不同分娩方式初产妇产后早期盆底结构及功能的超声评估
发布时间：2018-02-10 09:37
本文关键词： 经会阴二维盆底超声 肛提肌 盆底功能障碍性疾病 初产妇 出处：《大连医科大学》2017年硕士论文 论文类型：学位论文
【摘要】：目的:通过经会阴盆底超声观察初产妇产后早期盆底器官解剖位置及肛提肌增厚率的变化,探讨不同分娩方式对初产妇盆底结构及功能的影响;分析盆底器官活动度与肛提肌增厚率的相关性,进一步探索盆底功能障碍性疾病的发病机制,为临床及早采取干预措施提供影像学参考。方法:选择100例于我院住院分娩、产后6-10周的初产妇纳入研究组,其中经阴道分娩者50例,选择性剖宫产者50例,同期选择30例年龄、身高及体重均相匹配的已婚未育女性作为对照组。应用二维经会阴盆底超声技术获取盆底正中矢状切面,使耻骨联合中轴线与经耻骨联合下缘的直线呈45°角,分别在静息及最大Valsalva动作状态下,测量尿道倾斜角(urethral tilt angel,UTA)、膀胱尿道后角(posterior urethravesical angel,PUA)、膀胱颈的位置(bladder neck position,BNP)及宫颈外口的位置(cervical mouth position,CMP),并计算尿道旋转角(urethral rotation angel,URA)、膀胱颈移动度(bladder neck descent,BND)、宫颈外口移动度(cervix down distance,CDD),同时观察尿道内口有无漏斗化。将探头深入阴道内2-3cm处,获取盆底正中矢状切面肛直肠角部图像,在静息及Valsalva动作下,观察有无直肠前壁膨出(RC)并测量直肠前壁膨出的深度。调整探头方向显示肛提肌长轴切面,分别于静息及最大收缩状态下测量左、右两侧肛提肌中部的厚度(TN),计算收缩状态下肛提肌中部的增厚率(TR)。结果:1.静息状态下,经阴道分娩组BNP低于选择性剖宫产组,差异具有统计学意义(p0.05),经阴道分娩组UTA、CMP与选择性剖宫产组比较,差异无统计学意义(p0.05);经阴道分娩组BNP、CMP明显低于未育组(p0.05),经阴道分娩组UTA大于未育组,差异无统计学意义(p0.05);选择性剖宫产组BNP低于未育组,差异具有统计学意义(p0.05),选择性剖宫产组UTA、CMP与未育组比较,差异无统计学意义(p0.05)。静息状态下各组间PUA数值比较,差异均无统计学意义(p0.05)。2.最大Valsalva状态下,经阴道分娩组UTA、BNP、CMP数值与选择性剖宫产组和未育组相比,差异均具有统计学意义(p0.05);选择性剖宫产组BNP、CMP低于未育组,其中CMP差异无统计学意义(p0.05)。最大Valsalva状态下各组间PUA数值比较,差异均无统计学意义(p0.05)。3.经阴道分娩组URA、BND较未育组明显增高(p0.05)。选择性剖宫产组URA、BND与经阴道分娩组、未育组比较,无统计学意义(p0.05)。三组间CDD无显著差异(p0.05)。4.经阴道分娩组、选择性剖宫产组、未育组尿道内口漏斗化发生率分别为12%、10%、6.7%,差异无统计学意义(p0.05)。5.经阴道分娩组、选择性剖宫产组及未育组中,均未发现患有直肠前壁膨出者。6.(1)同一组内左、右两侧TR无明显差异(p0.05)。未育组左、右两侧TR明显大于选择性剖宫产组和经阴道分娩组(p0.05),选择性剖宫产组两侧TR大于经阴道分娩组,但差异无显著性(p0.05)。(2)未育组、选择性剖宫产组中,URA、BND、CDD与TR均呈负相关(p0.05)。经阴道分娩组URA、BND、CDD与TR无明显相关性(p0.05)。结论:1.经会阴二维盆底超声技术可用于动态观察女性盆腔脏器的解剖结构、位置及功能状态,操作简便,重复性好,为初产妇产后早期康复,提供可靠的影像学依据。2.妊娠及分娩主要影响前、中盆腔的结构及功能,对前盆腔影响最大,而与后盆腔结构及功能障碍性疾病发生相关性不大。3.初产妇两侧肛提肌TR低于未育女性,影响肛提肌收缩力的主要因素为妊娠本身,而非分娩方式。4.在肛提肌未受明显损伤的情况下,肛提肌增厚率越大,盆底器官的活动度越小。5.与经阴道分娩相比,选择性剖宫产在产后早期对女性盆底的结构及功能具有一定的保护作用,但并不提倡广大女性为了减少盆底功能障碍性疾病的发生而进行剖宫产手术。
[Abstract]:Objective: through the observation of primipara transperineal pelvic floor ultrasound after early pelvic organ anatomical position and the levator ani muscle thickening rate changes, to explore the influence of different modes of delivery on maternal pelvic floor structure and function; analysis of pelvic organ activity and levator ani muscle thickening rate correlation, to further explore the pathogenesis of pelvic floor dysfunction. Early intervention for clinical, imaging. Methods: 100 patients in our hospital, 6-10 weeks postpartum primipara were included in the study group, including 50 cases of vaginal delivery, 50 cases of cesarean section were compared with 30 cases of age, height and weight were matched married not fertile women as the control group. The application of two-dimensional ultrasound technology to obtain the transperineal pelvic pelvic floor median sagittal section, the axis of the pubic symphysis and straight through the lower edge of pubic symphysis was 45 degrees, respectively at rest and maximum Val The Salva action under the condition of measuring angle (urethral tilt urethral angel, UTA), posterior urethra vesical angle (posterior urethravesical, angel, PUA), bladder neck position (bladder neck position, BNP) and cervix position (cervical mouth position, CMP), and calculate the rotation angle (urethral rotation urethral angel. URA), bladder neck mobility (bladder neck, descent, BND), cervix mobile (cervix down distance, of CDD), and observe the urethral mouth without funnel. The probe deep inside the vagina at 2-3cm, access to the pelvic floor median sagittal anorectal angle images at rest and Valsalva action next, observe whether the anterior wall of the rectum prolapse (RC) and measuring the depth of the rectal wall prolapse. Adjust the direction of the probe showed the levator ani muscle long axis view measurement of left at rest and maximal contraction state respectively, the right side of the levator ani muscle middle thickness (TN), calculation of contraction In the middle of the levator ani muscle thickening rate (TR). Results: 1. of the resting state, the vaginal delivery group BNP was lower than that of selective cesarean section group, the difference was statistically significant (P0.05), vaginal delivery group UTA, CMP and selective cesarean section group, the difference was not statistically significant (P0.05); vaginal delivery group BNP, CMP was significantly lower than the nulliparous group (P0.05), vaginal delivery group UTA greater than the nulliparous group, the difference was not statistically significant (P0.05); selective cesarean section group BNP lower than the nulliparous group, the difference was statistically significant (P0.05), selective cesarean section group UTA, CMP and nonparous groups. There was no statistically significant difference (P0.05). The resting state between the groups of PUA numerical comparison, there were no significant differences (P0.05).2. Valsalva, vaginal delivery group UTA, BNP, CMP compared with numerical and selective cesarean section group and nulliparous group, the differences were statistically significant (P0.05); selective cesarean section delivery group BNP, C MP浣庝簬鏈偛缁，
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