经会阴三维超声动态观察生育后无盆底功能障碍女性不同状态下肛提肌裂孔形态变化

An investigation on the levator hiatus under different conditions in postparyum women without pelvic floor dysfunction using three-dimensional perineal ultrasound

目的观察生育后无盆底功能障碍女性在静息、瓦氏动作及缩肛状态下肛提肌裂孔形态结构及动态变化。方法生育后无盆底功能障碍性疾病女性36例,经会阴二维超声基础上进行三维超声成像,获得静息、瓦氏动作及缩肛状态下盆底三维横断面,观察肛提肌裂孔形态结构及动态变化,测量肛提肌裂孔前后径、左右径、面积、耻骨内脏肌夹角及厚度等相关参数。结果经会阴三维声像图显示肛提肌裂孔呈菱形结构,前方为耻骨联合下缘,形成倒V形,两侧为肛提肌(耻骨内脏肌部分),其内盆底器官自前往后依次为:尿道、阴道、直肠。生育后无盆底功能障碍女性在静息时肛提肌裂孔前后径(M)、左右径(N)、面积(A)、耻骨内脏肌夹角(γ)及厚度(T)分别为(5.61±0.69)cm、(4.41±0.43)cm、(17.36±2.80)cm2、(69.02±6.80)°、(0.79±0.12)cm;Valsalva时分别为(5.77±0.79)cm、(4.43±0.46)cm、(19.00±3.75)cm2、(69.34±7.04)°、(0.73±0.13)cm;缩肛状态下分别为(4.98±0.72)cm、(4.07±0.49)cm、(16.10±8.04)cm2、(73.12±5.80)°、(0.81±0.16)cm。生育后无盆底功能障碍女性静息时肛提肌裂孔内部结构紧凑,排列整齐,Valsalva时肛提肌裂孔增大,耻骨内脏肌夹角增大,耻骨内脏肌厚度变薄,缩肛时肛提肌裂孔变小,耻骨内脏肌夹角增大,耻骨内脏肌厚度变厚,内部结构更加紧凑。结论会阴三维超声能够清晰显示生育后无盆底功能障碍女性在静息、Valsalva及缩肛状态下的肛提肌裂孔形态结构及动态改变。

Objective To investigate the morphology and dynamic changes of levator hiatus in postparyum women without pelvic floor dysfunction （PFD） at resting, Valsalva and contracting state. Method Transperineal twodimensional ultrasound images were acquired in 36 postparyum women without PFD. The three-dimensional cross-sectional of pelvic floor image were reconstructed based on these 2D images. The anteroposterior diameter （M）, left to right diameter （N）, and area （A） of Levator hiatus,the angle （γ） and the thicknes （C） of pubovisceral muscles were measured at rest, Valsalva and contracting state,respectively. Result Transperineal three-dimensional ultrasound images showed Levator hiatus as a diamond-shaped structure. The front part was the lower edge of pubic symphysis which forming an inverted V. Both sides are levator （the part of puboviscera muscle）. The pelvic organs from front to back are the Urethra, vagina and rectum. To the postparyum women without pelvic floor dysfunction in rest state, the anteroposterior diameter （M）, left to right dimensiona （N）, area （A） of Levator hiatus, and the angle （7） and the thickness （C） ofpubovisceral muscles were （5.61 ± 0.69） cm, （4.41 ± 0.43） cm, （17.36 ± 2.80） cm2, （69.02 ± 6.80） °, （0.79 ±0.12） cm respectively. In Valsalva state, these dimensions were （5.77 ± 0.79）cm, （4.43 ± 0.46）cm, （ 19.00± 3.75）cm2, （69.34 ± 7.04）2, （0.73 ± 0.13） cm. In contracting state these values were（ 4.98 ± 0.72 ）cm, （4.07 ± 0.49 ）cm, （ 16.10± 8.04 ）cm2, （73.12 ±5.80 ）% （0.81 ±0.16） cm. In resting state, the internal structures of levator hiatus of postparyum women without pelvic floor dysfunction arranged compactly and regularly. Comparing with the state of the rest, the size of the Levator hiatus and the angle of the pubovisceral muscles increased, and the thickness of pubovisceral muscles decreased in Valsalva state,while the contracting state these values changed in the opposite direction except that the angle of pubovisceral muscles still increased. The internal structures of it arranged more campactly. Conclusion Transperineal three-dimensional ultrasound demonstrated the morphology and dynamic changes of Levator hiatus of the postparyum women without pelvic floor dysfunction clearly at resting, Valsalva and contracting state.