经会阴三维超声对不同状态未育正常女性盆底的初步研究

Apreliminary Study of Pelvic Floor during Different Statesin Normal Nulliparas by Perineal Three-Dimensional Ultrasound

目的:经会阴三维超声观察不同状态未育正常女性盆底,为女性盆底功能障碍的诊治提供正常值参考。方法:120例未育正常女性,采用经会阴三维超声分别在静息、张力及缩肛状态下观察盆底器官的位置、形态及运动,测量及分析比较盆底三维超声系列生物力学参数。结果:矢状面观察:与静息状态比较,在张力状态膀胱颈到耻骨联合下缘的水平距离绝对值(Dx)增大(P<0.01),垂直距离绝对值(Dy)减小(P<0.01),而在缩肛状态,Dx减小(P<0.01),Dy增大(P<0.01)。三维重建图观察:与静息状态相比,盆膈裂孔的左右径、前后径、周长和面积在缩肛状态均减小,而在张力状态均增大(P<0.05)。与静息状态相比,耻骨内脏肌厚度在缩肛状态增大,在张力状态减小(P<0.05),但耻骨内脏肌角度在缩肛状态及张力状态均增大(P<0.05)。在缩肛状态耻骨内脏肌应变值为(-19.11±7.36)%,在张力状态为(19.89±9.28)%。结论:经会阴三维超声能建立盆腔器官运动程度和盆底形态学的正常值参考,是一种有效影像学方法。

Objective： To observe the pelvic floor during different states in normal nulliparas by perineal threedimensional（ 3D） ultrasound,in order to provide the normal parameters for diagnosis and treatment of female pelvic floor dysfunction. M ethods： Perineal three-dimensinal ultrasound were performed in 120 normal nulliparas in the condition of resting,valsalva maneuver and anal sphincter contraction. The position,shape and movement of pelvic organs were observed and indices for biometric parameters of the pubovisceral muscle and levator biatus were determined in the sagittal and three-dimensinal reconstruction planes. Results： In sagittal plane,compared with rest state,the absolute value of the horizontal distence of bladder neck to symphysis pubis（ Dx） were increased（ P〈0. 01）,the absolute value of the vertical distence（ Dy） were reduced in tension state（ P〈0. 01）. On the other hand,Dx were reduced（ P〈0. 01） and Dy were increased（ P〈0. 01） in contracting state. In three-dimensinal reconstruction planes,compared with rest state,the hiatus＇ area,circumference,anteroposterior diameter and left-right diameter were all smaller in contracting state and bigger in tension state（ all P〈0. 05）. The thickness of the pubovisceral muscle were all thicker in contracting state and thinner in tension state（ all P〈0. 05）. But the angle of the pubovisceral muscle were bigger both in contracting state and in tension state thanthat in rest state（ all P〈0. 05）. In contracting state,the srain of pubovisceral muscle were（- 19. 11 ± 7. 36） %,but（ 19. 89 ± 9. 28） % in tension state. Conclusions： The trans-perineum three-dimensional ultrasound can establish the normal parameters of the morphology and the movement of pelvic floor,which is an effective imaging pattern to observe pelvic floor.