腔内超声观察未育女性耻骨直肠肌的初步研究

Preliminary study of endoluminal two-dimensional uitrasonography to evaluate puborectalis muscle of nuiliparous women

目的应用腔内超声经盆底旁矢状切面观察耻骨直肠肌解剖形态学结构及收缩功能，探讨规范标准的测量方法和临床应用的可行性。方法入组78例正常未育女性，经盆底旁矢状切面，在静息及收缩状态下分别测量尿道水平（前部）、阴道水平（中部）及直肠水平（后部）处耻骨直肠肌厚度及增厚率，比较收缩状态下耻骨直肠肌前部、中部及后部增厚率的差异，并通过计算组内相关系数评估不同观察者间测量结果的一致性。结果静息状态下耻骨直肠肌前部的厚度：左侧（9．23±0．20）mm，右侧（8．99±0．20）mm。收缩状态下，双侧耻骨直肠肌前部增厚率均大于同侧中部和后部，差异具有统计学意义（P〈0．05）。不同观察者在静息和收缩状态下测量耻骨直肠肌厚度具有很高的一致性，组内相关系数均〉0．93和0．83。结论应用腔内超声经盆底旁矢状切面可以动态观察耻骨直肠肌的解剖形态学结构及其收缩功能，方法简单，重复性好，可在临床推广应用。

Objective To investigate the measurement standards and clinical application of observing anatomical morphologies and contractile function of puborectalis muscle on pelvic floor parasagittal plane by endoluminai two-dimensional ultrasonography. Methods The thickness and thickening rate of puborectalis muscle of 78 young nulliparous women were measured on pelvic floor parasagittal plane at three levels- urethral level （anterior）, vaginal level （central） and rectal level （posterior）, both at rest and during contraction. And the thickening rates of these parts during contraction were compared with each other. Interclass correlation coefficients were calculated to evaluate the consistency of the datas~ Results At rest, thickness of anterior part of the left was （9.23 ± 0. 20） ram, and that of the right was （8.99 ± 0.20）mm. During contraction,thickness of anterior parts of bilateral puhorectalis muscle were significantly thicker than that of central or posterior parts （ P 〈0.05）. The interclass coefficients were more than 0.93 and 0.83. Conclusions The endoluminal two-dimensional ultrasonography can be used to observe morphologies and contractile function dynamically of puborectalis on pelvic floor parasagittal plane. It is simple, reproducible and worthy of clinical promotion.