探讨智能盆底超声联合断层超声成像(TUI)技术评估产后盆底功能障碍(PFD)患者的盆底肌结构和功能。

选取2021年4月至2023年10月沧州市人民医院收治的115例产后PFD初产妇为研究对象，并纳入PFD组。选取同期在本院进行产后常规检查结果无PFD的96例初产妇纳入对照组。所有受试者超声图像由2名超声科医师采用双盲法进行独立诊断，比较2组初产妇静息状态、Valsalva动作下智能盆底超声测量的膀胱逼尿肌厚度(DWT)、膀胱颈移动度(BND)、膀胱尿道后角(RA)、尿道旋转角(URA)值，以及静息状态、缩肛动作、Valsalva动作下的提肛肌裂孔面积(HA)、前后径、左右径及厚度。采用组内相关系数(ICC)评估2名超声科医师对智能盆底超声相关参数测量值的一致性，通过绘制受试者工作特征(ROC)曲线，计算智能盆底超声联合TUI技术对PFD的诊断效能。本研究遵循的程序符合沧州市人民医院医学伦理委员会要求，获得其批准(批号：K2020141)，并且与所有受试者签署临床研究知情同意书。

①2组产妇年龄、产后人体质量指数(BMI)、分娩方式构成比和会阴侧切率比较，差异均无统计学意义(P>0.05)。②静息状态、Valsalva动作下，PFD组产妇DWT、BND、RA、URA值均高于对照组，组间比较，差异均有统计学意义(P<0.05)；静息状态、缩肛动作、Valsalva动作下，PFD组产妇提肛肌HA、前后径、左右径及提肛肌厚度均大于对照组组间比较，差异均有统计学意义(P<0.05)。③2名超声科医师对智能盆底超声测量结果的一致性良好(ICC均>0.75)。智能盆底超声、TUI技术单独及二者联合诊断PFD的ROC曲线分析结果显示，ROC-曲线下面积(AUC)分别为0.727(95%CI：0.657~0.797)，0.777(95%CI：0.711~0.842)和0.884(95%CI：0.878~0.935)。

智能盆底超声联合TUI技术可动态评估PFD初产妇盆底肌结构与功能变化，测量结果具有较高重复性，可为临床诊断PFD提供可靠的影像学依据。

To investigates the application of AI-assisted pelvic floor ultrasound combined with tomographic ultrasound imaging (TUI) in assessing the structure and function of pelvic floor muscles in patients with postpartum pelvic floor dysfunction (PFD).

A total of 115 postpartum PFD patients admitted to Cangzhou People′s Hospital from April 2021 to October 2023 were selected as the research subjects and included in the PFD group. Additionally, 96 primiparous women without PFD during the same period were selected as the control group. All subjects′ ultrasound images were independently diagnosed by two examiners using a double-blind method. The detrusor wall thickness (DWT), bladder neck descent (BND), retrovesical angle (RA), and urethral rotation angle (URA) measured by intelligent pelvic floor ultrasound under resting state and Valsalva maneuver were compared between the two groups. In addition, the levator hiatus (HA) area, anteroposterior diameter, transverse diameter, and thickness under resting state, anal contraction, and Valsalva maneuver were also compared. The intraclass correlation coefficient (ICC) was used to assess the consistency of parameter measurements from intelligent pelvic floor ultrasound between the two physicians. The diagnostic performance of intelligent pelvic floor ultrasound combined with TUI technology for PFD was evaluated by drawing receiver operating characteristic (ROC) curves. The procedures followed in this study were in accordance with the requirements of the Medical Ethics Committee of Cangzhou People′s Hospital and were approved (Approval No.K2020141). Informed consents were obtained from all subjects.

① There were no statistically significant differences between the two groups in age, postpartum body mass index (BMI), distribution of delivery modes, or episiotomy rates (P>0.05). ② Under both resting conditions and during the Valsalva maneuver, the DWT, BND, RA, and URA were significantly higher in the PFD group compared to the control group (P<0.05). Additionally, the HA area, anteroposterior diameter, transverse diameter, and levator ani muscle thickness were all significantly greater in the PFD group under resting, anal contraction, and Valsalva conditions (P<0.05). ③ The inter-observer agreement for AI-assisted pelvic floor ultrasound measurements was high, with ICC all exceeding 0.75. ROC curve analysis demonstrated that the area under the curve (AUC) for diagnosing PFD was 0.727 (95%CI: 0.657-0.797) using AI-assisted pelvic floor ultrasound alone, 0.777 (95%CI: 0.711-0.842) using TUI alone, and 0.884 (95%CI: 0.878-0.935) when the two modalities were combined.

AI-assisted pelvic floor ultrasound combined with TUI enables dynamic evaluation of structural and functional changes in the pelvic floor muscles of patients with PFD. The measurements demonstrate high reproducibility, providing a reliable imaging basis for the clinical diagnosis of PFD.