应用超声评价产后盆底功能障碍的康复疗效

发布时间：2018-04-14 03:19

本文选题：超声 + 盆底功能障碍　；参考：《遵义医学院》2014年硕士论文

【摘要】：目的：应用会阴超声观察康复治疗对产后女性盆底结构的影响,试探全面评价盆底功能障碍康复疗效的影像学指标，为临床提供直观、可靠的影像学依据。方法：（1）收集2013年1月至2013年12月，在我院产后保健门诊诊断的67例产后（Female pelvic floor dysfunction,FPFD）患者。所有病例随机分2组：康复组(35例)和对照组(32例)，两组病例均采取自身对照分析。（2）康复组产后8周开始在我院盆底康复中心进行盆底康复治疗，疗程8周；对照组产后只进行一般的健康教育和产后保健操。康复组分别在产后6－8周和盆底康复治疗后经会阴超声检查；对照组分别在产后6－8周和产后20周经会阴超声检查。（3）应用会阴超声分别在静息、缩肛、瓦氏动作时动态观察产后康复治疗对FPFD盆底结构的影响，获得膀胱颈移动度（bladder neck descen,BND），存储三维容积数据，脱机应用4Dview软件后处理，测量盆膈裂孔面积、周长、前后径、左右径和耻骨直肠肌的宽度，并对上述参数进行统计分析。结果：（1）康复组：静息和瓦氏动作时康复治疗后的盆膈裂孔面积、周长、前后径较康复治疗前（产后6-8周）缩小,有统计学意义（p＜0.05），左右径、耻骨直肠肌宽度均未见明显改变（p＞0.05），BND较康复治疗前减小，有统计学差异（p＜0.05）；缩肛时康复治疗后的盆膈裂孔面积、周长、前后径和左右径均小于康复治疗前（p＜0.05），耻骨直肠肌宽度稍大于康复治疗前（p＜0.05），有统计学意义。（2）对照组：产后20周，静息和瓦氏动作时盆膈裂孔面积、周长、前后径、耻骨直肠肌宽度及BND与产后6-8周比较均无明显变化（p＞0.05），静息时盆膈裂孔左右径无统计学意义（p＞0.05），瓦氏动作时盆膈裂孔左右径比产后6-8周时增大（p＜0.05）；缩肛时产后20周的盆膈裂孔面积、周长、前后径和左右径均小于产后6-8周（p＜0.05），耻骨直肠肌宽度与产后6-8周比较未见明显差异（p＞0.05）。（3）康复组与对照组各参数对比：静息和瓦氏动作时，康复组盆膈裂孔面积、周长、前后径、左右径及BND均比对照组变小，有统计学意义（p＜0.05），静息时耻骨直肠肌无明显变化；瓦氏动作时，康复组耻骨直肠肌宽度比对照组稍宽(p＜0.05）；缩肛时盆膈裂孔面积、周长、前后径和左右径和耻骨直肠肌，两组病例比较未见明显差异。（4）康复组与对照组各参数差值比较：静息时的盆膈裂孔面积、周长、前后径和左右径和耻骨直肠肌的差值，两组病例比较均无明显变化（p＞0.05），，瓦氏动作时两组病例盆膈裂孔面积、周长、前后径和左右径的差值均有差异（p＜0.05），耻骨直肠肌的差值无明显变化（p＞0.05），康复组与对照组BND差值比较有差异（p＜0.05）；缩肛时两组病例盆膈裂孔面积、前后径和左右径的差值有差异（p＜0.05），周长和耻骨直肠肌的差值无明显变化（p＞0.05）。结论：（1）本课题研究证实了妊娠和分娩对女性盆底结构造成不同程度的损伤，是引发产后早期FPFD的重要危险因素；会阴超声可以推广应用于产后FPFD的诊断筛查、定量评估和康复疗效的评价，是一项具有重要临床价值的影像学技术。（2）经会阴超声动态观察盆底康复治疗前后盆底结构的各参数变化，统计分析认为盆膈裂孔、耻骨直肠肌和BND能全面和动态反映盆底结构、功能的变化,可作为评价盆底康复疗效的重要影像学指标，来进行盆底形态学和功能学的评价，为临床提供真实、可靠的影像学依据。
[Abstract]:Objective:
Objective To observe the effect of rehabilitation therapy on postpartum female pelvic floor structure by perineal ultrasound, and to explore the imaging indexes of pelvic floor dysfunction in order to provide intuitive and reliable imaging evidence for clinical practice.
Method:
(1) 67 cases of Female pelvic floor dysfunction (FPFD) diagnosed in our hospital from January 2013 to December 2013 were collected. All cases were randomly divided into 2 groups: rehabilitation group (35 cases) and control group (32 cases), two cases were self controlled analysis.
(2) the rehabilitation group started 8 weeks postpartum pelvic floor rehabilitation in the rehabilitation center of our hospital, 8 weeks; the control group only routine postpartum health education and postpartum health care. The rehabilitation group were at 6-8 weeks postpartum pelvic floor rehabilitation after treatment and transperineal ultrasonography; the control group respectively at 6-8 weeks postpartum and 20 weeks postpartum perineal ultrasonography.
(3) the application of perineal ultrasound in resting anal contraction, respectively, Valsalva maneuver dynamic observation of postpartum rehabilitation therapy on FPFD pelvic floor structure, obtain the bladder neck mobility (bladder neck, descen, BND), three-dimensional data storage, offline application of 4Dview postprocessing software, measuring the hiatus area, perimeter, diameter, diameter and puborectalis width, and the above parameters were analyzed.
Result:
(1) the rehabilitation group: resting and Valsalva maneuver rehabilitation after treatment of pelvic diaphragm hiatus area, perimeter, diameter compared with before treatment (6-8 weeks postpartum) reduced, with statistical significance (P < 0.05), diameter, width of puborectalis muscle showed no significant changes (P > 0.05), BND before treatment decreased, there was significant difference (P < 0.05); anal contraction rehabilitation after treatment of pelvic diaphragm hiatus area, perimeter, posterior diameter and left-right diameter were less than before treatment (P < 0.05), puborectalis muscle width slightly larger than before treatment (P < 0.05), there was statistical significance.
(2) control group: 20 weeks postpartum, resting and Valsalva maneuver when the hiatus area, perimeter, diameter, puborectalis width and BND and 6-8 weeks postpartum had no significant change (P > 0.05), resting hiatus diameter was not statistically significant (P > 0.05). Valsalva maneuver when hiatus diameter than 6-8 weeks postpartum increased (P < 0.05); anal contraction during and after 20 weeks of pelvic diaphragm hiatus area, perimeter, posterior diameter and left-right diameter were less than 6-8 weeks postpartum (P < 0.05), puborectalis muscle width and 6-8 weeks postpartum compared no significant difference (P > 0.05).
(3) rehabilitation group and control group comparing the parameters of resting and Valsalva maneuver, rehabilitation group hiatus area, perimeter, diameter, diameter and BND were smaller than the control group, was statistically significant (P < 0.05), resting puborectal muscle had no obvious change; Valsalva maneuver. The rehabilitation group than the control group of puborectal muscle width slightly wider (P < 0.05); when the levator hiatus area, perimeter, diameter and diameter and puborectalis muscle, two cases were no obvious difference.
(4) rehabilitation group and control group each parameter difference: the pelvic diaphragm hiatus resting area, perimeter, diameter and diameter and the difference about the puborectalis muscle, two cases had no significant change (P > 0.05), when the Valsalva maneuver group two cases of pelvic diaphragm hiatus area, perimeter. Posterior diameter and left-right diameter difference difference (P < 0.05), the difference of the puborectalis muscle did not change significantly (P > 0.05), the rehabilitation group and the control group BND difference difference (P < 0.05); two cases of levator hiatus area, posterior diameter and left-right diameter difference there are differences (P < 0.05), the difference between the perimeter and the puborectalis muscle did not change significantly (P > 0.05).
Conclusion:
(1) this study confirmed that pregnancy and childbirth cause of female pelvic floor structure damage is an important risk factor of FPFD caused early postpartum perineal ultrasound diagnosis; can be applied to the screening for postpartum FPFD evaluation, quantitative evaluation and rehabilitation treatment, is a technology has important clinical value in imaging.
(2) the dynamic observation of pelvic floor rehabilitation of perineal ultrasound parameters in pelvic floor structure before and after the treatment, the statistic analysis of pelvic diaphragm hiatus, rectal muscle and BND can fully reflect the dynamic and pubic pelvic floor structures, function changes, can be used as an important imaging evaluation of pelvic floor rehabilitation treatment index to evaluate the morphology and function of pelvic floor the basis for clinical provide true, reliable imaging.

【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R714.6

【参考文献】