進(jìn)行尿動(dòng)力學(xué)測定,包括術(shù)后殘余尿量、術(shù)前UDS-尿道梗阻、功能尿道長度、術(shù)前UDS-殘余尿量、逼尿肌過度活動(dòng)、最大尿流率、平均尿流率、最大尿道壓、最大尿道閉合壓(maximum urethral closure pressure,MUCP)。
靜息及Valsalva狀態(tài)下的超聲測量值,包括膀胱尿道后角(retrovesical angle,RVA)、尿道傾斜角(urethral tilt angle,UTA)、膀胱頸到恥骨聯(lián)合下緣的距離(bladder neck symphaseal distance,BSD)、直腸壺腹最低點(diǎn)距離恥骨聯(lián)合下緣的距離(rectal ampulla distance,RAD)、尿道旋轉(zhuǎn)角(urethral rotation angle,URA)及膀胱頸下降距離(bladder neck descend,BND)。
靜息及最大用力時(shí)提肌板角度(levator plate angle,LPA)、H線和M線;靜息及最大用力時(shí)肛提肌裂孔的寬度(levator hiatuswidth,LHW);左右側(cè)髂尾肌的角度(iliococcygeal angle,ICA)、兩側(cè)肛提肌的異向分?jǐn)?shù)(anisotropic fraction,F(xiàn)A)。
1.4判定標(biāo)準(zhǔn)
患者術(shù)前術(shù)后采用尿失禁問卷簡表(Urinary Incontinence Questionnaire Short Form,ICIQ-SF)評估尿失禁發(fā)生率[11]。術(shù)前尿失禁評估:患者的主觀癥狀、體格檢查和尿動(dòng)力學(xué)檢查綜合診斷。術(shù)后新發(fā)尿失禁定義為術(shù)前無尿失禁,術(shù)后出現(xiàn)尿失禁癥狀。
1.5儀器及檢查方法
采用Resona 8型彩色超聲診斷儀(邁瑞公司)進(jìn)行智能超聲檢查,探頭,2~8MHz,120°。腔內(nèi)探頭:3~11MHz,179°。方法:患者于檢查前使膀胱適度充盈,取截石位,探頭上緣緊貼恥骨聯(lián)合下緣,于會(huì)陰部放置。分別留取Valsalva和靜息狀態(tài)的矢狀切面恥骨聯(lián)合、膀胱和尿道的圖像并自動(dòng)測量Valsalva狀態(tài)下膀胱頸移動(dòng)度、α、膀胱后角腹部容積等。
1.6統(tǒng)計(jì)學(xué)方法
利用SPSS 23.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析。以均數(shù)±標(biāo)準(zhǔn)差(x-±s)表示計(jì)量資料,采用t檢驗(yàn)進(jìn)行兩組間比較;使用百分?jǐn)?shù)(%)表示計(jì)數(shù)資料,采用χ2檢驗(yàn)進(jìn)行組間比較。采用Logistic回歸分析術(shù)后POP術(shù)后患者出現(xiàn)新發(fā)尿失禁的危險(xiǎn)因素,構(gòu)建列線圖預(yù)測模型。采用受試者工作特征(receiver operating characteristic,ROC)曲線和Hosmer-Lemeshow goodness-of-fit檢驗(yàn)?zāi)P偷膮^(qū)分度和校準(zhǔn)度。采用臨床決策(decision curve analysis,DCA)曲線評價(jià)模型的精準(zhǔn)度。ROC曲線評估智能盆底超聲各參數(shù)對POP術(shù)后患者新發(fā)尿失禁的預(yù)測效能,檢驗(yàn)水準(zhǔn)α=0.05。
2結(jié)果
2.1兩組受試者的臨床資料比較
與對照組相比,病例組絕經(jīng)的患者比例更高,術(shù)前UDS-尿道梗阻的患者比例、最大尿流率、平均尿流率及MUCP均更低,差異有統(tǒng)計(jì)學(xué)意義(t/χ2值介于4.372~6.157之間,P<0.05),兩組受試者的其余指標(biāo)均無顯著差異(P>0.05),見表1。
2.2兩組受試者智能盆底超聲定量參數(shù)對比
病例組患者的URA值、BND及在靜息狀態(tài)下的RVA值均大于對照組,靜息狀態(tài)下的BSD值、RAD值均小于對照組,差異有統(tǒng)計(jì)學(xué)意義(t值介于3.562~17.413之間,P<0.05);在Valsalva狀態(tài)下,病例組患者的RVA值、UTA值均大于對照組,而BSD值、RAD值均小于對照組,差異有統(tǒng)計(jì)學(xué)意義(t值介于4.738~13.626之間,P<0.05);兩組受試者靜息狀態(tài)下的UTA值差異無統(tǒng)計(jì)學(xué)意義(P>0.05),見表2。
2.3 POP術(shù)后患者是否出現(xiàn)新發(fā)尿失禁的盆底超聲定量參數(shù)比較
出現(xiàn)新發(fā)尿失禁的POP術(shù)后患者URA值、BND及靜息狀態(tài)下的RVA值均大于未出現(xiàn)組,靜息狀態(tài)下的BSD值、RAD值均小于未出現(xiàn)組患者,差異有統(tǒng)計(jì)學(xué)意義(t值介于3.326~7.320之間,P<0.05);出現(xiàn)新發(fā)尿失禁的POP患者Valsalva狀態(tài)下的RVA值、UTA值均大于未出現(xiàn)組,而BSD值、RAD值均明顯小于未出現(xiàn)組,差異有統(tǒng)計(jì)學(xué)意義(t值介于3.807~5.803之間,P<0.05);兩組患者靜息狀態(tài)下的UTA值差異無統(tǒng)計(jì)學(xué)意義(P>0.05),見表3。
2.4有無出現(xiàn)新發(fā)尿失禁的POP術(shù)后患者肛提肌形態(tài)特征
與未出現(xiàn)新發(fā)尿失禁的POP術(shù)后患者相比,出現(xiàn)新發(fā)尿失禁的POP術(shù)后患者肛提肌在最大用力時(shí)和靜息狀態(tài)時(shí),LHW、H線及M線值均增大,LPA僅在最大用力時(shí)增大,差異有統(tǒng)計(jì)學(xué)意義(t值介于4.128~14.389之間,P<0.05);靜息狀態(tài)及最大用力時(shí)出現(xiàn)新發(fā)尿失禁的POP術(shù)后患者的FA-L、FA-R均更低,差異有統(tǒng)計(jì)學(xué)意義(t值分別為15.069、24.857之間,P<0.05),其余指標(biāo)差異均無統(tǒng)計(jì)學(xué)意義(P>0.05),見表4。
2.5多因素Logistic回歸分析影響患者新發(fā)尿失禁的因素
以表1中兩組差異具有統(tǒng)計(jì)學(xué)意義的指標(biāo)為自變量,以是否出現(xiàn)新發(fā)尿失禁為因變量,進(jìn)行多因素Logistic回歸分析,賦值情況見表5。結(jié)果顯示,絕經(jīng)、術(shù)前UDS-尿道梗阻,以及最大尿流率、平均尿流率、MUCP水平降低均為新發(fā)尿失禁發(fā)生的危險(xiǎn)因素,其OR值及95%CI分別為1.225(1.064~1.720)、1.580(1.194~1.865)、0.458(0.212~0.844)、0.406(0.201~0.742)、0.520(0.144~0.805),P<0.05,見表6。
2.6變量共線性診斷
共線性診斷分析篩選出的變量,結(jié)果顯示方差膨脹因子(variance inflation factor,VIF)均<10,說明變量之間不存在共線性且相互獨(dú)立,見表7。
2.7 ROC曲線評估智能盆底超聲參數(shù)對新發(fā)尿失禁的診斷效能
采用ROC曲線評估RVA值、UTA值、BSD值、RAD值、URA值及BND六個(gè)因素單獨(dú)和聯(lián)合預(yù)測新發(fā)尿失禁的診斷效能,ROC曲線的曲線下面積分別為0.810、0.844、0.788、0.805、0.822、0.817、0.889,表明六個(gè)因素聯(lián)合預(yù)測對新發(fā)尿失禁的診斷效能最好,見圖1。
2.8構(gòu)建列線圖預(yù)測模型
將Logistic回歸分析當(dāng)中的各危險(xiǎn)因素帶入SPSS中生成列線圖模型。根據(jù)列線圖模型讀出對應(yīng)指標(biāo)的賦分結(jié)果,預(yù)測新發(fā)尿失禁發(fā)生風(fēng)險(xiǎn)。例如王某,絕經(jīng)對應(yīng)賦分為45分,術(shù)前UDS-尿道梗阻對應(yīng)賦分為42分;最大尿流率為12.2mL,對應(yīng)賦分為52分;平均尿流率為11.5mL,對應(yīng)賦分為55分;MUCP為45.4cm H2O,對應(yīng)賦分為54分;總分為248分,其新發(fā)尿失禁發(fā)生風(fēng)險(xiǎn)為82.67%,見圖2。
2.9模型評價(jià)
列線圖模型內(nèi)部驗(yàn)證采用Bootstrap重采樣1 000次進(jìn)行,重復(fù)采樣前后以列線圖所得新發(fā)尿失禁發(fā)生風(fēng)險(xiǎn)為檢驗(yàn)變量,實(shí)際新發(fā)尿失禁發(fā)生情況為狀態(tài)變量,構(gòu)建ROC曲線及校準(zhǔn)曲線,并計(jì)算曲線下面積、預(yù)測概率及新發(fā)尿失禁的平均絕對誤差。結(jié)果顯示,內(nèi)部驗(yàn)證前后的曲線下面積分別為0.868(0.825~0.889)和0.837(0.812~0.870),敏感度分別為88.18%、86.39%,特異度分別為90.26%、90.55%,平均絕對誤差均為0.009,說明該列線圖模型有較高的區(qū)分度和校準(zhǔn)度,且靈敏度和特異度良好,見圖3、圖4及表8。
3討論
3.1 POP的研究背景
由于盆底支持功能薄弱,使得子宮及其相鄰的膀胱和直腸位置出現(xiàn)下降,從而引起POP[12]。該病在中老年及產(chǎn)后女性中較為常見,具有較高的手術(shù)率及復(fù)發(fā)率[13]。髂尾肌和恥骨直腸肌共同組成肛提肌,能夠支撐女性的盆底結(jié)構(gòu)[14]。作為盆底支持的主要結(jié)構(gòu),肛提肌的形態(tài)學(xué)改變能夠?qū)е翽OP[15]。作為一種婦科疾病,尿失禁在產(chǎn)后女性中較為常見,患病率在23%~45%之間,其中7%的患者病情較為嚴(yán)重[16]。嚴(yán)重的POP患者常常以盆底重建手術(shù)進(jìn)行治療,主要手術(shù)操作為膀胱尿道下移,加固周圍組織,進(jìn)而改善尿失禁狀況[17]。但部分患者在術(shù)后會(huì)出現(xiàn)新發(fā)尿失禁,對患者術(shù)后的生活造成嚴(yán)重影響。在臨床上,超聲直視盆底解剖結(jié)構(gòu)及盆底三維重建作為常用治療手段,常被用來評估POP[18]。目前關(guān)于智能盆底超聲評價(jià)POP術(shù)后患者肛提肌形態(tài)及對新發(fā)尿失禁的診斷效能鮮有研究,因此,本研究探討智能盆底超聲評價(jià)POP術(shù)后患者肛提肌形態(tài)特征及對新發(fā)尿失禁的診斷價(jià)值。
3.2 POP術(shù)后患者肛提肌形態(tài)特征
新發(fā)尿失禁由多種原因引起。本研究采用盆底超聲對病例組和對照組進(jìn)行檢查,結(jié)果顯示,與對照組相比,病例組患者的URA值、BND值、靜息及Valsalva狀態(tài)下的RVA值更高,且在Valsalva狀態(tài)下,病例組患者UTA值更高??赡苁怯捎谂璧捉Y(jié)構(gòu)下移且膀胱頸移動(dòng),從而造成角度改變[19]。對新發(fā)尿失禁的患者而言,上述超聲參數(shù)同樣產(chǎn)生明顯變化,說明由于盆底前支撐功能和抗腹壓功能的降低,導(dǎo)致盆底結(jié)構(gòu)出現(xiàn)變化,通過手術(shù)方式增加女性尿道活動(dòng)度,而使新發(fā)尿失禁發(fā)生風(fēng)險(xiǎn)增大[20]。此外,我們還探討了有無出現(xiàn)新發(fā)尿失禁的POP術(shù)后患者肛提肌形態(tài)特征,結(jié)果顯示,與未出現(xiàn)組患者相比,出現(xiàn)新發(fā)尿失禁的POP術(shù)后患者最大用力時(shí)的LPA、H線、M線和盆隔裂孔寬度均更高。既往研究發(fā)現(xiàn),盆底松弛能夠進(jìn)一步導(dǎo)致最大用力時(shí)LPA增大及H線和M線延長[21-22]。有研究顯示,與正常健康者相比,最大用力時(shí)POP患者LPA更大,且H線和M線均會(huì)移位[23],提示POP患者肛提肌肌肉虛弱、盆底薄弱、支撐能力下降,與肛提肌形態(tài)變化有關(guān)。
3.3新發(fā)尿失禁的影響因素
除此之外,本研究還發(fā)現(xiàn)絕經(jīng)、術(shù)前UDS-尿道梗阻及最大尿流率、平均尿流率、MUCP水平降低均為新發(fā)尿失禁發(fā)生的危險(xiǎn)因素。絕經(jīng)會(huì)使得體內(nèi)雌激素水平下降,尿道周圍結(jié)構(gòu)老化,使得尿道和膀胱尿道下移,導(dǎo)致尿道閉合功能降低,最終導(dǎo)致新發(fā)尿失禁[24]。近年來研究發(fā)現(xiàn),POP患者下尿路癥狀可通過尿動(dòng)力學(xué)檢查進(jìn)行評估[25]。MUCP能用來評估尿控能力,隨著尿道括約肌功能出現(xiàn)障礙,MUCP水平會(huì)降低[26]。且有研究發(fā)現(xiàn),POP患者術(shù)前MUCP較低會(huì)增加尿失禁的發(fā)生風(fēng)險(xiǎn)[27]。此外,尿道梗阻同樣也是新發(fā)尿失禁的獨(dú)立影響因素[28]。已報(bào)道的有關(guān)的POP術(shù)后患者新發(fā)SUI的危險(xiǎn)因素還包括最大尿流率時(shí)逼尿肌壓力<30cm H2O等[29],這與本研究結(jié)果基本一致。列線圖作為一種統(tǒng)計(jì)模型,能夠以直觀的方式預(yù)測臨床事件發(fā)生風(fēng)險(xiǎn)[30-31]。因此本研究構(gòu)建列線圖預(yù)測模型,通過對各獨(dú)立影響因素進(jìn)行量化評分,從而評估POP術(shù)后患者出現(xiàn)新發(fā)尿失禁的風(fēng)險(xiǎn),結(jié)果顯示該列線圖預(yù)測模型的區(qū)分度良好,可為評估POP術(shù)后患者出現(xiàn)新發(fā)尿失禁的風(fēng)險(xiǎn)提供一定依據(jù)。
本研究存在一定的局限性。由于本研究納入的樣本量相對較小,可能導(dǎo)致研究結(jié)果出現(xiàn)一定偏差,因此后續(xù)將擴(kuò)大樣本數(shù)做進(jìn)一步研究。
綜上所述,POP術(shù)后患者相較于健康女性術(shù)后智能盆底超聲定量參數(shù)發(fā)生顯著變化,出現(xiàn)新發(fā)尿失禁的術(shù)后POP患者肛提肌形態(tài)改變更為明顯,采用智能盆底超聲能夠準(zhǔn)確評估肛提肌形態(tài)改變。
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