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经直肠双平面超声在女性中盆腔器官脱垂中的应用价值研究
许家珺, 冯静, 王亦丹, 程允, 杨阳, 谢静燕, 李玉娟
中国实用妇科与产科杂志 ›› 2026, Vol. 42 ›› Issue (2) : 225-229.
PDF(5396 KB)
PDF(5396 KB)
经直肠双平面超声在女性中盆腔器官脱垂中的应用价值研究
Study on the application value of transrectal biplanar ultrasound in female pelvic organ prolapse of middle compartment
目的 明确子宫脱垂和（或合并）子宫颈延长的超声影像生物测量值，探讨经直肠双平面超声（transrectal biplane ultrasound，TRUS）在女性中盆腔器官脱垂（pelvic organ prolapse，POP）中的应用价值。方法 选取2023年4月至2024年4月于南京医科大学附属南京医院妇科门诊接受经会阴凸阵超声（transperineal ultrasound，TPUS）及TRUS检查的女性盆底功能障碍性疾病（female pelvic floor dysfunction，FPFD）患者共81例。使用经会阴凸阵探头和经直肠双平面探头正中矢状位分别测量静息状态和Valsalva状态下的子宫颈C点位置，计算子宫颈下降移动距离，并比较2种超声测量值的差异。使用TRUS描迹测量Valsalva状态下子宫颈管长度（内、外口距离）及子宫颈前、后唇长度，与盆腔器官脱垂定量分度法（pelvic organ prolapse quantification，POP-Q）测量的C-D测量值相比较，并测量阴道后穹隆移动度，探讨其在诊断女性中盆腔器官脱垂中子宫脱垂和（或合并）子宫颈延长的临床价值。结果 共纳入81例受检者，以POP-Q测量的C-D测量值≥4 cm定义为子宫颈延长（cervical elongation，CE），分为CE组32例，非CE组49例。两组患者的年龄、体质指数（BMI）、孕产史、绝经状态等差异均无统计学意义（P>0.05）。比较2种超声探头下测量的子宫颈最低点移动度，结果显示TRUS测量值明显小于TPUS测量值（P<0.05）。采用受试者工作特征曲线分析两组数据显示，最佳预测CE的截断值为子宫颈管长度>3.82 cm，子宫颈前唇长度>4.12 cm。结论 经直肠双平面正中矢状位超声能清晰地显示子宫颈前、后唇及子宫颈内、外口的解剖标记及结构，可以测量子宫颈前、后唇长度和子宫颈内、外口距离。TRUS通过静息和Valsalva两种状态清晰地显示了中盆腔子宫和子宫颈脱垂即时状态，是一种创新、客观、可行的中盆腔器官脱垂评价方法，有助于鉴别子宫脱垂和（或合并）子宫颈延长，指导临床制定切除或保留子宫的个性化手术治疗方案。
Objective To clarify the biological measurement values of uterine prolapse （UP） and/or combination with cervical elongation （CE）in ultrasound imaging，and to explore the application value of transrectal biplanar ultrasound （TRUS） in female pelvic organ prolapse （POP） of middle compartment. Methods From April 2023 to April 2024，a total of 81 patients underwent transperineal ultrasound （TPUS） and TRUS in the gynecology outpatient department of Nanjing Hospital Affiliated to Nanjing Medical University， and they were included in the study. The transperineal convex array probe and the transrectal biplanar probe were utilized to measure the position of the lowest point of the cervix （point C） at rest and during the maximum Valsalva maneuver. The mobility was calculated and the differences in ultrasound measurements between TPUS and TRUS were compared. Additionally，the length of cervical canal （CC），anterior lip （AL） and posterior lip （PL） during Valsalva maneuver were measured by TRUS and compared with the C-D point distance measured by pelvic organ prolapse quantification （POP-Q）， and the mobility of the posterior vaginal dome was measured to explore the clinical value of UP and/or combination with CE in the diagnosis of female POP of middle compartment. Results This study enrolled a total of 81 subjects. The C-D measurement value≥4 cm by POP-Q was defined as cervical elongation （CE），and the participants were divided into 32 cases in CE group and 49 cases in non-CE group. No statistically significant differences were observed between the two groups in terms of age，BMI，pregnancy and childbirth history，or menopausal status （P>0.05）. The comparison between two probes showed that the movement of the lowest cervical point measured by TRUS was significantly smaller than that by TPUS （P<0.05）. The receiver operating characteristic curve was used to analyze the data of the two groups， which showed that the cut-off values for the best predicted CE were CC length>3.82 cm and AL length>4.12 cm. Conclusions TRUS can clearly display the anatomical marker and structure of the cervical AL，PL，external orifice （EO） and internal orifice （IO）， and can be used to measure the length of cervical AL and PL， as well as the distance of cervical IO and EO. TRUS reflects the immediate state of uterine and cervical prolapse of middle compartment both at rest and during Valsalva maneuver，which is an innovative，objective，and feasible evaluation method for female POP of middle compartment. The method helps to identify UP and/or combination with CE，and guides the clinical development of personalized surgical treatment plan.
经直肠双平面超声 / 子宫脱垂 / 子宫颈延长 / Manchester手术
transrectal biplanar ultrasound / uterine prolapse / cervical elongation / Manchester procedure
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| [2] |
The appearance of the prostatic fossa on transrectal ultrasound following radical retropubic prostatectomy (RRP) is described. Transrectal ultrasonography was performed on 25 patients with normal bone scans and pelvic computed tomography from three to ninety months after RRP using a biplane high frequency probe. The area of the vesicourethral anastomosis (VUA) was identified, its contour characterized, surrounding tissues described, and changes induced by pelvic muscle contraction recorded. In 16 of these patients who had abnormal postoperative serum prostate-specific antigen levels, digital and ultrasound-guided transrectal needle biopsies for local recurrence were done and compared. The VUA was identifiable in all patients as either a smoothly tapered narrowing usually correlating with the presence of continence or distorted or blunted profile which often correlated with absence of urinary continence. The VUA was surrounded almost invariably by hypoechoic soft tissue which was pathologically nonspecific on biopsy. An extrinsic impression on the anterior bladder wall was noted in 80 percent. There was no clear distinguishing ultrasound feature for biopsy-proved local recurrence. The apparent length of the apposed walls of the urethra suggests a urethral high pressure zone (UHPZ). This lengthened significantly with voluntary contraction of the pelvic floor muscles.
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| [3] |
Worldwide, about 40% of women will experience pelvic organ prolapse (POP), and this proportion is expected to increase with the aging of the population. We investigated the global, regional and national influenza burden in the past 30 years through the age and sociodemographic index (SDI).
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| [4] |
The association between hypertrophic cervical elongation and pelvic organ prolapse (POP) has been observed, but causation has not been determined. This study assessed the relationship of POP with hypertrophic cervical elongation according to menopausal status and the pelvic compartment involved in prolapse.
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| [5] |
| [6] |
The objective was to identify the best parameter (pubis-cervix measurement, pubis-uterine fundus measurement or pubis-pouch of Douglas measurement) on transperineal ultrasound, based on the difference between measurements taken at rest and with the Valsalva maneuver, for presurgical differential diagnosis between uterine prolapse (UP) and cervical elongation (CE) without UP.A prospective observational study of 60 consecutively recruited patients who underwent corrective surgery of the middle compartment (UP or CE without UP). A transperineal ultrasound was performed, and the descent of the pelvic organ was measured in relation to the posteroinferior margin of the pubis in the midsagittal plane, referencing the uterine fundus, pouch of Douglas and the cervix at rest and with the Valsalva test.Receiver operating characteristic (ROC) curves were constructed for the three evaluated measures, based on the difference between rest and Valsalva, for the diagnosis of UP. For the pubis-cervix distance, an area under the curve (AUC) of 0.59 was obtained; for the pubis-uterine fundus distance, the AUC was 0.81; and for the pubis-pouch of Douglas distance, the AUC was 0.69. Based on the best AUC (the difference in the pubis-uterine fundus distance at rest and with the Valsalva maneuver), a cut-off point of 15 mm was established for the diagnosis of UP (sensitivity: 75%; specificity: 95%; positive predictive value: 86%; and negative predictive value: 89%).A difference of ≥15 mm in the pubis-uterine fundus distance at rest and with the Valsalva maneuver is useful for differentiating UP from CE without UP by ultrasound.© 2021. The International Urogynecological Association.
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| [7] |
Our study aims to determine the interobserver variability of different ultrasound measurements (pubis-cervix distance, pubis-uterine fundus distance, and pubis-Douglascul-de-sac distance) previously analyzed for the ultrasound differential diagnosis of uterine prolapse (UP) and cervical elongation CE without UP.
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| [8] |
To investigate the superiority of transrectal high-frequency ultrasound (TRUS) in precise assessment of middle compartment prolapse in comparison with routine transperineal ultrasound (TPUS).Prospectively analyzed and compared detection rates of entire cervical length and uterine descent on TPUS and TRUS in 101 patients with pelvic organ prolapse (POP).Detection rates of entire cervix on TRUS were significantly higher than those on TPUS both at rest and during Valsalva maneuver (90.10% VS 49.50%, 92.08% VS 9.90% respectively, both p < 0.05). Uterine descent was able to be evaluated in 92.08% of patients by TRUS and in 5.94% of patients by TPUS, which was statistically significant (p < 0.05). The interobserver repeatability for the measurements of anterior lip, cervical canal and posterior lip on TRUS was excellent. The mean lengths of anterior lip, cervical canal and posterior lip were significantly increased during Valsalva maneuver than those measured at rest (p < 0.05). And mean length of anterior lip was longer than posterior lip both at rest and during Valsalva (p < 0.05).TRUS can significantly raise detection rates of entire cervix, and make the direct evaluation of uterine descent feasible. TRUS can be used as a complementary method to TPUS to attain more comprehensive and accurate presurgical imaging information in middle compartment prolapse patients.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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| [9] |
Five midsagittal pelvic reference lines have been employed to quantify prolapse using MRI. However, the lack of standardization makes study results difficult to compare. Using MRI scans from 149 women, we demonstrate how use of existing reference lines can systematically affect measurements in three distinct ways: in oblique line systems, distances measured to the reference line vary with antero-posterior location; soft issue-based reference lines can underestimate organ movement relative to the pelvic bones; and systems defined relative to the MR scanner are affected by intra- and interindividual differences in the pelvic inclination angle at rest and strain. Thus, we propose a standardized approach called the Pelvic Inclination Correction System (PICS). Based on bony structures and the body axis, the PICS system corrects for variation in pelvic inclination, at rest of straining, and allows for the standardized measurement of organ displacement in the direction of prolapse.
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| [10] |
王亦丹, 许家珺, 冯静, 等. 经直肠双平面超声在宫颈延长中的诊断价值[J]. 现代妇产科进展, 2024, 33(7):535-538.
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| [11] |
江卓飞, 黄晓斌, 柳晓春, 等. 盆底重建术中三种阴道前壁修复手术临床效果评价[J]. 中国实用妇科与产科杂志, 2026, 42(1):91-94.DOI:10.19538/j.fk2026010119.
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| [12] |
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利益冲突 所有作者均声明不存在利益冲突
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