不同分娩方式对女性盆底功能影响的研究进展

Research progress on the effects of different delivery modes on female pelvic floor function

女性骨盆底由多层肌肉和筋膜构成,它封闭骨盆出口,主要作用为承托并保持盆腔脏器于正常的位置。妊娠过程中,子宫重量的增加、激素水平的变化、胎先露部对盆底组织的过度压迫以及基因水平决定的胶原纤维和结缔组织的脆弱均会造成盆底组织松弛。不同分娩方式会对女性盆底肌肉、纤维、神经等造成不同程度的损伤,进而在产后及老年期导致盆底肌肌力下降、压力性尿失禁(SUI)、盆腔脏器脱垂(POP)和大便失禁(FI)等盆底功能障碍性疾病(PFD),严重影响女性生活质量。随着肌电图、超声、动态MRI技术的发展,产后盆底功能的筛查已被予以重视,女性产后都应进行盆底功能的筛查,并根据自身情况选择盆底肌肉训练、生物电刺激或生物反馈训练等方式恢复盆底功能。不同分娩方式对女性产后盆底功能的影响将在以下做一综述。

Female pelvic floor consists of layers of muscle and fascia, which closed the pelvis exports and the main role is retainering and keeping the pelvic cavity viscera on the normal position. During pregnancy, the increase of uterus weight, the change of hormone level, the excessive oppression of fetal presentation on pelvic floor organization and the fragility of collagen fibers and the connective tissue which is decided by genetic level will cause the relaxation of pelvic floor tissues. Different delivery modes will lead to different degree of damage on female pelvic floor muscles, fibers and nerve, which will lead to the decrease of the pelvic floor muscle strength, stress urinary incontinence （SUI）, pelvic organ prolapse （POP）, fecal incontinence （FI）, and pelvic floor functional disorder （PFD） in postpartum and old period, and this will seriously affect the female postpartum quality of life. With the development of electromyography, ultrasonic and dynamic magnetic resonance imaging （MRI）, the screening for postpartum pelvic floor function has been attached importance to it, at the same time, women should screen the pelvic floor functional in postpartum and restore pelvic floor function by pelvic floor muscles training, bioelectricity stimulation or biofeedback training methods decided by own situation. The effects of different delivery modes on female pelvic floor function were reviewed in this paper.