通过经阴道超声滑动征技术预测膀胱阴道粘连:验证研究。

IF 6.1 1区 医学 Q1 ACOUSTICS
N Min, J van Keizerswaard, R H Visser, N B Burger, J W T Rake, J W M Aarts, T van den Bosch, M Leonardi, J A F Huirne, R A de Leeuw
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引用次数: 0

摘要

目的:子宫、膀胱和前腹壁之间的粘连与临床后遗症有关,包括慢性盆腔疼痛和排便困难,还可能在手术过程中产生并发症。经阴道超声(TVS)滑动膀胱征是一种微创诊断工具,用于评估是否存在膀胱阴道粘连。本研究旨在确定 TVS 滑动膀胱征在评估膀胱阴道粘连时的预测价值以及观察者内部和观察者之间的差异:这是一项前瞻性观察性双盲诊断准确性研究,在阿姆斯特丹大学医学中心进行。研究连续纳入了 2020 年 1 月至 2022 年 12 月期间因良性疾病而计划接受妇科腹腔镜手术的患者。所有患者都在门诊接受了术前TVS检查,包括动态滑动膀胱征检查。TVS 扫描的视频片段被保存起来以进行离线评估,并用作指标测试。TVS和腹腔镜检查记录由独立评估人员进行评估,以确定膀胱输尿管粘连的诊断特征,评估人员在评估TVS记录时,除了腹腔镜检查结果外,还对临床情况进行盲测,反之亦然。腹腔镜检查是否存在粘连被作为参考标准。计算了滑动膀胱征的阳性预测值(PPV)、阴性预测值(NPV)、特异性和敏感性。此外,还评估了 TVS 上滑动膀胱征的观察者之间和观察者内部的差异性:结果:在纳入的 116 名妇女中,有 57 名妇女的膀胱滑动征在 TVS 上呈阴性,而在腹腔镜检查中,51 名妇女有轻度膀胱粘连,28 名妇女有重度膀胱粘连。阴性滑动膀胱标志对任何膀胱阴道粘连的PPV为94.7%(95% CI,88.9-100%),阳性滑动膀胱标志的特异性为91.9%(95% CI,83.1-100%)。对于严重粘连,阴性滑动膀胱征的敏感性为 89.3%(95% CI,77.8-100%),阳性滑动膀胱征的 NPV 为 94.9%(95% CI,89.3-100%)。使用科恩卡帕系数(Cohen's kappa coefficient)计算,评估者之间和评估者内部的一致性良好:结论:使用 TVS 评估滑动膀胱征是预测腹腔镜膀胱粘连的可靠诊断工具。滑动膀胱征阴性表明存在膀胱阴道粘连,而滑动膀胱征阳性则不可能存在严重粘连。通过 TVS 确定膀胱输尿管粘连可优化术前计划,并可用于未来的研究,以评估症状学与膀胱输尿管粘连之间的关系,进而评估预防粘连干预措施的效果。© 2024 作者。妇产科超声》由 John Wiley & Sons Ltd 代表国际妇产科超声学会出版。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prediction of vesicouterine adhesions by transvaginal sonographic sliding sign technique: validation study.

Objective: Adhesions between the uterus, bladder and anterior abdominal wall are associated with clinical sequelae, including chronic pelvic pain and dyspareunia, and can also yield complications during surgery. The transvaginal sonographic (TVS) sliding bladder sign is a minimally invasive diagnostic tool to evaluate the presence of vesicouterine adhesions. This study aimed to determine the predictive value and intra- and interobserver variation of the TVS sliding bladder sign in the assessment of vesicouterine adhesions.

Methods: This was a prospective observational double-blind diagnostic accuracy study conducted at the Amsterdam University Medical Center. Patients scheduled for gynecological laparoscopic surgery for a benign disorder between January 2020 and December 2022 were included consecutively. All patients underwent preoperative TVS, including a dynamic sliding bladder sign examination in our outpatient clinic. Videoclips of the TVS scans were stored for offline assessment and used as an index test. The recordings of both TVS and laparoscopy were evaluated for diagnostic characteristics of vesicouterine adhesions by independent assessors, who were blinded to the clinical situation in addition to the laparoscopic findings when assessing recordings of TVS and vice versa. The presence of adhesions on laparoscopy was used as the reference standard. The positive predictive value (PPV), negative predictive value (NPV), specificity and sensitivity of the sliding bladder sign were calculated. In addition, inter- and intraobserver variability of the sliding bladder sign on TVS were assessed.

Results: Of 116 included women, 57 had a negative sliding bladder sign on TVS, while on laparoscopy, 51 women had mild and 28 had severe vesicouterine adhesions. A negative sliding bladder sign had a PPV of 94.7% (95% CI, 88.9-100%) for the presence of any vesicouterine adhesions, and a positive sliding bladder sign had a specificity of 91.9% (95% CI, 83.1-100%). For severe adhesions, the negative sliding bladder sign had a sensitivity of 89.3% (95% CI, 77.8-100%) and a positive sliding bladder sign had a NPV of 94.9% (95% CI, 89.3-100%). When using Cohen's kappa coefficient, inter- and intraobserver agreement between assessors was good.

Conclusions: Sliding bladder sign evaluation using TVS is a reliable diagnostic tool for the prediction of vesicouterine adhesions on laparoscopy. A negative sliding bladder sign indicates the presence of vesicouterine adhesions, while a positive sliding bladder sign makes the presence of severe adhesions unlikely. Establishing vesicouterine adhesions by TVS may optimize preoperative planning, and can be used for future studies to evaluate the relationship between symptomatology and vesicouterine adhesions and, subsequently, the effect of adhesion-prevention interventions. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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来源期刊
CiteScore
12.30
自引率
14.10%
发文量
891
审稿时长
1 months
期刊介绍: Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.
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