经会阴三维超声评价经阴道分娩或剖宫产后女性盆膈裂孔变化的临床研究

Changes of pelvic diaphragm and pelvic floor dysfunction in women with vaginal delivery and cesarean section by transvaginal three-dimensional ultrasound

目的通过经会阴三维超声观察经阴道分娩或剖宫产后女性的膈裂孔的变化情况,探讨生产方式对女性盆底形态的影响。方法选取我院产科分娩后的产妇320例,根据不同分娩方式分为经阴道分娩组(120例)与剖宫产组(200例),另选同期60例我院妇科门诊以阴道炎就诊的未育且无分娩史妇女作为对照组。入选产妇于产后7 d及产后2个月分别行经会阴三维超声检查,对照组于门诊入组时接受经会阴三维超声检查。比较各组盆膈裂孔各项参数。结果经阴道分娩组、剖宫产组产后7 d在静息状态和Valsalva动作下,盆膈裂孔各项参数均大于对照组,差异均有统计学意义(均P<0.05),其中经阴道分娩组盆膈裂孔各项参数均大于剖宫产组,差异均有统计学意义(均P<0.05)。经阴道分娩组、剖宫产组产后2个月在静息状态和Valsalva动作下,盆膈裂孔各项参数均大于对照组,差异均有统计学意义(均P<0.05)。经阴道分娩组静息状态和张力状态下,产后2个月与产后7 d盆膈裂孔面积比较差异均有统计学意义(均P<0.05),其余各项参数比较差异均无统计学意义。剖宫产组静息状态和Valsalva动作下,产后2个月与产后7 d盆膈裂各项参数比较差异均无统计学意义。结论经阴道分娩或剖宫产对产后女性盆底形态均有影响,其中经阴道分娩产后7 d影响大于剖宫产;产后2个月,经阴道分娩产妇盆底修复能力优于剖宫产产妇。经会阴盆底三维超声成像层次全面、清晰度高,能够准确提示不同分娩方式产妇产后早期盆膈裂孔、阴道形态及盆底形态的变化情况,为产后盆底疾病的预测和治疗提供参考。

Objective To observe the changes of pelvic diaphragm and pelvic floor function injury in women with vaginal delivery and cesarean section by transvaginal three-dimensional ultrasound, and to investigate the effect of delivery mode on pelvic floor function and morphology. Methods Three hundred and twenty women were divided into vaginal delivery group （120 cases ） and caesarean birth group（200 cases ） according to the different modes of delivery, 60 cases of vaginitis in the gynecological out-patient department with no birth and labor history were served as the control group. 7 d and 2 months after delivery, the women underwent transvaginal three-dimensional ultrasound examination, and the control group received transvaginal three-dimensional ultrasound examination in the out-patient department. And the measurement results were statistically analyzed. Results At 7 d postpartum,the pelvic diaphragm crack hole parameters in vaginal delivery and cesarean section production group were higher than those in control group on resting state and Valsalva state, the difference was statistically significant（all P〈0.05）, and the pelvic diaphragm crack hole parameters in vaginal delivery group was also significantly higher than those in the cesarean section group, the difference had statistical significance （all P〈0.05 ）. At 2 months postpartum, the parameters of the diaphragm were greater in vaginal delivery group and cesarean section group than those in the control group on resting state and Valsalva state, the difference was statistically significant（all P〈0.05 ）. In vaginal delivery group, the pelvic diaphragm area was significant difference7 d postpartum compared with 2 months postpartum on resting state and tension state（all P〈0.05）, and the other parameters were not statistically significant. There was no significant difference in the parameters of the 7 d postpartum and 2 months after delivery in the cesarean section group on resting state and Valsalva state, Conclusion Vaginal delivery and cesarean section have effect on the pelvic floor function, which is more obvious in vaginal delivery group than in cesarean section group 7 d postpartum, the pelvic floor function repair ability in vaginal delivery group is higher than the cesarean section group 2 months postpartum.