产后女性盆底康复治疗后盆膈裂孔的三维超声评估

Three-dimensional ultrasonography in evaluating pelvic diaphragm hiatus after pelvic floor rehabilitation in postpartum women

目的探讨三维超声在评估产后女性盆底康复治疗前、后盆膈裂孔变化中的作用。方法产后行盆底康复治疗产妇76例,依据分娩方式分为剖宫产组40例,经阴道分娩组36例,分别于产后42d(治疗前)及盆底康复治疗3个疗程后(治疗后)行经会阴盆底三维超声检查,测量静息状态及Valsalva运动状态下盆膈裂孔前后径、左右径,计算盆膈裂孔面积,并进行比较。结果治疗前剖宫产组静息状态及Valsalva运动状态下盆膈裂孔前后径[(4.83±0.64)、(5.01±0.74)cm]、左右径[(4.14±0.44)、(4.53±0.64)cm]及盆膈裂孔面积[(13.41±2.33)、(16.09±4.81)cm^2]均低于阴道分娩组[前后径(5.12±0.56)、(5.46±0.87)cm,左右径(4.39±0.42)、(4.87±0.69)cm,盆膈裂孔面积(15.07±2.25)、(19.34±5.74)cm^2],差异均有统计学意义(P<0.05);治疗后,剖宫产组静息状态及Valsalva运动状态下、以及阴道分娩组静息状态下盆膈裂孔前后径、左右径、盆膈裂孔面积与治疗前比较差异均无统计学意义(P>0.05),阴道分娩组Valsalva运动状态下盆膈裂孔前后径[(5.02±0.57)cm]、面积[(16.90±3.46)cm^2]低于治疗前(P<0.05),左右径与治疗前比较差异无统计学意义(P>0.05)。结论经阴道分娩产妇产后盆底康复治疗3个疗程后盆底肌恢复情况优于剖宫产产妇,经会阴盆底三维超声有助于初步评估、随访盆底康复治疗效果。

Objective To observe the role of three-dimensional （3D） ultrasonography in evaluating the changes of pelvic diaphragm hiatus before and after pelvic floor rehabilitation in postpartum women. Methods Seventy six patients receiving pelvic floor rehabilitation were divided into cesarean section group （n = 40） and vaginal delivery group （n = 36） according to the delivery methods, and were examined by transperineal 3D pelvic floor ultrasonography in 42 days after delivery and after 3 courses of pelvic floor rehabilitation to determine the change of pelvic diaphragm hiatus anteroposterior diameter and left to right diameter to calculate the area of pelvic diaphragm hiatus in quiescent condition and during Valsalva movements. Results The anteroposterior diameters （（4. 83 ± 0. 64）, （5. 01 ± 0. 74） cm）, and left to right diameters （（4.14±0.44）, （4.53±0.64） cm） were significantly shorter, and areas of pelvic diaphragm hiatus （（13.41± 2. 33）, （16. 09±4. 81） cm2） were significantly smaller in cesarean section group than those in vaginal delivery group （（5.12±0.56）, （5.46±0. 87） cm; （4.39±0. 42）, （4. 87±0. 69） era; （15.07±2. 25）, （19. 34±5. 74） cm2） in quiescent condition and during Valsalva movement before treatment （P〈 0.05）. After treatment, there were no significant differences in the anteroposterior diameter, left to right diameter and area of pelvic diaphragm hiatus in quiescent condition and during Valsalva movement between two groups （P 〉 0. 05 ）. The anteroposterior diameter （（5.02±0.57） cm） was significantly shorter and area of pelvic diaphragm hiatus （（16.90±3.46） cm2） was significantly smaller after pelvic floor rehabilitation in comparison with those before treatment during Valsalva movement in vaginal delivery group （P〈0.05）, and there was no significant difference in the anteroposterior diameter in comparison that before treatment （P〉0.05）. Conclusion After 3 courses of pelvic floor rehabilitation, the pelvic floor muscle recovery in vaginal delivery group is superior to cesarean section group. Transperineal 3D uhrasonography contributes to the preliminary assessment and evaluating the follow-up of the pelvic floor rehabilitation.