Wen Lieming, Liu Minghui, Zhao Baihua, Qing Zhenzhen
Department of Ultrasound Diagnosis, Second Xiangya Hospital, Central South University, Changsha, China.
J Ultrasound Med. 2018 Oct;37(10):2363-2369. doi: 10.1002/jum.14590. Epub 2018 Mar 12.
To use Z scores to quantify hiatal distensibility and to test the performance of Z scores for levator hiatal areas in predicting substantial pelvic organ prolapse (POP).
We undertook a retrospective study of the data from 145 nulliparas and 166 patients with POP who had a clinical POP examination with 3-dimensional translabial ultrasonography. Z scores were used to normalize levator hiatal areas of nulliparas. The Z score model for the hiatal area was built by the formula Z score = (measured value - predicted mean value)/predicted standard deviation and was used to evaluate hiatal ballooning in women with POP.
Valid data were gathered from 134 nulliparas and 159 patients with POP. POP stage 1 was found in 46 women, stage 2 in 62, stage 3 in 43, and stage 4 in 8. We built the Z score model as follows: Z-Av = (measured value - 17.15)/3.11, where Av represented the minimal levator hiatal area on the maximum Valsalva maneuver. The levator hiatal area was strongly related to the POP stage (P < .001). On a receiver operating characteristic curve analysis, the cutoff of Z-Av was 1 for POP stage 2 or higher (sensitivity, 77%; specificity, 60%) and substantial POP on ultrasonography (sensitivity, 84%; specificity, 75%).
Hiatal distensibility can be exactly evaluated by Z-Av. A Z-Av value of less than 1.0 was defined as a "normal hiatal expansion," 1 to 3 as "mild ballooning," 3 to 5 as "moderate ballooning," 5 to 7 as "marked ballooning," and 7 or greater as "severe ballooning."
使用Z值量化裂孔扩张性，并测试提肌裂孔面积的Z值在预测严重盆腔器官脱垂（POP）方面的性能。
我们对145例未生育女性和166例患有POP的患者的数据进行了回顾性研究，这些患者接受了三维经阴唇超声临床POP检查。使用Z值对未生育女性的提肌裂孔面积进行标准化。裂孔面积的Z值模型通过公式Z值 =（测量值 - 预测平均值）/预测标准差构建，并用于评估患有POP的女性的裂孔扩张情况。
从134例未生育女性和159例患有POP的患者中收集了有效数据。发现46名女性为POP 1期，62名女性为2期，43名女性为3期，8名女性为4期。我们构建了如下Z值模型：Z-Av =（测量值 - 17.15）/3.11，其中Av代表最大瓦氏动作时的最小提肌裂孔面积。提肌裂孔面积与POP分期密切相关（P <.001）。在受试者工作特征曲线分析中，Z-Av的临界值为1用于POP 2期或更高期（敏感性，77%；特异性，60%）以及超声检查中的严重POP（敏感性，84%；特异性，75%）。
裂孔扩张性可通过Z-Av准确评估。Z-Av值小于1.0被定义为“正常裂孔扩张”，1至3为“轻度扩张”，3至5为“中度扩张”，5至7为“明显扩张”，7或更高为“严重扩张”。
