经会阴超声评价肛提肌损伤对产后康复疗效的影响

发布时间：2018-04-20 23:10

本文选题：三维超声 + 肛提肌损伤　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:经会阴三维超声测量康复治疗前、后肛提肌裂孔各超声参数,分析其与肛提肌肌力之间的相关关系,探讨并评估肛提肌损伤对产后康复疗效的影响。方法:(1)收集阴道分娩后盆腔器官脱垂伴肛提肌肌力0-2级患者86例。于产后6-8周在静息、瓦氏、缩肛状态下,对86例患者进行经会阴超声检查。产后18周再次对86例患者经会阴超声检查。肛提肌裂孔的面积、左右径、前后径由超声科两位医师双盲测量。(2)将患者分成两组:康复组(43例)和对照组(43例);用三维超声断层成像方法判断是否存在肛提肌损伤,将康复组和对照组各再分为肛提肌损伤组和肛提肌未损伤组。产后第8周起,康复组患者开始进行为期8周的盆底电刺激及阴道哑铃锻炼的康复治疗,对照组患者自行做凯格尔运动8周。均于产后18周复查盆腔器官脱垂情况和肛提肌肌力。结果:(1)经会阴三维超声断层成像评估,86例患者中有35例并发肛提肌损伤;康复治疗后,康复组中肛提肌损伤与未损伤组盆腔器官脱垂和肛提肌肌力的康复改善率均高于对照组(P0.05)。(2)康复组:康复治疗后,肛提肌损伤组在最大瓦氏、缩肛状态下肛提肌裂孔的面积、左右径、前后径及静息状态下的面积、前后径均较康复治疗前减小(P0.05);肛提肌未损伤组在静息、最大瓦氏、缩肛状态下肛提肌裂孔的面积、左右径、前后径均较康复治疗前减小(P0.05);肛提肌未损伤组在最大缩肛状态下肛提肌裂孔的面积、左右径、前后径均小于损伤组(P0.05)。(3)对照组:产后18周,肛提肌损伤组在最大缩肛状态下肛提肌裂孔的前后径和未损伤组的面积、前后径较产后6-8周减小(P0.05);肛提肌未损伤组在最大缩肛状态下肛提肌裂孔的面积、左右径、前后径均较损伤组减小(P0.05)。(4)康复组与对照组比较:康复治疗后,康复组中肛提肌损伤组在静息、最大瓦氏状态下肛提肌裂孔的面积、前后径及最大缩肛状态下的面积、左右径、前后径均较对照组减小(P0.05);康复组中肛提肌未损伤组在最大瓦氏、缩肛状态下肛提肌裂孔的面积、左右径、前后径及静息状态下的面积、前后径均较对照组减小(P0.05)。(5)最大缩肛状态下肛提肌裂孔的面积、左右径、前后径与肛提肌肌力之间呈中度至较高的负相关关系(R=-0.792,P0.01、R=-0.506,P0.01、R=-0.714,P0.01);静息和最大缩肛状态下肛提肌裂孔的面积差值、左右径差值与肛提肌肌力之间呈中度的正相关关系(R=0.426,P0.01、R=0.406,P0.01)。结论:(1)经会阴三维超声断层成像可有效应用于产后肛提肌损伤的诊断。(2)肛提肌损伤是影响产后康复疗效的重要因素,可根据经会阴三维超声断层成像下肛提肌是否损伤来预测盆底康复疗效。(3)经会阴三维超声可根据肛提肌裂孔各超声参数及差值的动态变化来评估康复疗效,定量评估肛提肌肌力,为临床评估盆底康复疗效提供可靠的影像学依据。
[Abstract]:Objective: to measure the ultrasonic parameters of posterior levator sphincter fissure before and after rehabilitation, analyze the relationship between the ultrasonic parameters and muscle strength of levator ani muscle, and evaluate the effect of levator ani muscle injury on postpartum rehabilitation. Methods 86 cases of pelvic organ prolapse with levator ani muscle strength 0-2 grade after vaginal delivery were collected. In 6-8 weeks postpartum, 86 patients were examined by transperineal ultrasound under the condition of rest, warts and contraction of anus. At 18 weeks postpartum, 86 patients were examined by perineum ultrasound. The area, left and right diameter and anteroposterior diameter of levator ani muscle fissure were measured by two doctors in ultrasonic department. The patients were divided into two groups: rehabilitation group (n = 43) and control group (n = 43). The rehabilitation group and the control group were subdivided into two groups: the group without injury of levator ani muscle and the group without injury of levator ani muscle. From the 8th week of postpartum, the patients in the rehabilitation group were treated with pelvic floor electrical stimulation and vaginal dumbbell exercise for 8 weeks, while the patients in the control group were given Kegel exercise for 8 weeks. Pelvic organ prolapse and levator ani muscle strength were reviewed at 18 weeks postpartum. Results among 86 patients, 35 cases were complicated with levator ani muscle injury by transperineal three-dimensional ultrasound tomography. The improvement rate of prolapse of pelvic organs and muscle strength of levator ani muscle in the rehabilitation group was higher than that in the control group (P0.05. 2): after rehabilitation treatment, the area of the hiatus of the levator ani muscle in the maximal valva, the area of the fissure of the levator ani muscle in the constricted anal state was higher than that in the control group. The left and right diameters, the anteroposterior diameters and the area under resting state, the anteroposterior diameters were smaller than those before rehabilitation treatment, and the area of the fissure of levator ani muscle in the rest, maximal Watts, contraction of anus, the left and right diameter of the levator ani muscle without injury group, were smaller than those before rehabilitation treatment. The anterior and posterior diameters were smaller than those before rehabilitation, and the area, left and right diameters and anteroposterior diameters of the hiatus of levator ani muscle in the uninjured group were smaller than those in the injured group under the maximum contraction of anus) the control group was 18 weeks postpartum. The anteroposterior diameter of levator ani muscle fissure and the area of uninjured group in the group of levator ani muscle injury were smaller than those in the group of 6-8 weeks postpartum, the area of the hiatus of levator ani muscle in the group without injury of levator ani muscle at the maximum constriction of anus, the area of the hiatus of levator ani muscle, the diameter of left and right levator muscle, The anterior and posterior diameters of the patients in the rehabilitation group were significantly lower than those in the injured group (P 0.05). Compared with the control group, after rehabilitation treatment, the area of the fissure of the levator ani muscle in the rehabilitation group was at rest, the area of the fissure of the levator ani muscle at the maximum Waters state, the area of the anterior and posterior diameter and the area under the maximum contraction of the anus, and the left and right diameters. The anterior and posterior diameters of levator ani muscle in the rehabilitation group were lower than those in the control group, and the area of the fissure of the levator ani muscle, the right and left diameters, the anteroposterior diameter and the area in the resting state of the uninjured levator ani muscle in the maximal valgus and contraction of the anus were all decreased. Compared with the control group, the anterior and posterior diameters decreased the area of the levator sphincter fissure, the right and left diameters, the anteroposterior diameter and the muscle strength of the levator ani muscle under the condition of maximum anal contraction. There was a moderate to high negative correlation between the anteroposterior diameter and the muscle strength of the levator ani muscle. There was a moderate positive correlation between the difference of left and right diameter and muscle strength of levator ani muscle. Conclusion 1) Three-dimensional ultrasound tomography via perineum can be effectively used in the diagnosis of postpartum levator ani muscle injury. The injury of levator ani muscle is an important factor affecting the postpartum rehabilitation effect. The effect of pelvic floor rehabilitation can be predicted according to the injury of levator ani muscle under transperineal three-dimensional ultrasound tomography. The dynamic changes of ultrasonic parameters and differences in the hiatus of levator ani muscle can be used to evaluate the curative effect. Quantitative evaluation of levator ani muscle strength provides a reliable imaging basis for clinical evaluation of pelvic floor rehabilitation.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R714.6

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