经会阴超声评估对产后女性盆底功能康复治疗的分析

Assessment on postpartum pelvic floor function rehabilitation therapy through perineal ultrasound

目的探讨会阴超声观察康复治疗对产后女性盆底结构的影响。方法选取丽水市中心医院妇产科2014年6月至2016年6月收治的85例女性盆底功能障碍性疾病患者分为两组,康复组给予康复治疗,常规组给予常规健康教育和产后保健操,运用会阴超声检测两组患者治疗前后,分别在静息、缩肛时、瓦氏动作时盆膈裂孔前后径、周长、面积和耻骨直肠肌宽度的变化;检测静息到瓦氏动作患者膀胱颈位置变化。结果康复组治疗后静息时盆膈裂孔前后径、周长、面积均显著低于治疗前(t值分别为3.189、4.024、4.385,均P<0.05),而常规组上述指标均无显著性差异(t值分别为0.075、0.816、0.139,均P>0.05)。两组患者治疗后盆膈裂孔前后径、周长、面积均显著低于治疗前(t=3.001~4.365,均P<0.05),康复组耻骨直肠肌宽度显著高于治疗前(t=3.257,P<0.05),而常规组治疗前后耻骨直肠肌宽度无显著性差异(t=0.012,P>0.05)。治疗后康复组瓦氏动作时盆膈裂孔前后径、周长、面积和BND均显著低于治疗前(t值分别为3.871、4.582、5.347、3.562,均P<0.05),而常规组治疗前后上述指标无显著性差异(t值分别为0.871、0.492、0.323、0.435,均P>0.05),且康复组治疗后瓦氏动作时盆膈裂孔前后径、周长、面积和BND均显著低于常规组治疗后(t值分别为3.281、4.134、4.762、3.511,均P<0.05)。结论女性盆底功能障碍性疾病经康复治疗能有效地改善盆底结构和功能,会阴超声能有效地评估康复治疗的疗效情况。

Objective To investigate the effect of rehabilitation treatment on postpartum pelvic floor structure assessed through perineal ultrasound. Methods A total of 85 cases of female pelvic floor dysfunction were selected and divided into two groups,rehabilitation group and conventional group. Patients in the rehabilitation group received rehabilitation treatment and patients in the conventional group were given conventional health education and postnatal exercises. Following items in two groups were detected by perineal ultrasound before and after treatment： anteroposterior diameter,circumference,area of pelvic diaphragm hiatus and muscoli puborectalis width in resting,anal contraction and valsalva maneuver,and bladder neck position change from resting to valsalva maneuver. Results Anteroposterior diameter,circumference and area of pelvic diaphragm hiatus in resting after treatment were significantly lower than before treatment in the rehabilitation group（t value was 3. 189,4. 024 and 4. 385,respectively,all P〈0. 05）,but there was no significant difference in above indexes in the conventional group（t value was 0. 075,0. 816 and 0. 139,respectively,all P〈0. 05）. Anteroposterior diameter,circumference and area of pelvic diaphragm hiatus after treatment in both groups were significantly lower than before treatment（t value ranged 3. 001-4. 365,all P〈0. 05）. Width of muscoli puborectalis after treatment was significantly greater than before treatment in the rehabilitation group（t = 3. 257,P〈0. 05）,but no significant difference in muscoli puborectalis before and after treatment was found in the conventional group（t = 0. 012,P〈0. 05）. Anteroposterior diameter,circumference,area and BND of pelvic diaphragm hiatus during valsalva maneuver after treatment were significantly lower than before treatment in the rehabilitation group（t value was 3. 871,4. 582,5. 347 and 3. 562,respectively,all P〈0. 05）,but no significant difference in above indexes appeared in the conventional group（t value was 0. 871,0. 492,0. 323 and 0. 435,respectively,all P〈0. 05）. In the rehabilitation group pelvic diaphragm hiatus anteroposterior diameter,perimeter,area and BND during valsalva maneuver were significantly lower than those in the conventional group after treatment（t value was 3. 281,4. 134,4. 762 and 3. 511,respectively,all P〈0. 05）. Conclusion Rehabilitation treatment for female pelvic floor dysfunction can effectively improve pelvic floor structure and function, and perineal altrosound can effectively evaluate efficacy of rehabilitation treatment.