经会阴三维超声对正常未育妇女盆膈裂孔的研究

Observation of urogenital hiatus in nulliparas by transperineal three-dimensional ultrasound

目的 通过经会阴三维超声对正常未育妇女盆膈裂孔的观察，探讨盆腔器官下降与Valsalva动作时盆膈裂孔面积之间的关系。方法选择年龄20～36岁未育妇女65例，应用经会阴三维超声获取静息状态及Valsalva动作时盆膈裂孔容积数据成像。离线分析测量肛提肌平均厚度（Tm-PR），盆膈裂孔前后径（AP）、左右径（LR）、面积（HA）及盆腔器官至耻骨联合下缘的距离。结果①静息状态下肛提肌的厚度为0．58-1．15cm[平均（O．89±0．13）cm]，Valsalva动作时其厚度为0．56-1．11cm[平均（0．76±0．11）cm]；静息状态下AP、LR及HA分别为3．31-5．31cm[平均（4．56±0．54）cm]、3．03-4．29cm[平均（3．62±0．36）cm]、7．16～15．64cm2[平均（12．59±2．77）cml；Valsalva动作时AP、LR及HA分别为3．62，6．40cm[平均（5．25±0．89）cm]、3．32～4．77cm[平均（3．92±0．45）cm]、7．40～28．51cm^2[平均（15．70±4．68）cm^2]；②Valsalva动作时AP、LR及HA均较静息状态下增大，肛提肌平均厚度较静息状态下减小，差异均有统计学意义（均P〈0．05）；③膀胱颈、宫颈及直肠壶腹部下降与HA的相关系数分别为0．682、0．484、0．487，呈中度相关（P〈0．05）。结论盆腔器官下降与Valsalva动作时HA呈中度相关；经会阴三维超声对盆膈裂孔各参数的测量可靠性高、重复性好，是观察女性盆底结构的一种有效的新影像学技术。

Objective To assess the relationship between pelvic organ descent and hiatus area on Valsalva maneuver by observing the urogenital hiatus in nulliparous women with three-dimensional （3D） transperineal ultrasound. Methods Sixty- five nulliparous women （aged 20-36 years） were examined by 3D transperineal ultrasound. Urogenital hiatus volumes were acquired at rest and on Valsalva maneuver, and the mean thickness of puborectalis（Tm-PR）, anteroposterior diameter（AP）, left to right diameter （LR）, the area of urogenital hiatus （HA） and the distance between pelvic organs and inferior margin of pubic symphysis were measured off-line. Results ①Tm-PR varied 0.58-1.15 cm[mean（0.89＋0.13） em] at rest,and 0.56-1.11 cm [ mean （0.76±0.11 ） cm ] on Valsalva maneuver. The AP, LR and HA varied 3.31 -5.31 cm [ mean （4.56±0.54）cm ], 3.03-4.29 cm [ mean（3.62±0.36） cm ], 7.16- 15.64 cm^2[ mean（12.59±2.77） cm^2 ] at rest. During the maximum Valsalva maneuver, AP, LR and HA varied 3.62-6.40 cm [ mean（5.25±0.89） cm ], 3.32-4.77 cm [ mean （3.92±0.45） cm ], 7.40-28.51 cm^2[ mean （15.70±4.68） cm^2]. ② AP,LR and HA ffere increased and Tm-PR was decreased during the maximum Valsalva maneuver as compared to rest condition （P〈0.05）. ③There were significant correlations between descent of bladder neck, cervix, rectum ampulla and HA on Valsalva maneuver,correlation coefficient was 0.682, 0.484, 0.487, respectively （P〈0.05）. Conclusion There is significant correlation between pelvic organ descent and HA on Valsalva maneuver. Parameters of the urogenital hiatus can be determined by 3D ultrasound repeatly and reliably, and 3D ultrasound is a new effective image technology to observe the pelvic floor structures.