不同阶段剖宫产对产妇盆底结构和功能影响的对比研究

Comparative study on the pelvic floor structure and function of cesarean section at different stages

目的探讨不同阶段剖宫产对产妇盆底结构和功能的影响。方法选择2015年5月至2016年10月于本院待产的133例产妇为研究对象,将其中经阴道分娩的40例产妇纳入阴道分娩组,56例择期剖宫产产妇纳入择期剖宫产组,37例经相应评估及处理后选择行第二产程剖宫产的产妇纳入第二产程剖宫产组。三组产妇均于产后6~8周完成压力性尿失禁(stress urinary incontinence,SUI)检查、盆腔器官脱垂(pelvic organ prolapse,POP)检查及超声检查。所有产妇均随访40天,第1次随访于上述检查后的第20天,第2次随访与第1次随访间隔20天,记录随访中产妇不良反应发生情况。结果三组产妇SUI阳性比和POP阳性比比较均具有显著差异(P<0.05),第二产程剖宫产组产妇SUI阳性比和POP阳性比最高(P<0.05)。三组产妇膀胱颈角度(静息状态和最大幅度Valsalva动作时)、膀胱旋转角、膀胱颈移动度比较均具有显著差异(P<0.05),择期剖宫产组上述指标最小(P<0.05)。三组产妇随访期间不良反应发生率比较均具有显著差异(P<0.05),阴道分娩组和择期剖宫产组产妇不良反应发生率较低且无显著差异(P>0.05),第二阶段剖宫产组产妇不良反应发生率明显高于其他两组(P<0.05)。结论相较于第二产程剖宫产和阴道分娩,择期剖宫产对产妇盆底结构和功能具有一定的保护作用。

Objective To investigate the impact of cesarean section at different stages on pelvic floor structure and function. Method 133 cases of partutients from May 2015 to October 2016 in our hospital were selected as the research objects, in which 40 cases who underwent vaginal delivery were included in vaginal delivery group, 56 cases who underwent elective cesarean section were included in elective cesarean section group, and 37 cases who underwent cesarean section for the second stage of labour after the corresponding evaluation and treatment were included in the second stage of cesarean section group. Three groups completed the stress urinary incontinence （SUI） examination, pelvic organ prolapse （POP） examination and ultrasonic examination at 6～8 weeks postpartum. All partutients were followed up by research assistants to make sure whether they feel physically uncomfortable after delivery, the first follow up was at 20 days after above mentioned examinations, and the second follow up was at 40 days after abvoe mentioned examinations. And the adverse reactions were recorded. Result The positive ratio of SUI and POP among the three groups were significantly different （P〈0.05）, the positive ratio of SUI and POP in the second stage of cesarean section group were the highest. The angle of the bladder neck （resting state and amplitude peak Valsalva action）, bladder rotation angle and bladder neck mobility were significantly different among three groups （P〈0.05）, and all of them were the least in elective cesarean section group. The adverse reaction rate during the follow-up among three groups showed significant differences （P〈0.05）, vaginal delivery group and elective cesarean section group had lower adverse reaction rate and showed no significant difference （P〉0.05）, the adverse reaction rate in the second stage of cesarean section group was the highest （P〈0.05）. Conclusion Compared with cesarean section for the second stage of labour and vaginal delivery, elective cesarean section has a protective effect on the structure and function of pelvic floor.