经会阴二维及三维超声检查在绝经后女性盆底功能障碍性疾病患者肛提肌裂孔形变情况评估中的应用

Application of transperineal two-dimensional and three-dimensional ultrasonography in the evaluation of the levator ani muscle deformation in postmenopausal women with pelvic floor dysfunction

目的 探讨经会阴二维及三维超声检查在绝经后女性盆底功能障碍性疾病患者肛提肌裂孔形变情况评估中的应用价值。方法 选择2015年8月~2016年10月我院接诊的64例女性盆底功能障碍性疾病患者,均给予经会阴二维及三维超声检查,32例绝经后女性盆底功能障碍性疾病患者为观察组,32例未绝经女性盆底功能障碍性疾病患者为对照组。观察膀胱颈下移距离、尿道旋转角度、前盆腔膨出距离、子宫下移、直肠下移等情况,记录静息时及Valsalva动作时,肛提肌裂孔的左右径、前后径、周长及面积。结果 两组患者膀胱颈下移距离比较差异无统计学意义（P〉0.05）;观察组尿道旋转角度大于对照组,差异有统计学意义（t=2.0608,P=0.0435）;观察组前盆腔膨出距离长于对照组,差异有统计学意义（t=3.6267,P=0.0006）;观察组子宫下移数量（24例）多于对照组的17例;观察组子宫下移距离长于对照组,差异有统计学意义（t=4.4759,P=0.0000）;观察组直肠下移数量（23例）多于对照组（15例）,观察组直肠下移距离长于对照组,差异有统计学意义（t=4.1457、4.7955,P=0.0417、0.0000）。观察组患者无论静息时还是Valsalva动作时,肛提肌裂孔的左右径、前后径、周长及面积均明显大于对照组,差异有统计学意义（P〈0.01）。结论 经会阴二维及三维超声检查能反映患者肛提肌裂孔形变情况,对绝经后女性盆底功能障碍性疾病患者肛提肌裂孔形变情况评估提供有效参考依据。

Objective To investigate the application value of transesophageal two-dimensional and three-dimensional ultrasonography in the evaluation of the levator ani muscle deformation in postmenopausal women with pelvic floor dysfunction.Methods 64 cases of women with pelvic floor dysfunction were admitted to our hospital from August 2015 to October 2016.All patients Were examined through two-dimensional and three-dimensional uhrasonography.32 cases of postmenopausal women with pelvic floor dysfunction were chosen as the observation group,and 32 cases of non- menopausal female patients with pelvic floor dysfunction were chosen as the control group.A discussion was carried out on the application of transperineal two-dimensional and three-dimensional uhrasonography in the evaluation of the lev- ator ani muscle deformation in postmenopausal women with pelvic floor dysfunction through assessing the pelwic floor prolapse and the levator ani hiatus deformation of the patients in the two groups.The distance of vesical neck down- moving,urethral rotation angles,the distance of pelvic bulging,uterine down-moving,rectal down-moving was observed; left-right diameter, anteroposterior,perimeter and area of anal levator hiatal at resting and Valsalva gesture was record- e d.Results There was no significant difference between the two groups in the distance of vesical neck down-moving （P〉 0.05）;the urethral rotation angle of patients in the observation group was larger than that in the control group （t=2.0608,down-moving in the observation group,which was more than that in the control group （17 cases）,the uterine down-mov- ing distance in the observation group was longer than that in the control group （t=4.4759,P=0.0000）;for the observation, group,there were 23 cases with rectal down-moving,which was larger than the number of cases with rectal down-moving in the control group （15 cases）;the rectal descent distance in the observation was longer than that in the control group （t=4.1457,4.7955,P=0.0417,0.0000）.In the observation group,left-right diameter,anteroposterior,perimeter and area of anal levator hiatal were significantly greater than those of the patients in the control group whether at resting and Valsalva action,the differences between the two groups were statistically significant （P 〈0.01）.Conclusion Transperineal twodimensional, and three-dimensional ultrasonography can reflect the degree of levator ani hiatus deformation of patients, provides effective reference for the evaluation of the levator ani muscle deformation in postmenopausal women with pelvic floor dysfunction.