三维超声用于产后盆膈裂孔形态观察与功能评估的价值研究

发布时间：2018-06-05 17:23

本文选题：经会阴三维超声 + 盆底功能障碍性疾病　；参考：《中南大学》2014年硕士论文

【摘要】：目的探讨经会阴三维超声对产后早期无盆底功能障碍女性盆膈裂孔形态及功能评价的价值。方法选择2013年5月～2014年2月于产后6-8周在本院进行产后复查的初产妇共65例为实验组,其中选择性剖宫产(剖宫产组)31例,阴道自然分娩(顺产组)34例,对照组30例,同期于本院产科就诊,年龄、身高、体重指数均相匹配的无生育流产史妇女。阴道指诊检测肛提肌收缩时肌力,按照Oxford肌力分级法对肛提肌的肌力进行评分；采用美国GE公司的Voluson E8型彩色多普勒三维超声诊断仪分别于静息状态或缩肛状态对受检者进行三维盆底超声检查,获得两种状态下盆膈裂孔三维声像图并测量盆膈裂孔大小包括前后径(AP)、左右径(LR)、面积(HA)；根据公式计算缩肛期盆膈裂孔大小变化量,即盆膈裂孔面积该变量(As)、前后径该变量(Ps)、左右径该变量(Rs)；对比观察产后早期女性(包括顺产组与剖宫产组)与正常未育女盆膈裂孔三维声超声声像表现,比较盆膈裂孔内、外部结构改变发生率在顺产组与剖宫产组之间差异,比较盆膈裂孔大小(HA、AP、LR)、缩肛期盆隔裂孔大小变化量(As、Ps、Rs)以及肛提肌肌力分级在对照组、顺产组、剖宫产组之间差异,分析缩肛期盆隔裂孔大小改变量与Oxford肌力分级评分之间相关性。结果①经会阴三维超声检查可清晰显示产后女性盆底解剖结构,产后早期盆膈裂孔异常包括：盆膈裂孔形态异常、肛提肌形态、走行异常以及盆底器官横断面形态异常等；②顺产组盆底内、外部结构异常发生率均高于剖宫产组,差异有统计学意义,P0.05；③静息状态或缩肛状态下,顺产组、剖宫产组盆膈裂孔均大于对照组,差异有统计学意义,P0.05,缩肛状态下,顺产组盆膈裂孔大于剖宫产组,差异有统计学意义,P0.05,静息状态下,顺产组盆膈裂孔大于剖宫产组,但差异无统计学意义,P0.05；④顺产组、剖宫产组缩肛期盆膈裂孔大小变化量均小于对照组,差异有统计学意义P0.05,顺产组缩肛期盆膈裂孔大小变化量小于剖宫产组,差异有统计学意义P之0.05；⑤顺产组、剖宫产组肌力较对照组减弱,顺产组肌力较剖宫产组减弱,差异有统计学意义,P0.05；⑥缩肛期盆膈裂孔面积变化量(As)前后径变化量(Ps)左右径变化量(Rs)均与oxford肌力分级法呈正相关,相关系数0.40至0.53。结论①三维盆底超声具有多平面成像功能,能够客观、清晰显示产后早期盆膈裂孔及其内部结构的形态变化,可作为早期筛查产后盆底疾病的影像学检查技术。②肛提肌收缩能力的三维超声评估法能有效评估肛提肌不同收缩功能状态,可预测产后盆底疾病的发生趋势,具有一定的临床应用前景。
[Abstract]:Objective to evaluate the value of transperineal three-dimensional ultrasound in evaluating the shape and function of pelvic diaphragm hiatus in women without pelvic floor dysfunction in early postpartum period. Methods Sixty-five primipara who underwent postpartum reexamination in our hospital from May 2013 to February 2014 were selected as experimental group, including 31 cases of cesarean section (caesarean section group), 34 cases of spontaneous vaginal delivery (spontaneous delivery group) and 30 cases of control group (control group). At the same time in our hospital obstetrical visit, age, height, body mass index matching matched non-abortion women. The muscle strength of levator ani muscle was measured by vagina finger examination, and the muscle strength of levator ani muscle was graded according to Oxford method. Using Voluson E8 color Doppler three dimensional ultrasound diagnostic instrument of GE Company in USA, the patients were examined by three dimensional pelvic floor ultrasound in resting state or anal contraction state, respectively. Three dimensional sonograms of the pelvic diaphragm hole were obtained and the size of the pelvic diaphragm hole including the anterior and posterior diameters, the left and right diameters, the LRN, the area of the diaphragm hiatus were obtained, and the changes of the size of the pelvic phrenic holes during the anus contraction period were calculated according to the formula. That is, the area of the pelvic diaphragm hiatus is a variable, the anteroposterior diameter is Psl, and the diameter of the left and right is Rs.Three dimensional sonographic features of the pelvic diaphragm hole in the early postpartum women (including the normal delivery group and the cesarean section group) were compared with those in the normal female patients, and the results in the pelvic diaphragm fissure were compared. The incidence of external structural changes was different between the normal delivery group and the cesarean section group. The size of the pelvic diaphragm hiatus was compared between the two groups. The size of the pelvic septum and the size of the pelvic septum in the constrictive period were compared. The muscle strength of levator ani muscle was graded in the control group, the normal delivery group, and the cesarean section group, and the difference was also found between the control group, the normal labor group and the cesarean section group. To analyze the correlation between the change of the size of the pelvic septal hole and the Oxford muscle strength score in the anus contraction period. Results 1the postpartum female pelvic floor anatomical structure could be clearly displayed by transperineal three-dimensional ultrasound examination. The early postpartum abnormal pelvic and phrenic hiatus included: the shape of the pelvic and phrenic hiatus, the shape of the levator ani muscle, the abnormal walking and the abnormal cross-sectional shape of the pelvic floor organ. (2) the incidence of abnormal pelvic floor and external structure in the normal delivery group was higher than that in the cesarean section group. The difference was statistically significant under the resting or anal contraction status of the normal delivery group and the cesarean section group, and the pelvic diaphragm hole in the normal delivery group and the cesarean section group was higher than that in the control group. The difference was statistically significant (P 0.05). Under the condition of constriction of anus, the pelvic diaphragm hiatus in the normal delivery group was larger than that in the cesarean section group, and the difference was statistically significant (P 0.05). At rest, the pelvic diaphragm fissure in the normal delivery group was greater than that in the cesarean section group, but the difference was not statistically significant in the normal delivery group. The changes of the size of the pelvic and phrenic holes in the caesarean section group were smaller than those in the control group (P 0.05), and the changes in the size of the pelvic fissure hole in the constricting anal phase of the normal delivery group were smaller than those in the cesarean section group (P < 0.05), and the difference was significant in the normal delivery group (P < 0.05). The muscle strength of cesarean section group was weaker than that of control group, and that of normal delivery group was lower than that of cesarean section group. The difference was statistically significant (P 0.05). The correlation coefficient is 0.40 to 0.53. Conclusion 1Three-dimensional pelvic floor ultrasound has the function of multiplanar imaging and can clearly display the morphological changes of the pelvic diaphragm fissure and its internal structure in the early postpartum period. As an early imaging technique for screening postpartum pelvic floor diseases, the three-dimensional ultrasonic evaluation method of levator ani muscle contraction ability can effectively evaluate the different contraction function of levator ani muscle, and can predict the occurrence trend of postpartum pelvic floor disease. It has certain clinical application prospect.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1

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