会阴侧切对女性盆底功能的近期影响

Effect of episiotomy on the short-term function of the pelvic floor

目的探讨常规会阴侧切与非会阴侧切两种方式对女性盆底功能的近期影响。方法回顾性分析2012年1-7月在大连市妇产医院经阴道自然分娩的单胎头位足月初产妇共116例。其中侧切组70例,非侧切组46例,分娩后6～8周由专人对产妇临床症状、盆底功能和结构进行检测评估。结果分娩后侧切组压力性尿失禁、会阴疼痛发生率高于非侧切组(P<0.05);分娩后侧切组与非侧切组盆腔脏器脱垂发生率差异无统计学意义(P>0.05);分娩后Ⅰ类肌纤维损伤:侧切组肌电值、肌力损伤及疲劳度重于非侧切组(P<0.05);分娩后Ⅱ类肌纤维损伤:侧切组肌电值损伤重于非侧切组(P<0.05),侧切组与非侧切组肌力损伤及疲劳度差异无统计学意义(P>0.05);分娩后侧切组膀胱尿道后角和膀胱颈活动度大于非侧切组(P<0.05)。结论会阴侧切对女性盆底结构和功能损伤重于非会阴侧切。会阴侧切可有效缩短产程,但不能对近期盆底功能起到保护作用。

Objective To explore the effect of routine episiotomy and non-episiotomy on the short-term function of the pelvic floor function. Methods One hundred and sixteen healthy primipara women were interviewed at 6-8weeks postpartum ,who delivered naturally in Maternity Hospital of Dalian between Jan. 2012 and July 2012 ,episiotomy group（ n = 70）, non-episiotomy group（ n = 46）. The two groups were compared in patients with post-natal clinical symptoms, pelvic floor function and structure by hand at 6 - 8 weeks postpartum . Results The prevalence of stress urinary incontinence （SUI） and perineal pain after delivery in the episiotomy group was higher than the non-episiotomy group respectively （P 〈 0.05 ）. The prevalence of pelvic organ prolapse （POP） between the episiotomy group and the non-episiotomy group had no significant difference（P 〉 0. 05）. Class Ⅰ muscle fibers after delivery,the EMG value , muscle damage and fatigue of the episiotomy group were injured more seriously than the non-episiotomy group （ P 〈 0. 05 ）, Class Ⅱ muscle fibers damage after delivery, the EMG value of the episiotomy group was injured more seriously than the non-episiotomy group （ P 〈 0. 05 ）. Muscle damage and fatigue had no significant difference between the episiotomy group and the non- episiotomy group （P 〉 0. 05 ）. After delivery , the posterior urethrovesical angle （PUVA）and mobility of the urethrovesical junction （UVJ-M） of the episiotomy group was greater than the non-episiotomy group respectively （P 〈 0. 05） . Conclusion Episiotomy injures on pelvic floor structure and function more seriously than non-episiotomy. Episiotomy can shorten the birth process effectively, but it could not play a protective role on recent pelvic floor function.