应用阴道前庭超声方法评估分娩方式对女性盆底的近期影响

Evaluating short-term impact of delivery methods on pelvic floor of women using introital ultrasound

目的应用阴道前庭超声方法评价阴道分娩和选择性剖宫产对女性盆底的近期影响。方法2008年3月～2008年6月在我院产科分娩后6～8周的产妇75例,其中经阴道分娩产妇55例,选择性剖宫产产妇20例,选择非妊娠年轻女性24例作为对照组,应用阴道前庭超声在安静状态及压力状态下(Valsalva动作时)分别测量各组患者的膀胱尿道后角角度(Ar、As);膀胱颈至耻骨联合下缘的距离(Dr、Ds);膀胱颈角度(θr、θs);膀胱颈旋转角度(θ);尿道膀胱连接部移动度(UVJ-M),并将各组结果进行统计学分析。结果阴道分娩组与对照组比较,Dr缩短,有统计学意义(P<0.05),θs、θ及UVJ-M明显增大,有统计学意义(P<0.01)。选择性剖宫产组与对照组比较,θs及θ增大,有统计学意义(P<0.05)。阴道分娩组与选择性剖宫产比较,θs及UVJ-M明显增大,有统计学意义(P<0.01)。阴道分娩组中无产后尿失禁症状者与有产后尿失禁症状者比较,无统计学意义(P>0.05)。结论阴道分娩近期对盆底功能的影响大于选择性剖宫产。

Objective To evaluate the shortterm impact of vaginal delivery and selective caesarean section on pelvic floor of women using introital ultrasound. Methods From March to June 2008, 55 women after vaginal delivery, 20 after elective caesarean section were selected at their follow - up visit at 6 - 8 weeks after delivery in Pe- king University People＇s Hospital, and 24 normal non- pregnant women serves as control. Introital ultrasonography was used to measure the posterior urethrovesical angle （Ar, As）, the distance from bladder neck to lower tip of symphysis pubis （Dr, Ds）, angle of bladder neck （θr, θs）, rotational angle of bladder neck （θ） and mobility of urethrovesical junction （UVJ - M） under resting and stress （Valsalva movement） state. Results Compared to the control group, Dr was shorter in the vaginal delivery group （P〈0. 05）, as well as increase in θs, θ and UVJ - M （P〈 0. 01）. θs and θ increased in the elective caesarean section group than the control group （P〈0. 05）. θs and UVJ - M were larger in the vaginal delivery group than the elective caesarean section group （P〈0. 01）. No statistical difference was found between the patients without urinary incontinence （UI） after vaginal delivery and UI ones （P〉0. 05）. Conclusion Compared to elective caesarean section, vaginal delivery affect more on the pelvic floor function.