剪切波弹性成像技术在阴道分娩会阴评估中的应用

张旱梅; 刘明扬; 罗琦; 李嘉欣; 程玉婷; 刘学琴; 周利华; 程娟

doi:10.16766/j.cnki.issn.1674-4152.004540

剪切波弹性成像技术在阴道分娩会阴评估中的应用

doi: 10.16766/j.cnki.issn.1674-4152.004540

1.
安徽医科大学第一附属医院妇产科, 安徽合肥 230032
2.
安徽医科大学基础医学院生理学教研室, 安徽合肥 230032
3.
安徽医科大学第一附属医院超声影像科
4.
安徽医科大学护理学院母婴教研室，安徽合肥 230032

基金项目:

安徽高校自然科学研究项目 KJ2021A0254

详细信息

通讯作者:
程娟, E-mail: JuanCheng@ahmu.edu.cn

中图分类号: R715.7 R445.1
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- 文章访问数: 3
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- 被引次数: 0
出版历程
- 收稿日期: 2025-06-25
- 网络出版日期: 2026-11-10

Application of shear wave elastography in perineal assessment during vaginal delivery

1.
Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, China

摘要

摘要: 目的应用剪切波弹性成像技术（SWE）对晚孕女性会阴体组织进行定量测量，分析其评估会阴体弹性的效能, 探讨其在阴道分娩临床会阴评估中的应用价值。方法采用前瞻性研究设计，便利抽样选取2022年3月—2023年11月在安徽医科大学第一附属医院进行产前检查符合纳入标准的197例晚孕女性，采用剪切波弹性成像技术测量其会阴体弹性。随诊其分娩结局并收集阴道分娩产妇临床会阴评估指标数据，剔除产钳助产、第二产程延长和急性胎儿窘迫病例后，以阴道分娩时是否行会阴切开将观察对象分为会阴切开组(53例)和非会阴切开组(50例)，比较2组的会阴评估指标。以会阴切开为因变量，进行logistic回归分析，构建联合预测模型，绘制ROC曲线，分析SWE测量数据对会阴切开的预测价值。结果会阴切开组与非会阴切开组临床会阴评估指标中会阴体弹性差异有统计学意义(P < 0.05)。2组SWE测量结果中Max、Min和Mean值比较差异均有统计学意义(P < 0.05)。采用Mean值、弹性及两者联合3种方法评估会阴是否需要切开的AUC(95% CI)分别为0.647（0.538~0.756）、0.796（0.705~0.887）、0.829（0.749~0.908），灵敏度分别为0.904、0.904、0.885，特异度分别为0.674、0.630、0.674，约登指数分别为0.230、0.534、0.559，Mean联合弹性的预测效能优于单独预测。结论临床会阴体弹性评估联合SWE测量可提供更加准确的评估效能，显示出良好的应用前景。
- 剪切波弹性成像 /
- 会阴体 /
- 阴道分娩 /
- 会阴评估
Abstract: Objective To employ shear wave elastography (SWE) technology to quantitatively measure the perineal body tissue in late-pregnant women, analyze its efficacy in assessing perineal body elasticity, and explore its application value in the clinical perineal assessment for vaginal delivery. Methods A prospective study design was employed. Convenience sampling was employed to select 197 late-pregnant women who met the inclusion criteria and underwent prenatal examinations at the First Affiliated Hospital of Anhui Medical University from March 2022 to November 2023. SWE was used to measure perineal body elasticity. Their delivery outcomes were followed up, and clinical perineal assessment indicators were collected for those who underwent vaginal delivery. After excluding cases involving forceps-assisted delivery, prolonged second stage of labor, and acute fetal distress, participants were categorized into an episiotomy group (53 cases) and a non-episiotomy group (50 cases) based on whether an episiotomy was performed during vaginal delivery. The perineal assessment indicators were compared between the two groups. Using episiotomy as the dependent variable, logistic regression was performed, a combined prediction model was constructed, and a receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of SWE measurements for episiotomy. Results Among the clinical perineal assessment parameters, perineal body elasticity showed a statistically significant difference (P < 0.05) between the episiotomy and non-episiotomy groups. There were statistically significant differences (P < 0.05) in the Max, Min, and Mean values of SWE measurements between the two groups. The areas under the ROC curve (AUC, 95% CI) for predicting the necessity of episiotomy using SWE Mean value, clinical elasticity assessment, and their combination were 0.647 (0.538-0.756), 0.796 (0.705-0.887), and 0.829 (0.749-0.908), respectively. The corresponding sensitivities were 0.904, 0.904, and 0.885; specificities were 0.674, 0.630, and 0.674; and Youden indices were 0.230, 0.534, and 0.559. The predictive efficacy of the Mean value combined with clinical elasticity was superior to that of either clinical elasticity or the Mean value alone. Conclusion Clinical perineal body elasticity assessment in combination with SWE measurement offers enhanced assessment accuracy and shows favorable application prospects.
- Shear wave elastography /
- Perineal body /
- Vaginal delivery /
- Perineal assessment

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图 1 妊娠≥36周孕妇会阴体剪切波弹性成像

Figure 1. Shear wave elastography of the perineal body in pregnant women at ≥36 weeks of gestation

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图 2 Mean、弹性、Mean+弹性评估会阴体侧切的ROC曲线

Figure 2. ROC Curves for Mean, Elasticity, and Mean + Elasticity in assessing the need for lateral episiotomy

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表 1 会阴切开组与非会阴切开组产妇的一般资料比较

Table 1. Comparison of general data between parturients with and without episiotomy

组别	例数	年龄(x±s，岁)	产前BMI (x±s)	孕前BMI [M(P₂₅, P₇₅)]	分娩孕天[M(P₂₅, P₇₅)，d]	新生儿体质量(x±s，g)
非会阴切开组	50	29.14±3.78	27.24±2.91	20.85(19.27, 23.40)	282.00(277.75, 287.00)	3 412.20±393.93
会阴切开组	53	28.60±3.32	27.33±3.72	21.30(19.45, 23.55)	283.00(277.50, 286.00)	3 352.64±227.57
统计量		0.763^a	0.131^a	-0.178^b	-0.076^b	0.921^a
P值		0.447	0.896	0.859	0.939	0.359
注：^a为t值，^b为Z值。

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表 2 会阴切开组与非会阴切开组产妇的临床会阴评估指标和SWE参数比较

Table 2. Comparison of clinical perineal assessment indicators and swe parameters between parturients with and without episiotomy

项目	非会阴切开组(n=50)	会阴切开组(n=53)	统计量	P值
会阴体弹性(例)			-5.365^a	＜0.001
差	5	22
一般	12	25
好	29	5
会阴体长度(例)			1.050^b	0.305
＜3 cm	9	14
3~7 cm	41	39
会阴体水肿(例)			4.204^b	0.122
无	46	41
轻微	1	9
有	3	3
Max[M(P₂₅, P₇₅)，kPa]	74.01(64.25, 85.18)	85.70(71.25, 93.61)	-2.531^a	0.011
Min[M(P₂₅, P₇₅)，kPa]	8.60(6.75, 11.82)	10.75(8.20, 18.33)	-2.597^a	0.009
Mean(x±s，kPa)	30.62±7.59	34.87±6.64	3.014^c	0.003
SD(x±s，kPa)	12.11±2.78	13.36±3.19	2.118^c	0.037
注：^a为Z值，^b为χ²值，^c为t值。会阴体弹性非会阴切开组缺失4例，会阴切开组缺失1例。

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表 3 产妇会阴侧切影响因素的logistic回归分析

Table 3. Logistic regression analysis of influencing factors of lateral episiotomy in parturients

变量	B	SE	Waldχ²	P值	OR值	95% CI
Mean	0.083	0.037	5.130	0.024	1.087	1.011~1.167
会阴体弹性	1.696	0.374	20.567	＜0.001	5.453	2.620~11.349

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表 4 3种会阴评估指标对会阴切开的评估效能比较

Table 4. Comparison of the efficacy of three perineal assessment indicators for episiotomy

项目	AUC(95% CI)	截断值(kPa)	灵敏度	特异度	约登指数
Mean	0.647(0.538~0.756)	26.065	0.904	0.674	0.230
弹性	0.796(0.705~0.887)		0.904	0.630	0.534
Mean+弹性	0.829(0.749~0.908)		0.885	0.674	0.559

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