经会阴四维盆底超声立体成像检测初产妇盆底肌及盆膈裂孔异常

Abnormality of pelvic floor muscle and pelvic diaphragm hole was detected by four-dimensional perineal pelvic floor ultrasound

目的探讨经会阴四维盆底超声立体成像检测初产妇盆底肌及盆膈裂孔异常的应用价值。方法选取2018年6月—2019年6月平煤神马医疗集团总医院收治的患有盆底功能障碍疾病(PFD)的初产妇112例,根据产妇分娩方式分为经阴道组和剖宫产组,各56例。两组均接受经会阴四维超声检查,比较两组盆腔肌力分布和盆膈裂孔及肛提肌情况。结果经阴道组盆底肌力、阴道压力异常率分别为66.07%、71.43%,盆底肌疲劳率为60.71%,其中Ⅰ类、Ⅱ类肌纤维肌力异常率分别为48.21%、12.50%;剖宫产组盆底肌力、阴道压力异常率分别为55.36%、69.64%;盆底肌疲劳率为55.36%,其中Ⅰ类、Ⅱ类肌纤维肌力异常率为46.43%、8.93%。两组上述异常率比较均无显著性差异(P>0.05)。相较于剖宫产组,在任意状态下经阴道组前后径、横径、面积均显著更高,肛提肌厚度均更小(P<0.05)。相较于静息状态,两组前后径及面积在Valsalva时显著更高而在缩宫时显著更低,肛提肌厚度在上述两种动作时均显著更高,经阴道组横径在Valsalva时显著更高而在缩宫时显著更低,剖宫产组横径在上述两种动作时均显著更低(P<0.05)。结论采用不同分娩方式分娩的PFD初产妇的盆膈裂孔和肛提肌情况均存在显著差异,经会阴四维成像技术可直观、立体显示盆膈裂孔的三维结构及形态,可为产后PFD的临床诊断提供有力的科学参考依据。

Objective To explore the application value of four-dimensional transperineal pelvic floor ultrasonography in the detection of abnormal pelvic floor muscles and pelvic diaphragmatic hiatus in primiparas.Methods Totally 112 cases of primiparas with pelvic floor dysfunction(PFD)admitted to our hospital from June 2018 to June 2019 were selected.According to the mode of delivery,they were divided into two groups:transvaginal group and cesarean section group,each with 56 cases.Both groups were examined by perineal four-dimensional ultrasound.The pelvic muscle strength distribution and the pelvic diaphragm hiatus and levator ANI were compared between the two groups.Results The transvaginal group of pelvic floor muscle,vaginal abnormal pressure rate is 66.07%,71.43%respectively,pelvic floor muscles fatigue rate was 60.71%,among them,such asⅠ,Ⅱabnormal muscle fiber strength rate are 48.21%and 12.50%respectively;The abnormal rates of pelvic floor muscle strength and vaginal pressure in cesarean section group were 55.36%and 69.64%,respectively.Pelvic floor muscle fatigue at a rate of 55.36%,of which theⅠ,Ⅱmuscle fiber strength abnormal rate was 46.43%,8.93%.There was no significant difference in the above abnormal rates between the two groups(P>0.05).Compared with the cesarean section group,the anterior and posterior diameters,transverse diameters and areas were significantly higher in the transvaginal group under any condition,and the levator ANI muscle thickness was smaller(P<0.05).Compared with the resting state,the anterior and posterior diameters and areas of the two groups were significantly higher at Valsalva and lower at contractions,levator ANI muscle thickness was significantly higher at both of the above movements,transverse diameters were significantly higher at Valsalva and lower at contractions in the transvaginal group,and transverse diameters were significantly lower at both of the above movements in the cesarean section group(P<0.05).Conclusion there are significant differences in the pelvic diaphragmatic hiatus and levator ANI of PFD parturient women with different delivery methods.The four-dimensional perineal imaging technology can visually and stereoscopic display the three-dimensional structure and morphology of the pelvic diaphragmatic hiatus,which can provide a strong scientific reference for the clinical diagnosis of PFD after delivery.