真空辅助和自然阴道分娩对提肛肌撕裂的影响

Influence of vacuum extraction delivery and spontaneous delivery on levator ani avulsion

目的 本研究运用超声诊断技术比较经阴道真空辅助分娩（VE）和自然分娩（SD）两种分娩方式对提肛肌撕裂类型和发病率的影响。方法 选取2010-2012年该院的产妇VE和SD 188例,分娩6个月后对其进行超声诊断,测量尿道-提肛肌间隙距离,定义间隙距离〉25 mm为提肛肌肌肉撕裂。结果 VE后产妇尿道-提肛肌间隙距离比SD的产妇长,差异有统计学意义（=0.000）。VE后提肛肌撕裂发生率为14%（11/79）,SD后提肛肌撕裂发生率为9%（10/109）,两者比较差异无统计学意义。产妇年龄、分娩前体重指数、第二产程时间是产后提肛肌撕裂的高危因素。结论 VE显著增加初产妇尿道-提肛肌间隙距离,但提肛肌撕裂发生率无显著变化。

Objectives To compare the influence of vacuum extraction delivery （VE） and spontaneous delivery （SD） on the incidence and type of levator ani avulsion. Methods Totally 188 woman of vacuum extrac- tion delivery and spontaneous delivery between 2010 and 2012 were collected. They were diagnosed by ultra- sound evaluation 6 months after delivery, the length of urethra-levator gap was measured, and that urethra-levator gap 〉 25 mm was defined as levator ani avulsion. Results A significantly longer urethra-levator gap was found in the woman after vacuum extraction delivery compared to those after spontaneous delivery （P = 0.000）. The incidence of levator ani avulsion was 14% （11/79） after vacuum extraction delivery and 9% （10/109） after spontaneous delivery, but there was no difference between them. Maternal age, body mass index before labor and longer duration of the second labor stage were the risk factors for levator ani avulsion. Conclusions Vacuum extraction delivery significantly increases the length of urethra-levator gap, but does not have significant influence on the incidence of levator ani avulsion.