盆底超声和腹直肌分离检测对产后盆底功能的评估及压力性尿失禁的诊断价值

方静; 王梦娟; 陈果

doi:10.16766/j.cnki.issn.1674-4152.004458

盆底超声和腹直肌分离检测对产后盆底功能的评估及压力性尿失禁的诊断价值

doi: 10.16766/j.cnki.issn.1674-4152.004458

方静^{1, 2},
王梦娟¹,
陈果^{1, 2, ,}

1.
安徽医科大学妇幼医学中心, 安徽合肥 230001
2.
安徽医科大学, 安徽合肥 230032

基金项目:

国家卫生健康委员会医药卫生科技发展研究中心临床科研专项 WKZX2024DN0144

安徽省科技厅临床医学研究转化专项 202204295107020048

详细信息

通讯作者:
陈果，E-mail: m13855114981@163.com

中图分类号: R445.1 R714.46
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出版历程
- 收稿日期: 2025-07-19

Diagnostic value of pelvic floor ultrasound and diastasis recti assessment in the evaluating pelvic floor function and postpartum stress urinary incontinence

FANG Jing^{1, 2},
WANG Mengjuan¹,
CHEN Guo^{1, 2
, ,}

1.
Maternal and Child Health Center, Anhui Medical University, Hefei, Anhui 230001, China

摘要

摘要: 目的探讨盆底超声参数及腹直肌分离程度与产后盆底功能障碍的关系，并分析其对压力性尿失禁(SUI)的诊断价值。方法回顾性分析2022年2月—2024年10月于安徽医科大学妇幼医学中心就诊的307例顺产产后女性，收集盆底超声最大Valsalva动作下的膀胱颈移动度(BND)、尿道旋转角(URA)、肛提肌裂孔面积(LHA)及膀胱后角(BA)、腹直肌间距(脐上3 cm、脐水平、脐下3 cm)。根据门诊病历查阅是否出现SUI相关症状，将其分为61例SUI组以及246例非SUI组，比较2组的差异，并通过logistic回归及ROC曲线评估指标的独立及联合诊断价值。结果 SUI组BND、URA、LHA高于非SUI组，差异有统计学意义(P＜0.001)。SUI组脐水平腹直肌间距高于非SUI组, 差异有统计学意义(P＜0.001)。而2组的BA、脐上3 cm与脐下3 cm腹直肌间距差异无统计学意义(P＞0.05)。经多因素logistic回归分析显示，BND、URA、LHA以及脐水平腹直肌间距均是产后发生SUI的影响因素(P＜0.05)。ROC曲线结果显示，BND、URA、LHA以及脐水平腹直肌间距诊断产后SUI的曲线下面积分别为0.794、0.814、0.782、0.716(P＜0.001)，联合诊断曲线下面积可达0.886。结论产妇盆底超声指标、脐水平腹直肌间距对SUI具有一定的临床诊断价值。
- 盆底超声 /
- 盆底功能 /
- 腹直肌分离 /
- 压力性尿失禁
Abstract: Objective To explore the relationship between pelvic floor ultrasound parameters and the degree of rectus abdominis diastasis in postpartum women, and to analyze their diagnostic value for stress urinary incontinence (SUI). Methods A retrospective analysis was performed on 307 postpartum women who had undergone vaginal delivery and attended the Maternal and Child Health Center, Anhui Medical University from February 2022 to October 2024. The bladder neck mobility (BND), urethral rotation angle (URA), latissimus dorsi muscle cleavage area (LHA), and bladder posterior angle (BA), as well as rectus abdominis muscle spacing measured during maximal Valsalva maneuver (at the umbilical level, 3 cm above the umbilicus, and 3 cm below the umbilicus), were collected. According to the outpatient medical records, participants were divided into 61 cases of SUI group and 246 cases of non-SUI group. Differences between the two groups were compared, and the independent and combined diagnostic values of the indexes were evaluated by multivariate logistic regression and ROC curve analyses. Results The BND, URA, and LHA were significantly higher in the SUI group than in the non-SUI group (P < 0.001). The rectus abdominis muscle spacing at the umbilical level was also higher in the SUI group than in the non-SUI group (P < 0.001). No statistically significant differences were observed in BA, 3 cm above the umbilicus, or 3 cm below the umbilicus (P> 0.05). After multifactorial logistic regression analysis identified BND, URA, LHA, and rectus abdominis muscle spacing at the umbilical level as independent influencing factors for postnatal SUI (P < 0.05). ROC curves showed that the areas under the curve for BND, URA, LHA, and rectus abdominis muscle spacing at the umbilical level were 0.794, 0.814, 0.782, and 0.716, respectively (P < 0.001), while the combined area under the curve could reached 0.886. Conclusion Maternal pelvic floor ultrasound indexes and abdominis muscle spacing at the umbilical level demonstrate clinical diagnostic value for the diagnosis of SUI.
- Pelvic floor ultrasound /
- Pelvic floor function /
- Diastasis recti abdominis /
- Stress urinary incontinence
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图 1 盆底超声指标、脐水平腹直肌间距诊断产后SUI的ROC曲线

Figure 1. ROC curve of pelvic floor ultrasound indices and umbilicus-level rectus abdominis diastasis for diagnosing postpartum stress urinary incontinence

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表 1 2组产妇一般资料比较

Table 1. Comparison of general characteristics between two groups of postpartum women

项目	SUI组(n=61)	非SUI组(n=246)	统计量	P值
年龄(x±s，岁)	30.02±3.27	29.15±3.43	1.781^a	0.076
孕次[M(P₂₅, P₇₅)，次]	1(1, 2)	1(1, 2)	-0.865^b	0.387
产次[M(P₂₅, P₇₅)，次]	1(1, 2)	1(1, 1)	-1.051^b	0.293
阴道手术助产[例(%)]	4(6.6)	9(3.7)	0.424^c	0.515
身高[M(P₂₅, P₇₅)，cm]	162.0(158.5, 167.0)	161.0(158.0, 165.0)	-1.359^b	0.174
孕前体重(x±s，kg)	56.91±7.68	55.17±7.74	1.576^a	0.116
孕前BMI(x±s)	21.61±2.49	21.28±2.77	0.847^a	0.398
孕周(x±s周)	39.63±0.90	39.64±1.01	0.091^a	0.928
注: ^a为t值，^b为Z值，^c为χ²值。

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表 2 2组产妇最大Valsalva动作下盆底超声相关指标比较(x±s)

Table 2. Comparison of pelvic floor ultrasound indicators during maximal Valsalva maneuver between two groups of postpartum women (x±s)

组别	例数	BND(mm)	URA(°)	BA(°)	LHA(cm²)
SUI组	61	30.54±5.73	68.26±10.20	115.43±18.95	26.61±2.82
非SUI组	246	23.80±6.23	53.26±14.45	110.91±21.20	22.33±4.85
t值		7.674	9.383	1.519	8.999
P值		＜0.001	＜0.001	0.130	＜0.001

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表 3 2组产妇静息状态下不同位置腹直肌间距比较(x±s)

Table 3. Comparison of inter-recti distance at different positions in the resting state between two groups of postpartum women (x±s)

组别	例数	腹直肌间距(cm)
组别	例数	脐上3 cm	脐水平	脐下3 cm
SUI组	61	2.20±0.79	2.86±0.72	1.02±0.70
非SUI组	246	2.17±0.68	2.33±0.68	0.94±0.60
t值		0.310	5.461	0.850
P值		0.756	＜0.001	0.422

下载: 导出CSV

表 4 影响产后发生SUI的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis of factors associated with postpartum stress urinary incontinence

变量	B	SE	Waldχ²	P值	OR值	95% CI
BND	0.133	0.033	16.013	＜0.001	1.142	1.070~1.219
URA	0.042	0.014	8.671	0.003	1.043	1.014~1.073
LHA	0.153	0.050	9.404	0.002	1.165	1.057~1.285
脐水平腹直肌间距	0.751	0.245	9.408	0.002	2.119	1.311~3.425

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表 5 盆底超声指标、脐水平腹直肌间距对产后SUI的诊断价值

Table 5. Diagnostic value of pelvic floor ultrasound indicators and umbilical-level inter-recti distance for postpartum stress urinary incontinence

项目	AUC	SE	95% CI	灵敏度	特异度	约登指数	cut-off值	P值
BND(mm)	0.794	0.028	0.740~0.849	0.852	0.610	0.462	25.50	＜0.001
URA(°)	0.814	0.024	0.767~0.861	0.918	0.659	0.577	55.50	＜0.001
LHA(cm²)	0.782	0.026	0.731~0.833	0.967	0.598	0.565	23.50	＜0.001
脐水平腹直肌间距(cm)	0.716	0.036	0.646~0.786	0.787	0.650	0.437	2.52	＜0.001
联合	0.886	0.019	0.849~0.923	0.852	0.822	0.674		＜0.001

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