Wen Lieming, Zhang Jing, Zeng Shi, Zhou Qichang
Department of Ultrasonography, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
J Obstet Gynaecol Res. 2017 Dec;43(12):1840-1847. doi: 10.1111/jog.13454. Epub 2017 Oct 6.
This study represents the first attempt to use 'Z-scores' to assess levator hiatal dimensions and quantify hiatal expansion.
We undertook a retrospective study on the data of 110 nulliparae and 73 pelvic organ prolapse (POP) patients who had a clinical POP exam and translabial 4-D ultrasound. We used Z-scores to normalize the dimensions of nulliparae levator hiatus and to build a Z-score model to evaluate the 'hiatal ballooning' against the POP staging.
Valid data were gathered from 102 nulliparae and 64 POP patients. We built the Z-score models as follows: Z-Av = (measured value - 17.19) / 2.98, Z-Lv = (measured value - 55.65) / 5.48, where 'Av' and 'Lv' represented the 'hiatal area' and the 'anterior-posterior diameter' on Valsalva, respectively. The '90% reference range' of Z-Av was (-1.8-+1.8) and that of Z-Lv was (-2.0-+2.0). On receiver-operator curve analysis, the cut-off against POP stage 2 for Av was 20 cm (sensitivity of 79%, specificity of 66%), and that for Lv was 6.0 cm (sensitivity of 68%, specificity of 65%), which were approximately equal to a Z-Av of 1.0 and a Z-Lv of 1.0, correspondingly. For POP stage 3, the cut-off was an Av of 24 cm (sensitivity of 85%, specificity of 83%) or an anterior-posterior diameter of 6.3 cm (sensitivity of 77%, specificity of 80%), which was approximately equal to a Z-Av of 2.0 or a Z-Lv of 1.5, respectively.
'Normal hiatal dimension' was defined as Z-Av ≤ 1.0 or Z-Lv ≤ 1.0, and 'hiatal ballooning' was defined as Z-Av ≥ 2.0 or Z-Lv ≥ 1.5.
本研究首次尝试使用“Z值”评估提肌裂孔尺寸并量化裂孔扩张情况。
我们对110例未生育女性及73例盆腔器官脱垂（POP）患者的数据进行了回顾性研究，这些患者均接受了临床POP检查及经阴唇四维超声检查。我们使用Z值对未生育女性提肌裂孔的尺寸进行标准化，并建立一个Z值模型以根据POP分期评估“裂孔扩张”情况。
收集到102例未生育女性及64例POP患者的有效数据。我们建立了如下Z值模型：Z-Av =（测量值 - 17.19）/ 2.98，Z-Lv =（测量值 - 55.65）/ 5.48，其中“Av”和“Lv”分别代表用力屏气时的“裂孔面积”和“前后径”。Z-Av的“90%参考范围”为（-1.8至+1.8），Z-Lv的“90%参考范围”为（-2.0至+2.0）。在受试者工作特征曲线分析中，Av针对POP 2期的截断值为20 cm（灵敏度为79%，特异度为66%），Lv针对POP 2期的截断值为6.0 cm（灵敏度为68%，特异度为65%），相应地分别约等于Z-Av为1.0和Z-Lv为1.0。对于POP 3期，截断值为Av 24 cm（灵敏度为85%，特异度为83%）或前后径6.3 cm（灵敏度为77%，特异度为80%），分别约等于Z-Av为2.0或Z-Lv为1.5。
“正常裂孔尺寸”定义为Z-Av≤1.0或Z-Lv≤1.0，“裂孔扩张”定义为Z-Av≥2.0或Z-Lv≥1.5。
