经会阴三维超声评估分娩对初产女性盆膈裂孔及尿道移动度的影响

发布时间：2018-09-05 08:26

【摘要】：目的：应用会阴三维超声观察初产妇产后早期盆膈裂孔的大小形态及尿道移动度的运动变化，探讨不同分娩方式对盆底功能的影响。方法：选择在我院产科定期产检并分娩的初产妇132例（其中自然分娩组70例，剖宫产组62例）于产后6周左右行盆底三维超声检查，同期选择正常未育女性65例作为对照组。应用三维阴道探头经会阴分别获取静息期、缩肛动作及Valsalva动作时盆膈裂孔容积数据成像并存储。离线分析测量不同状态下盆膈裂孔前后径（AP）、左右径（LR）、面积（HA）、肛提肌尿道间距（LUG）及尿道移动度。结果：1、不同观察者对盆膈裂孔各参数及尿道移动度的测量结果重复性高、一致性好，ICC为0.72～0.88。2、自然分娩组HA、LR、AP及LUG在缩肛动作及Valsalva动作时均较对照组增大(P均0.05)，而在静息期两组各参数无明显差异（P0.05）。3、剖宫产组HA、LR、AP及LUG在三种不同状态下与对照组无明显差异（P均0.05）。4、自然分娩组HA、LR、AP及LUG在缩肛动作及Valsalva动作时均较剖宫产组增大，差异有统计学意义(P均0.05)，而在静息期两组各参数无明显差异（P0.05）。5、自然分娩组与剖宫产组比较，前者出现肛提肌裂伤、阴道异常及盆腔器官脱垂的比例明显提高，差异有统计学意义(P0.05)。6、Valsalva动作时所有受检者远端尿道移动度均小于近端尿道，差异有统计学意义（P0.05），，且产后组尿道整体移动度较正对照组增大，差异有统计学意义（P0.05）。7、自然分娩组U1-5移动度较剖宫产组增大，差异有统计学意义（P0.05），而两组尿道U6移动度无明显差异（P0.05）。结论：经会阴三维超声是一种有效的评估女性盆膈裂孔及尿道移动度的影像学方法。分娩对女性盆膈裂孔及尿道移动度均产生一定的影响，自然分娩者发生肛提肌裂伤及盆腔器官脱垂的危险性较剖宫产者增大，且前者尿道移动度亦明显增加，故产后早期的初产妇应及时进行盆底相关的康复训练，减少盆底功能障碍的发生。
[Abstract]:Objective: to investigate the effect of different delivery modes on pelvic floor function by using perineum three-dimensional ultrasound to observe the size and shape of pelvic diaphragm fissure and the movement of urethra in the early postpartum period. Methods: 132 primipara (70 cases in natural delivery group and 62 cases in cesarean section group) were examined with pelvic floor three dimensional ultrasound about 6 weeks after delivery. 65 normal unbred women were selected as control group at the same time. Three dimensional vaginal probe was used to obtain the volume data of pelvic diaphragm fissure during resting period, anal contraction and Valsalva motion respectively. Off-line analysis was performed to measure the anteroposterior diameter of the pelvic and phrenic fissure (AP),) and the area of (LR), (left and right diameter). The distance between the levator ani muscle and the urethral space (LUG) and the urethral mobility were measured. Results the measurements of the parameters and urethral mobility of pelvic and phrenic fissure by different observers were highly reproducible. HA,LR,AP and LUG in spontaneous delivery group were higher than those in control group in anal contraction and Valsalva movement (P 0.05), but there was no significant difference between two groups in resting period (P0.05). HA,LR,AP and LUG in caesarean section group were different from those in control group in three different states (P0.05). There was no significant difference between the two groups (P0. 05). 4. The HA,LR,AP and LUG in the spontaneous delivery group were significantly higher than those in the caesarean section group during anal contraction and Valsalva movement. The difference was statistically significant (P 0.05), but there was no significant difference between the two groups in the resting period (P0.05). Compared with the cesarean section group, the rate of levator ani laceration, vaginal abnormality and pelvic organ prolapse in the natural delivery group was significantly higher than that in the caesarean section group. The distal urethral mobility of all subjects was lower than that of proximal urethra during Valsalva movement (P0.05), the difference was statistically significant (P0.05), and the overall urethral mobility of postpartum group was higher than that of control group. The difference was statistically significant (P0.05). The U1-5 mobility of the spontaneous delivery group was higher than that of the cesarean section group (P0.05), while the urethral U6 mobility of the two groups had no significant difference (P0.05). Conclusion: transperineal three-dimensional ultrasonography is an effective imaging method for evaluating the pelvic and phrenic hiatus and urethral mobility in women. The risk of laceration of levator ani muscle and prolapse of pelvic organs in spontaneous delivery was higher than that in cesarean section, and the urethral mobility of the former was also significantly increased. Therefore, early postpartum primipara should carry on pelvic floor related rehabilitation training in time to reduce the occurrence of pelvic floor dysfunction.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R714.69

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