超声对初产妇产后早期盆底结构与功能的评估价值

Value of ultrasonography in evaluating the structure and function of pelvic floor in the early postpartum women

目的:探讨经会阴超声检查对初产妇产后早期盆底结构与功能的评估价值。方法:320例初产妇中177例为经阴道分娩者,作为经阴道分娩组;143例为选择性剖宫产者,作为剖宫产组。另选取100例已婚未育女性作为未育组。所有受试者均进行经会阴超声检查,比较各组在静息状态下、最大Valsalva状态下检测膀胱尿道后角(PUA)、尿道倾斜角(UTA)、宫颈外口位置(CMP)、膀胱颈位置(BNP),计算尿道旋转角(URA)、膀胱颈移动度(BND)、宫颈外口移动度(CDD),同时与临床检查结果对比,分析超声检查对盆底异常的检出率。结果:静息状态下,各组间PUA和UTA比较,差异无统计学意义(P>0.05);经阴道分娩组CMP、BNP小于剖宫产组和未育组(P<0.05),剖宫产组BNP小于未育组(P<0.05)。最大Valsalva状态下,各组间PUA比较,差异无统计学意义(P>0.05);经阴道分娩组UTA大于剖宫产组及未育组(P<0.05),CMP、BNP小于剖宫产组及未育组(P<0.05),剖宫产组UTA大于未育组(P<0.05),CMP、BNP小于未育组(P<0.05);经阴道分娩组、剖宫产组URA、CDD、BND均大于未育组(P<0.05)。经阴道超声检查盆底异常检出率明显高于临床盆底异常检出率(P<0.05)。结论:相对于经阴道分娩,剖宫产产后早期盆底组织损伤较轻;经会阴超声检查能动态观察女性盆腔脏器结构及形态,提高产后早期盆底异常检出率。

Objective:To explore the value of transperineal ultrasound in evaluating the structure and function of pelvic floor in early postpartum women.Methods:A total of 320 parturients treated were selected as subjects,including 177 cases of vaginal delivery as vaginal delivery group and 143 cases of selective cesarean section as cesarean section group.In addition,100 married infertile women were selected as the infertility group.All subjects were examined by transperineal ultrasonography.The posterior urethravesical angel(PUA),urethral tilt angel(UTA),cervical mouth position(CMP)and bladder neck position(BNP),urethral rotation angle(URA),bladder neck descent(BND)and cervix down distance(COD)were detected at rest and maximum Valsalva.At the same time,compared with the results of clinical examination,the detection rate of pelvic floor abnormalities by ultrasonography was analyzed.Results:There was no significant difference in PUA and UTA among groups at rest(P>0.05).CMP and BNP in vaginal delivery group were significantly lower than those in cesarean section group and infertility group(P<0.05).BNP in cesarean section group was significantly lower than that in infertility group(P<0.05).Under the maximum Valsalva,there was no significant difference in PUA among the three groups(P>0.05).The UTA of vaginal delivery group was significantly higher than those of cesarean section group and infertility group(P<0.05).The CMP and BNP were significantly lower than those of cesarean section group and infertility group(P<0.05).The UTA of cesarean section group was significantly higher than that of infertility group(P<0.05).The CMP and BNP were significantly lower than those of infertility group(P<0.05).The levels of URA,CDD and BND in vaginal delivery group and cesarean section group were significantly higher than those in infertility group,and the detection rate of pelvic floor abnormality detected by transvaginal ultrasound was significantly higher than that of clinical pelvic floor abnormality(P<0.05).Conclusion:Compared with vaginal delivery,the early injury of pelvic floor after cesarean section is slighter.Perineal ultrasonography can dynamically observe the structure and shape of female pelvic organs and improve the detection rate of pelvic floor abnormalities in the early postpartum period.