经会阴三维超声评价女性盆底功能障碍疾病的诊断价值

Value of transperineal three-dimensional ultrasound in evaluation of female pelvic floor dysfunction disease

目的应用经会阴三维超声观察女性盆底功能障碍性疾病（PFD）患者术前及术后盆膈裂孔的形态结构改变。方法选取盆底功能障碍患者（PFD组）和妇科良性疾病患者各60例，经会阴三维超声观测对照组、PFD组术前及术后3-6个月静息期、缩肛期及张力期盆膈裂孔大小、形态结构。结果PFD组术前的盆膈裂孔面积较对照组增大，其结构松散，形态呈圆形，PFD组术后3-6个月后盆膈裂孔面积较术前减小，结构较前完整，其内可显示强回声植入性材料。PFD组术前在静息期、缩肛期及张力期盆膈裂孔面积、前后径、左右径、耻骨直肠肌厚度均大于对照组，差异均有统计学意义（均P〈0．01）；PFD组术后在静息期、缩肛期及张力期盆膈裂孔面积、前后径、左右径均较术前减少，差异均有统计学意义（均P〈0．05），但耻骨直肠肌厚度均无统计学意义。结论经会阴三维超声对盆膈裂孔的大小和肛提肌厚度能进行简便、准确地测量，对PFD患者的临床诊断、手术前后功能评估及术后植人性材料形态观察具有重要的应用价值。

Objective To observe the morphosis changes of pelvic diaphragm hiatus in patients with female pelvic floor disfunction （PFD） by transperineal three-dimensional （3D） ultrasound before and after operation. Methods Sixty patients with PFD （PFD group） and 60 patients with benign gynecological diseases（control group） were enrolled. The size and morphosis of the pelvic diaphragm hiatus were observed with transperineal 3D ultrasound at rest, on pelvic muscle contraction and during maximum Valsalva maneuver condition before and 3 -6 months after operation. Results Before operation, the area of pelvic diaphragm hiatus in PFD group was bigger than that in control group with loose structure and round shape. 3 -6 months after operation, the area of pelvic diaphragm hiatus was decreased and the structure was complete in PFD group. Strong echo of implanting materialsl was displayed. The area, anterior-posterior diameter, left-right diameter of the pelvic diaphragm hiatus and the thickness of the puborectalis were greater in PFD group than those in the control group at rest, on pelvic muscle contraction and during maximum Valsalva maneuver condition before operation. There was significant difference （P〈0.01） . After operation, the area, anteriorposterior diameter, left-right diameter of the pelvic diaphragm hiatus were decreased in PFD group, there was significant differece （P〈0.05） , the thickness of the puborectalisno had no statistical significance. Conclusion Transperineal 3D ultrasound can measure the size of pelvic diaphragm hiatus and the thickness of levator ani simply and accurately, it has important application value for clinical diagnosis of PFD, function assessment before and after operation and morphological observation of postoperative implantable materials.