经会阴三维超声评估不同分娩方式对初产妇产后早期肛提肌弹性的影响

Transperineal three-dimensional ultrasound in evaluation on impact of different delivery modes on levator ani muscle elasticity in early postpartum women

目的应用经会阴三维超声评估不同分娩方式对初产妇产后早期肛提肌弹性的影响。方法选择60名初产妇[经阴道分娩30名(阴道分娩组)、选择性剖宫产30名(剖宫产组)]及30名未育女性(对照组)为研究对象,并对所有受检者行经会阴三维超声检查。采集静息、收缩状态和最大瓦氏动作下盆腔图像,测量盆膈裂孔的面积(A)、周长(C)和肛提肌肌性部分长度(L),计算肛提肌收缩与静息状态时A、C、L差值(ΔA、ΔC、ΔL)及收缩状态时的应变率(ε);计算肛提肌最大瓦氏动作与静息状态时A、C、L差值(ΔA'、ΔC'、ΔL')及最大瓦氏动作时的应变率(ε')。结果阴道分娩组、剖宫产组ΔA、ΔC、ΔL、ε均小于对照组(P均<0.05),ΔA'、ΔC'、ΔL'、ε'均大于对照组(P均<0.05)。阴道分娩组与剖宫产组ΔA、ΔC、ΔL、ε、ΔA'、ΔC'、ΔL'、ε'比较,差异均无统计学意义(P均>0.05)。结论初产妇产后早期肛提肌弹性下降;选择性剖宫产对肛提肌弹性的保护作用有限。

Objective To evaluate the impact of different delivery ways on levator ani muscle elasticity in early postpartum women with transperineal three-dimensional ultrasound. Methods Totally 60 postpartum women （30 in spontaneous transvaginal delivery group and 30 in selective cesarean delivery group） and 30 non-fertile women （control group） were enrolled. All subjects underwent transperineal three-dimensional ultrasound. The images were acquired at rest, Valsalva and maximal levator ani muscle contraction, respectively, and then the area （A）, circumference （C） of levator hiatus and the length （L） of levator ani muscle were measured. The difference values of A, C, L （AA, AC, AL） were calculated between contraction and rest, and the strain rate （ε） was calculated at contraction. The difference of A, C, L （AA＇, △C, △L） were calculated between Valsalva and rest, and strain rate （ε） was calculated at Valsalva. Results The AA, △C,△L, εin spontaneous transviginal delivery group and selective cesarean delivery group were smaller than those in control group （all P〈0.05）, and △A＇, △C＇, △L＇,ε＇ in spontaneous transviginal delivery group and selective cesarean delivery group were larger than those in control group （all P〈0.05）, while there was no statistical difference between spontaneous transviginal delivery group and selective cesarean delivery group of △A, △C, △L, ε, △A＇, △C＇, △L＂ nor ε＂ （all P〉0.05）. Conclusion The levator ani muscle elasticity decreases in the early postpartum women, and selective cesarean delivery has limited role in protection of levator ani muscle.