Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
Sydney Medical School Nepean, University of Sydney, Penrith, Australia.
Ultrasound Obstet Gynecol. 2019 Jul;54(1):124-127. doi: 10.1002/uog.20210. Epub 2019 Jun 12.
Levator ani trauma and hiatal overdistension have been shown to be associated with female pelvic organ prolapse (POP); however, the role of the shape of the levator hiatus in POP has not been examined to date. The aim of this study was to investigate the association between the configuration of the levator ani hiatus and POP.
This was a retrospective study of 547 women who attended a tertiary urogynecological center for symptoms of pelvic floor and lower urinary tract dysfunction between October 2014 and August 2016. All women underwent a standardized interview and prolapse assessment using the International Continence Society (ICS) Pelvic Organ Prolapse Quantification (POP-Q) method and four-dimensional translabial ultrasound (TLUS). Measurements of the hiatal anteroposterior diameter (APD), coronal diameter (CD) and hiatal area (HA), at rest and on maximal Valsalva maneuver, and those of organ descent were performed offline at a later date by an investigator blinded to all other data. Hiatal configuration was defined as the ratio APD/CD. Associations between HA and HA adjusted by APD/CD at rest and on maximal Valsalva and symptoms and signs of prolapse were analyzed statistically using logistic regression modelling.
The mean age of the women was 54 ± 13.6 (range, 16-89) years. Of the 547 women included, 241 (44%) presented with prolapse symptoms. Clinically significant POP was detected in 406 (74%) patients and significant prolapse on TLUS was detected in 331 (61%). Hiatal ballooning was observed in 310 (57%) women and this was strongly associated with signs and symptoms of POP. HA at rest and on Valsalva was associated with significant POP both on clinical examination and on TLUS. Adjusted odds ratios for hiatal shape showed no effect of the hiatal configuration on the association between HA and POP.
Hiatal shape does not seem to influence the association between HA and symptoms and signs of prolapse. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
已证实肛提肌损伤和裂孔过度扩张与女性盆腔器官脱垂（POP）有关；然而，迄今为止，尚未检查肛提肌裂孔的形状在 POP 中的作用。本研究旨在探讨肛提肌裂孔形态与 POP 之间的关系。
这是一项回顾性研究，共纳入 2014 年 10 月至 2016 年 8 月期间因盆底和下尿路功能障碍症状在三级妇科泌尿学中心就诊的 547 名女性。所有女性均接受了标准化访谈，并使用国际尿控协会（ICS）盆腔器官脱垂量化（POP-Q）方法和四维经会阴超声（TLUS）进行了脱垂评估。在以后的日期，由一名对所有其他数据均不知情的研究者离线测量静止时和最大 Valsalva 动作时裂孔的前后径（APD）、冠状径（CD）和裂孔面积（HA）以及器官下降的测量值。裂孔形态定义为 APD/CD 比值。使用逻辑回归模型分析静止时和最大 Valsalva 时 HA 和经 APD/CD 调整的 HA 与脱垂的症状和体征之间的关联。
女性的平均年龄为 54±13.6（范围 16-89）岁。547 名女性中，241 名（44%）有脱垂症状。406 名（74%）患者检测到临床显著的 POP，331 名（61%）患者经 TLUS 检测到显著的脱垂。310 名（57%）女性出现裂孔气球样变，这与 POP 的症状和体征强烈相关。静止时和 Valsalva 时的 HA 与临床检查和 TLUS 上的显著 POP 均相关。调整后的 hiatal 形状比值表明，hiatal 形态对 HA 与 POP 之间的关联没有影响。
裂孔形状似乎不会影响 HA 与脱垂症状和体征之间的关联。版权所有©2018 ISUOG。由 John Wiley & Sons Ltd 出版。
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