目的

研究经会阴超声检测肛提肌形态及功能对盆腔器官脱垂（POP）的诊断价值。

方法

选取2023年10月至2024年5月中南大学湘雅医院收治的100例POP患者为研究组，同期100例非POP者为对照组。经会阴部扫查，启用三维模式，在静息及最大Valsalva状态下实时测量肛提肌裂孔的前后径、左右径及面积；启用断层成像技术，在盆底肌肉收缩状态下评估肛提肌的完整性，并测量左、右侧肛提肌尿道间隙。采用独立样本t检验比较组间肛提肌裂孔测值的差异，采用χ²检验比较组间肛提肌损伤率的差异。

结果

静息状态下，研究组肛提肌裂孔的前后径、左右径及面积均高于对照组［（57.6±4.1）mm vs （53.2±4.7）mm，（47.7±4.4）mm vs （40.8±4.1）mm，（18.12±2.15）cm² vs （14.87±2.63）cm²］，最大Valsalva状态下，研究组肛提肌裂孔的前后径、左右径及面积也高于对照组［（63.4±3.1）mm vs （53.5±3.2）mm，（51.3±4.7）mm vs （40.2±3.0）mm，（22.27±2.65）cm² vs （16.46±2.71）cm²］，差异均具有统计学意义（t=6.922、11.275、9.383、21.820、19.618、15.053，P均＜0.001）。盆底肌收缩状态下，研究者肛提肌损伤率为22.1%，明显高于对照组（3.1%），差异具有统计学意义（χ²=16.067，P＜0.001）。研究组左、右侧肛提肌尿道间隙均高于对照组［（23.92±3.87）mm vs （18.14±2.75）mm，（24.76±3.62）mm vs （18.72±2.76）mm］，差异具有统计学意义（t=11.989、13.060，P均＜0.001）。

结论

经会阴三维、实时三维超声联合断层成像检测肛提肌形态及功能对POP具有较高的诊断价值。

Objective

To investigate the diagnostic efficacy of transperineal ultrasound in detecting the morphology and function of the levator ani muscle in patients with pelvic organ prolapse （POP）.

Methods

The clinical and ultrasonographic data of 100 POP patients and 100 non-POP patients from the Xiangya Hospital of Central South University from October 2023 to May 2024 were retrospectively analyzed in this study. In resting and maximal Valsalva state， three-dimensional transperineal ultrasound was used to measure the anteroposterior and left-to-right diameters and area of levator ani hiatus in real time. The integrity of the levator ani muscle was assessed during pelvic floor muscle contraction， and the levator-urethra gap for both sides was measured. Independent sample t-test was used to compare the differences in measurements of anal sphincter hiatus between groups， and Chi-square test was used to compare the differences in rates of anal sphincter injury between groups.

Results

In the resting state， the anteroposterior and left-toright diameters， and area of levator ani hiatus in the study group were significantly higher than those of the control group ［（57.6±4.1） mm vs （53.2±4.7） mm， （47.7±4.4） mm vs （40.8±4.1） mm， and （18.12±2.15） cm² vs （14.87±2.63） cm²； t=6.922， 11.275， and 9.383， respectively； P＜0.001 for all］. In maximum Valsalva state， the anteroposterior and left-to-right diameters and area of levator ani hiatus in the study group were also significantly higher than those of the control group ［（63.4±3.1） mm vs （53.5±3.2） mm， （51.3±4.7） mm vs （40.2±3.0） mm， and （22.27±2.65） cm² vs （16.46±2.7） cm²； t=21.820， 19.618， and 15.053， respectively；P＜0.001 for all］. Assessing the contraction status of pelvic floor muscles showed that the injury rate of the levator ani muscle in the study group was 22.1%， which significantly higher than that of the control group （3.1%；χ²=16.067， P＜0.001）. The left and right levator-urethra gaps in the study group were significantly higher than those in the control group ［（23.92±3.87） mm vs （18.14±2.75） mm and （24.76±3.62） mm vs （18.72±2.76） mm； t=11.989 and 13.060， respectively； P＜0.001 for both］.

Conclusion

Three-dimensional and real-time three-dimensional transperineal ultrasound combined with tomographic ultrasound imaging can effectively assess the morphological changes and the functional status of levator ani muscles， which has high diagnostic value for POP.