阴道分娩对初产妇盆膈裂孔影响的超声影像学研究

Evaluation of ultrasound imaging for maternal pelvic diaphragm hiatus in vaginal delivery primipara

目的应用三维超声观察阴道分娩初产妇盆膈裂孔的形态学改变。方法选择阴道分娩初产妇41例(产后组),平均年龄26.59岁,身高(156.33±5.75)cm,体质量(59.45±4.62)kg。未育女性35例(对照组),孕0产0,平均年龄22.54岁,身高(157.21±6.25)cm,体质量(55.77±5.38)kg。经会阴三维超声分别采集静息期、张力期和缩肛期的图像,观察产后组盆膈裂孔的形态改变,并测量裂孔的形态学参数。结果静息期、缩肛期和张力期测得对照组矢状位盆膈裂孔长度分别为(4.56±0.75)cm、(4.02±0.58)cm、(4.82±0.80)cm;静息期、缩肛期和张力期测得产后组矢状位盆膈裂孔长度分别为(4.81±0.68)cm、(4.41±0.85)cm、(5.24±0.79)cm。静息期、缩肛期和张力期测得对照组盆膈裂孔面积分别为(13.98±2.04)cm2、(12.25±1.49)cm2、(15.22±2.46)cm2;静息期、缩肛期和张力期测得产后组盆膈裂孔面积分别为(15.11±1.67)cm2、(13.27±2.44)cm2、(16.88±1.98)cm2。产后组3个时期盆膈裂孔的面积及矢状位裂孔的长度均较对照组明显增大(P<0.001)。产后组盆膈裂孔形态学异常主要表现为裂孔呈"类椭圆形",耻骨直肠肌向外膨隆,裂孔内器官排列较松散。结论三维超声能有效评价阴道分娩初产妇盆膈裂孔的形态结构,可以为妊娠分娩相关盆底功能障碍性疾病的发生及产后盆底结构和功能的恢复提供影像学信息。

Objective To dynamically observe and evaluate the morphological changes of levator hiatus in vaginal delivery primipara with translabial three-dimensional （3D） ultrasound, and provide the imaging basis for the diagnosis and treatment of pregnancy and childbirth associated pelvic floor dysfunction. Methods A total of 41 primipara（postpartum group） by vaginal birth were enrolled, which mean age was 26.59 years old, body height was （156.33±5.75） cm and body weight was （59.45±4.62） kg. The 35 cases of nulliparous women was control group, which were nonpregnant and nulliparous, and their mean age was 22.54 years old, body height was （157.21 ± 6.25） cm and body weight was （55.77± 5.38） kg. Translabial 3D ultrasound was performed on postpartum group and control group to observe the morphological changes of levator hiatus and acquire the levator hiatal dimensions at resting, pelvic muscle contraction and morphological parameters. Results The sagittal hiatal diameter of control group at resting, pelvic muscle contraction and during maximum valsalva maneuver were （4.56±0.75） cm, （4.02±0.58） cm and （4.82 ± 0.80） cm, respectively, and in postpartum group the sagittal hiatal diameter during 3 maneuvers were （4.81±0.68） cm, （4.41±0.85） cm and （5.24±0.79） cm, respectively. The hiatal area of control group at resting, pelvic muscle contraction and during maximum valsalva maneuver were （ 13.98±2.04） cm^2, （12.25±1.49） cm^2 and （15.22±2.46） cm^2, respectively, and in postpartum group the hiatal area during 3 maneuvers were （ 15.11±1.67） cm2, （13.27±2.44） cm^2 and （16.88±1.98） cm^2 respectively. The hiatal area and sagittal hiatal diameter of postpartum group were significantly larger than that of control group in 3 stages（P 〈 0.001）. The morphological abnormalities in postpartum group mainly presented as： levator hiatus tended to be circular, the puborectalis was distributed outside and the pelvic floor organ were loosely arranged. Conclusion It is demonstrated that translabial 3D ultrasound could dynamically observe and evaluate the morphological changes of levator hiatus in vaginal delivery primipara, which could provide the imaging basis for the occurrence of pelvic floor dysfunction after delivery and the structure and function recovery of the pelvic floor.