正常阴道分娩及选择性剖宫产对女性下尿路解剖和控尿功能的影响

Influence of normal vaginal delivery and selective caesarean section on anatomy and function of female lower urinary tract: a clinical trial

目的研究正常阴道分娩和选择性剖宫产对女性下尿路解剖和控尿功能的近期影响.方法选择2003年1～12月在我院作产前检查的24例孕妇为研究组,再进一步均分为正常阴道分娩亚组和选择性剖宫产亚组,以20名非妊娠健康女性为对照组.研究组于孕38～40周和产后6～8周、对照组于排卵期分别进行前庭超声和尿动力检查,分析尿道膀胱连接部移动度(UVJ-M)、静态最大尿道关闭压(MUCP)、功能性尿道长度(FL)和腹压漏尿点压(VLPP)在分娩前、后的变化以及与非妊娠女性的差异.结果各组VLPP均＞90 cm H2O.分娩前、后的UVI-M均较非妊娠女性明显增加(P＜0.01),分娩后均较分娩前轻度下降(P＞0.05),两种分娩方式分娩后UVJ-M的差异无显著性(P＞0.05).分娩后MUCP均较分娩前及非妊娠女性显著增加(P＜0.01),两种分娩方式分娩后MUCP的差异无显著性(P＞0.05).分娩前FL较非妊娠女性明显增加(P＜0.01),两种分娩方式分娩后FL的差异无显著性(P＞0.05),且与非妊娠女性的差异亦无显著性(P＞0.05).结论正常阴道分娩和选择性剖宫产近期内不降低女性下尿路的控尿功能,但是妊娠末期膀胱颈活动度明显增加,并持续到分娩后,是压力性尿失禁的危险因素之一,这种改变是否会随着时间而加重有待长期随访.

Objective To assess the influence of normal vaginal delivery and selective caesarean section on the anatomy and urinary control function of female lower urinary tract. Methods From Jan to Dec 2003, twenty four primigravida having antenatal health care in Shanghai Sixth People’s Hospital were randomly enrolled and divided into two groups(group 1: normal vaginal delivery; group 2: selective caesarean section), while twenty nulliparous women were served as control. Perineal ultrasound and urodynamic measurements were performed at the gestational age of 38～40 weeks and repeated 6～8 weeks after delivery, the same examinations were done in the controls. The parameters of lower urinary tract function before and after delivery(vaginal and caesarean section) were analysed and compared with those of the nullipara, including mobility of urethrovesical junction (UVJ-M),maximal urethral closure pressure (MUCP),functional urethral length (FL) and Valsalva leak point pressure (VLPP). Results We found that the hypermobility of urethrovesical junction was more conspicuous in the third trimester comparing with that of the nullipara(P< 0.01). MUCP increased before and after delivery, but the difference was not significant, whereas FL decreased very prominently (P< 0.01). There were no significant differences in UVJ-M, MUCP and FL between the two types of delivery. Conclusions The urinary control function of female lower urinary tract is not deceased in vaginal delivery or selective caesarean section, however, there is hypermobility of bladder neck in the third trimester. The persisting bladder neck hypermobility after delivery is one of the risk factors of stress urinary incontinence. Whether this change would be augmented ongoing need further follow-up.