妊娠后不同时期妇女肛提肌收缩状况的超声影像学研究

Ultrasound imaging of the contraction of the anal sphincter in different periods of pregnancy

目的：通过观察孕妇盆底超声图像的差异，探讨不同妊娠时期妇女肛提肌收缩状况。方法选取2015年6月至2016年3月进行孕检且符合条件的妇女158例为研究对象。按不同妊娠时期分为三组：妊娠早期、妊娠中期和妊娠晚期，分别测量静息和肛提肌收缩状态下三维成像时肛提肌裂孔面积和长度、膀胱颈位置及矢状位肛提肌裂孔水平夹角，计算肛提肌收缩动作引起的盆底结构改变量。结果在静息状态，四组受检者的肛提肌裂孔长度、水平夹角及裂孔面积比较差异均未见统计学意义（P ﹥0.05）。在缩肛状态下，不同妊娠时期妇女与健康组女性肛提肌裂孔长度、水平夹角及裂孔面积比较差异均有统计学意义（P ﹤0.05）；而在三组妊娠受检者中，妊娠中期组与妊娠早期组以上三个方面比较差异均有统计学意义（P ﹤0.05）；妊娠晚期组与妊娠中期组以上三个方面比较差异均有统计学意义（P ﹤0.05）。妊娠晚期与健康组受检者肛提肌裂孔面积改变比例比较差异有统计学意义（P ﹤0.05）。不同妊娠时期妇女与健康组女性在肛提肌裂孔长度改变量、水平夹角改变量及膀胱颈移动度上比较差异均有统计学意义（P ﹤0.05）；而在三组妊娠受检者中，妊娠中期组与妊娠早期组以上三个方面比较差异均有统计学意义（P ﹤0.05）；妊娠晚期组与妊娠中期组以上三个方面比较差异均有统计学意义（P ﹤0.05）。结论不同妊娠时期对肛提肌收缩功能的改变量不同，妊娠晚期能明显降低肛提肌收缩功能，应在妊娠期加强肛提肌功能锻炼，防止发生盆底功能障碍疾病。

Objective To observe the difference of ultrasound images of the pelvic floor in preg-nant women,and to investigate the status of the contraction of the anal sphincter in different pregnancy periods. Methods From June 2015 to March 2016,158 women who were pregnant and qualified in hos-pital were selected as research subjects. According to the different period of pregnancy,158 pregnant women were divided into three groups：early pregnancy,mid pregnancy and late pregnancy. they were measured at rest and levatorani muscle contraction under 3D imaging of levatorani muscle crack pore area and length,bladder neck position and sagittal imperforate anus levator muscle splitting hole horizontal an-gle,calculation of the levatorani muscle contraction movement caused by pelvic floor structure change were measured. Results There was no significant difference in the length of the anal sphincter,the hor-izontal angle or the crack area between the four groups in rest（P ﹥ 0. 05）. In the anal contraction state, differences of pregnancy women with healthy group of women in the anus levator muscle splitting hole length,horizontal angle and crack hole area during different periods were significant（P ﹤ 0. 05）;in the three groups of pregnant subjects,the differences of middle and early pregnancy group in the above three aspects were significant（P ﹤ 0. 05）;difference of pregnancy group of late and middle pregnancy in the above three aspects were significant（P ﹤ 0. 05）. There had significant difference in the proportion of the area of the anal sphincter of the healthy group in the late period of pregnancy（P ﹤ 0. 05）. The differ-ences of anus provided muscle hiatus length change,horizontal angle change volume and bladder neck mobility degree among women in different periods of pregnancy and group of health women were signifi-cant（P ﹤ 0. 05）;in the above three aspects,middle and early pregnancy in the three groups of pregnant subjects had significant differences（P ﹤ 0. 05）;the above three aspects of late and middle pregnancy were significant（P ﹤ 0. 05）. Conclusions In different gestation period,the change of the contraction function of the anal sphincter muscle is different,the late pregnancy can significantly reduce the contrac-tile function of the anal sphincter,so the pregnant women are suggested to strengthen the functional exer-cise of the anal sphincter during pregnancy,and prevent the disease of pelvic floor dysfunction.