超声评价不同分娩方式对盆底结构和功能的影响及康复治疗的效果

发布时间：2018-01-22 12:10

本文关键词： 女性盆底功能障碍经会阴盆底超声分娩方式盆底康复治疗压力性尿失禁　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:女性盆底功能障碍性疾病(Female Pelvic Floor Dysfunction,FPFD)是盆底支持结构缺陷、损伤与功能障碍造成的不良结果,包括尿失禁、便失禁、盆腔脏器脱垂以及与此相关的性生活障碍,严重影响患者的社交活动、体育锻炼和性生活,被称为“社交癌”。本研究意在通过会阴超声检查探讨不同的分娩方式对盆底结构的改变和对盆底功能的影响,并评价盆底康复治疗对产后压力性尿失禁的治疗效果,从而为产后评估盆底功能提供可靠的影像学依据,并为产后压力性尿失禁的治疗提供理论依据。方法:从2015年4月-2015年9月就诊于河北医科大学第一附属医院妇科、产科及生殖门诊的健康育龄女性中,选择符合条件的未育女性和初产妇360例作为研究对象。其中,未育女性(105例)作为对照组,根据分娩方式不同将初产妇分为2组:经阴道顺产分娩组(129例)和选择性剖宫产组(126例)。对以上初产妇在产后6周进行经会阴盆底超声检查,测量其在静息和最大valsalva动作下膀胱逼尿肌厚度、尿道膀胱后角、膀胱颈移动度、肛提肌裂孔的面积及其周长等指标,并用同样的方法测量对照组研究对象的上述指标。使用方差分析比较对照组、经阴道顺产分娩组和选择性剖腹产组的以上测量指标有无显著性差异,并用SNK法进行两两比较,从而判断不同的分娩方式对女性盆底结构的改变和对盆底功能的影响。同期,从产后6周在河北医科大学第一附属医院盆底康复门诊被诊断为压力性尿失禁的患者中收集自愿接受盆底康复治疗的患者75例,其中经阴道自然分娩产后患者43例,选择性剖宫产产后患者32例。治疗前后对所有研究对象均行经会阴盆底超声检查,测量指标及方法同前,使用配对样本t检验比较治疗前后产后压力性尿失禁患者的各项指标有无显著性差异,以分析盆底康复治疗的效果。结果:1方差分析结果显示,经阴道自然分娩组、选择性剖宫产组与对照组三组间膀胱逼尿肌厚度、尿道膀胱后角、膀胱颈移动度、肛提肌裂孔面积及肛提肌裂孔周长的差异均有统计学意义(F值分别为271.88、546.26、455.81、265.17、237.02,P值均小于0.01)。进一步作两两比较,结果显示阴道自然分娩组、选择性剖宫产组的上述指标均高于对照组,而且阴道自然分娩组的上述指标均高于选择性剖宫产组。2经阴道自然分娩产后的压力性尿失禁患者进行盆底康复治疗,总有效率为93.02%。治疗后,患者的膀胱逼尿肌厚度、尿道膀胱后角、膀胱颈移动度、肛提肌裂孔面积及周长均比治疗前减小,差异均有统计学意义(t值分别为9.87、12.24、8.98、8.43、7.23,P值均小于0.05)。选择性剖宫产产后的压力性尿失禁患者进行盆底康复治疗,总有效率为90.63%。治疗后,患者的上述盆底结构和功能相关指标也均比治疗前减小,差异均有统计学意义(t值分别为7.91、10.29、6.97、8.16、9.79,P值均小于0.05)。结论:1经会阴盆底超声对盆底功能障碍性疾病的诊断提供了依据,分娩会对女性盆底结构和功能产生不同程度的损伤,且经阴道自然分娩比选择性剖宫产对盆底结构和功能造成的损伤更为显著。2进行盆底康复治疗能有效的治疗产后压力性尿失禁,经会阴盆底超声能完成产后压力性尿失禁患者的治疗效果评价。
[Abstract]:Objective: pelvic floor dysfunction (Female Pelvic Floor Dysfunction, FPFD) is the support structure of pelvic floor defects, resulting in bad injury and dysfunction, including urinary incontinence, urinary incontinence, pelvic organ prolapse and related sexual problems, seriously affecting the patient's social activities, physical exercise and sex life, called "social cancer. This study aims to explore the different delivery methods of perineal sonography effect on pelvic floor structure change and on the pelvic floor function, and evaluation of pelvic floor rehabilitation treatment of incontinence curative effect on postpartum stress urinary, and pelvic floor function to provide imaging evidence for the evaluation of postpartum, and provide theoretical basis for treatment postpartum stress urinary incontinence. Methods: from April 2015 -2015 September in the First Affiliated Hospital of Hebei Medical University Department of Gynecology, obstetrics and reproductive health of women of childbearing age outpatients In accordance with the conditions of nulliparous women and 360 pregnant women were included in the study. Among them, nulliparous women (105 cases) as the control group, according to the different modes of delivery will be divided into 2 groups: early maternal vaginal birth childbirth group (129 cases) and selective cesarean section group (126 cases). For more than 6 weeks postpartum in primipara were transperineal pelvic ultrasonography, measuring the bladder in resting and Valsalva under the action of bladder detrusor thickness, posterior horn, bladder neck mobility, levator hiatus area and perimeter index, and the index of measuring the same method controls the object of study. Using the analysis of variance compared with the control group, the above indicators measuring spontaneous vaginal delivery and selective caesarean delivery group group had no significant difference, and 22 compared with SNK method, to determine the different modes of delivery on the pelvic floor and the change of pelvic floor function The effect of the same period, from 6 weeks postpartum pelvic floor rehabilitation clinic in the First Affiliated Hospital of Hebei Medical University were diagnosed with stress urinary incontinence were collected 75 cases of voluntary pelvic floor rehabilitation of patients, including 43 cases with vaginal delivery postpartum with selective cesarean section postpartum in 32 patients before and after treatment in all the subjects. Underwent transperineal pelvic ultrasonography, with indexes and measuring methods, using paired samples t test to compare the indicators before and after treatment in patients with postpartum stress urinary incontinence had no significant difference, with the analysis of pelvic floor rehabilitation therapy. Results: 1 of the variance analysis results showed that vaginal delivery group and selective cesarean section group the thickness of the bladder detrusor and the control group between the three groups, urinary bladder angle, bladder neck mobility, levator hiatus area and levator hiatus. The differences were statistically significant (F-measure respectively. For 271.88546.26455.81265.17237.02, P values were less than 0.01). Further comparison results show 22, vaginal delivery group, the above indexes of elective cesarean section group were higher than control group, and the index of vaginal delivery group were higher than that of selective cesarean section group.2 by stress urinary incontinence in patients with vaginal delivery postpartum pelvic floor rehabilitation treatment, the total effective rate was 93.02%. after treatment, patients with detrusor thickness, urinary bladder angle, bladder neck mobility, levator hiatus area and Changjun week than before treatment decreased, the differences were statistically significant (t = 9.87,12.24,8.98,8.43,7.23, P < 0.05). Selective cesarean section the stress urinary incontinence in patients with pelvic floor rehabilitation treatment, the total effective rate was 90.63%. after treatment, the pelvic floor structure and function related indexes were also decreased than before treatment, the difference Differences were statistically significant (t = 7.91,10.29,6.97,8.16,9.79, P < 0.05). Conclusion: 1 transperineal ultrasound in diagnosis of pelvic floor dysfunction disease to provide the basis, delivery will produce different degrees of damage to the structure and function of female pelvic floor, and vaginal delivery than elective cesarean section on the pelvic floor structure and the function of the damage caused by the more significant.2 pelvic floor rehabilitation can be effective in the treatment of postpartum stress urinary incontinence, the evaluation of treatment effect of postpartum stress urinary incontinence in patients with pelvic perineal ultrasound.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.6;R445.1

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