经会阴盆底四维超声评估产后妇女盆隔裂孔影像特征的应用

Application of transperineal pelvic floor 4-dimensional ultrasound in evaluating the image features of pelvic diaphragm hiatus of postpartum women

目的探讨经会阴盆底四维超声评估产后妇女盆隔裂孔影像特征的应用价值。方法病例组1为经阴道分娩组:选取经阴道自然分娩后6~8周,经产科门诊产后随访病例87例;病例组2为选择性剖宫产组:选取在湖南省怀化市妇幼保健院产科行选择性剖宫产后6~8周,经产科门诊产后随访病例64例。对照组:选取同期收治的未育未产患妇科良性疾病的35例患者。进行经会阴盆底四维超声获得容积数据,分别测量三组在静息状态、最大Valsalva状态盆膈裂孔面积(LHA)、盆膈裂孔的左右径(LHLR)、前后径(LHAP)、肛提肌尿道间隙(LUG)。对两组之间的差异进行统计学分析。结果静息状态下前后径、肛提肌尿道间隙左、右各测量值阴道分娩组(5.06±0.88cm、2.21±0.36cm、2.22±0.36cm),剖宫产组(4.67±1.33 cm、2.08±0.26cm、2.08±0.26 cm),均大于对照组(4.55±0.87 cm、1.88±0.26 cm、1.88±0.26 cm);在Valsalva状态前后径、盆膈裂孔面积、肛提肌尿道间隙左、右各测量值阴道分娩组(6.10±0.82cm、23.27±4.85 cm^2、2.54±0.44cm、2.57±0.44cm),剖宫产组(5.48±1.46 cm、20.86±4.75 cm^2、2.42±0.33 cm、2.42±0.33 cm),均大于对照组(5.01±0.49cm、17.82±3.32 cm^2、2.09±0.25cm、2.09±0.25cm)差异均有统计学意义(均P<0.05)。结论产后经会阴盆底四维超声,可检出临床不易发现的轻度盆底功能障碍性疾病(PFD)和肛提肌损伤,为临床早期评估PFD及预防和干预PFD提供参考依据,值得推广。

Objective To investigate the application value of transperineal pelvic floor 4-dimensional ultrasonography in the assessment of image feature of pelvic diaphragm hiatus of postpartum women. Methods Case group 1 was transperineal delivery group with 87 cases at 6-8 weeks after childbirth labor and followed-up after delivery in obstetric outpatient. Case group 2 was selective uterine-incision delivery group with 64 cases at 6-8 weeks after uterine-incision delivery and followed up after delivery in obstetric outpatient. Control group included35 cases of benign gynecological diseases admitted in the hospital during the same period with no pregnancy or delivery history. Volumetric data was collected from 4-dimensional transperineal ultrasonography and the values of levator hiatal area（ LHA）,levator hiatal lateral pathway（ LHLP）,levator hiatal anteroposterior pathway（ LHAP） and levator-urethra gap（ LUG） of three groups were measured during the resting state and maximum Valsalva. The differences among groups were analyzed statistically. Results At the resting state,the LHAP,LUG for right and left of case group 1（ 5. 06 ± 0. 88 cm,2. 21 ± 0. 36 cm,2. 22 ± 0. 36cm） and case group 2（ 4. 67 ± 1. 33 cm,2. 08 ±0. 26 cm,2. 08 ± 0. 26cm） were greater than those of the control group（ 4. 55 ± 0. 87 cm,1. 88 ± 0. 26 cm,1. 88 ± 0. 26 cm）. At maximum Valsalva state,the LHAP,LHA,LUG for right and left of case group 1（ 6. 10 ± 0. 82 cm,23. 27 ± 4. 85 cm^2,2. 54 ± 0. 44 cm,2. 57 ± 0. 44cm） and case group 2（ 5. 48 ± 1. 46 cm,20. 86 ± 4. 75 cm^2,2. 42 ± 0. 33 cm,2. 42 ± 0. 33 cm） were greater than those of the control group（ 5. 01 ± 0. 49 cm,17. 82 ± 3. 32 cm^2,2. 09 ± 0. 25 cm,2. 09 ± 0. 25cm）,and the differences were statistically significant（ P〈0. 05）. Conclusion Postpartum 4-dimensional ultrasonography can detect mild pelvic floor dysfunction（ PFD） and injuries of puborectalis muscle which are not easily found by clinical examinations. It provides reference for clinical early assessment and preventing PFD,and it is worthy of promotion.