经会阴超声成像在女性盆底结构显示中的应用

Application of Transperineal Ultrasound Imaging in Displaying of the Anatomy of Female Pelvic Floor

目的探讨经会阴超声成像在显示女性盆底结构中的应用价值。方法选取129例初产妇,分为经阴道分娩组(A组)44例,经阴道分娩不成功改剖宫产组(B组)43例,择期剖宫产组(C组)42例。使用腔内实时三维容积超声探头,经3组产妇会阴部进行扫查,显示产妇静息状态下及做最大Valsalva动作时盆底器官的结构,在二维图像上测量膀胱颈至耻骨联合下缘的垂直间距,计算出膀胱颈移动度(Bladder Neck Descent,BND),在三维图像上测量肛提肌裂孔的面积、周长、左右径及前后径。结果 BND:A组>B组>C组(P<0.05);静息状态下肛提肌裂孔面积、周长、左右径及前后径:A组>B组>C组(P<0.05);做最大Valsalva动作时,3组肛提肌裂孔的相应参数值均大于静息状态下的相应参数值(P<0.01)。结论经会阴超声成像能够清晰显示分娩后妇女的盆底结构,可作为诊断女性盆底疾病的首选方法。

Objective To discuss the effectiveness of application of transperineal ultrasound imaging in displaying of the anatomy of the female pelvic floor. Methods A total of 129 primiparas were enrolled in the study, including 44 cases with vaginal delivery（Group A）, 43 cases with unsuccessful vaginal delivery to cesarean（Group B）, and 42 cases with elective cesarean delivery（Group C）. The anatomy of the female pelvic floor was observed under the resting state and the maximum valsalva maneuver by using real-time three-dimensional ultrasound probe and transperineal scanning for primiparas in all three groups. The vertical distance between the bladder neck and pubic bone was measured, and then the degree of bladder neck descent（BND） in two-dimensional ultrasound images was calculated so as to measure the area, perimeter, transversal diameters and anteroposterior diameters of the levator hiatus（LH） in three-dimensional images. Results BND： Group A 〉Group 〉B Group C（P〈0.05）; the area, perimeter, transversal diameters and anteroposterior diameters of LH under the resting state： Group A 〉Group B〉 Group C（P〈0.05）; parameters of LH under the maximum valsalva maneuver in three groups were greater than those under the resting state（P〈0.01）. Conclusion The transperineal ultrasound imaging could show the anatomy of the postpartum female pelvic floor clearly, which might serve as a top option for diagnosis of female pelvic floor dysfunction.