不同分娩方式对产后早期盆底功能的影响

Impact of mode of delivery on early postpartum pelvic floor function

目的探讨不同分娩方式对产后早期盆底功能的影响。方法随机抽取2007年7—10月在广州医学院第一附属医院分娩的产妇43例，根据不同分娩方式分为选择性剖宫产组（21例）和阴道顺产组（22例）。分别于产后6—8周及12～14周行POP—Q评分、尿垫试验、超声检测残余尿以及会阴超声检查，比较两组产妇压力性尿失禁（SUI）、盆腔器官脱垂（POP）的发生率及膀胱颈移动度情况。结果产后6—8周和产后12—14周随访时，SUI发生率依次为选择性剖宫产组4．76％（1／21），0（0／14）；顺产组27．27％（6／22），28．57％（4／14），两组比较差异均无统计学意义（P〉0．05）。产后6～8周和产后12～14周随访时，POP发生率依次为选择性剖宫产组38．10％（8／21），35，71％（5／14），较顺产组72，72％（16／22），78．57％（11／14）低，差异均有统计学意义（P〈0．05）。产后6—8周会阴超声结果显示：选择性剖宫产组与顺产组膀胱颈角度[（81．48±7．96）。对（93．82±15，37）°]及膀胱颈旋转角度[（15．71±8．01）°对（27．72±11．14）°]比较，差异有统计学意义（P〈0．05）。产后12—14周选择性剖宫产组与顺产组膀胱颈角度[（79.93±8．19）°对（89.93±13．92）°]及膀胱颈旋转角度[（13．79±4．98）°对（23.07±12．17）°]比较，差异有统计学意义（P〈0．05）。结论剖宫产可降低产后早期POP的发生率，并可减少发生SUI的风险。

Objective To investigate the impact of mode of delivery on early postpartum pelvic floor function. Methods The 43 pregnant women who had their childbirth in the First Affiliated Hospital of Guangzhou Medical College during July to October 2007 were randomly selected and were allocated into two groups , elective caesarean section group and vaginal delivery group. In 6 - 8 weeks and 12 - 14 weeks after childbirth,they were respectively given POP-Q scoring, protective pad experimenting, ultrasonic testing of residual urine and perineum ultrasound examination . An analysis on their occurrence of SUI and POP and bladder neck mobility was carried out. Results Followed up in 6 - 8 weeks and 12 - 14 weeks after childbirth,the proportion of occurrence of stress urinary incontinence was respectively 4. 76% （1/21） ,0（0/14）in elective caesarean section group and 27.27% （6/22） ,28.57% （4/14）in vaginal delivery group. There was no significant difference between two groups（ P 〉 0. 05 ）. The proportion of occurrence of pelvic organ prolapse was respectivly 38.10% （8/21） ,35.71% （5/14）in elective caesarean section group,lower than that [72. 72% （16/22） ;78.57% （11/14） ] in vaginal delivery group , the differences having statistical significance （ P 〈 0. 05 ）. The perineum ultrasound examination in 6 - 8 weeks after childbirth showed that there was significant difference between two groups when comparing the bladder neck angle[ （81.48 ±7.96）° vs（93.82 ± 15.37 ） ° ] and the bladder neck rotation angle[ （ 15.71 ± 8.01 ）° vs（27.72 ± 11.14）° ] （ P 〈 0. 05 ）. There was also significant difference between two groups in 12 - 14 weeks after childbirth when comparing the bladder neck angle[ （79. 93 ± 8.19）° vs（89.93 ± 13.92） ° ] and the bladder neck rotation angle[ （ 13.79 ±4.98）° vs（23.07 ±12. 17）°] （P〈0.05）. Conclusion In comparison , elective caesarean section can reduce the impact on pelvic floor function.