经会阴三维盆底超声检查对不同分娩方式产妇盆腔脏器脱垂的诊断价值分析

Value of transperineal three-dimensional ultrasound in diagnosis of pelvic organ prolapse in different delivery methods

目的探讨经会阴三维盆底超声检查对经阴道分娩、剖宫产产妇盆腔脏器脱垂(pelvic organ prolapse,POP)的诊断价值。方法回顾性分析苏州市立医院北区2017年10~12月收治的POP产妇90例的临床资料,收集产妇一般资料、影像学资料等,根据产妇分娩方式的不同,将产妇分为经阴道分娩组(47例)及剖宫产组(43例)。另选同期正常健康体检女性47例为对照组,比较3组对象不同状态下肛提肌裂孔面积、矢状位肛提肌裂孔长度,并比较经会阴三维盆底超声检查对经阴道分娩组及剖宫产组产妇POP的检出率及诊断准确率。结果在静息状态、Valsalva动作状态、缩肛状态下,经阴道分娩组和剖宫产组的肛提肌裂孔面积和矢状位肛提肌裂孔长度明显大于对照组,差异均有统计学意义(P<0.05);但经阴道分娩组和剖宫产组产妇在静息状态、Valsalva动作状态、缩肛状态下肛提肌裂孔面积及矢状位肛提肌裂孔长度无明显差异(P>0.05);经阴道分娩组POP的检出率及诊断准确率分别为97.87%、95.74%,剖宫产组POP的检出率及诊断准确率分别为97.67%、95.34%,两组产妇POP的检出率及诊断准确率无明显差异(P>0.05)。结论经会阴三维盆底超声检查可较好显示盆底解剖结构,诊断经阴道分娩及剖宫产产妇POP准确率高,可为临床制定治疗方案提供可靠影像学资料。

Objective To investigate the diagnosis value of transperineal three - dimensional ultrasound in diagnosis of pelvic organ prolapsed （POP） in vaginal delivery and cesarean delivery. Methods 90 cases of POP maternity admitted to Suzhou City Hospital North district from October to December 2017 were selected, and their the maternal general information and imaging information were collected. According to different delivery methods, the women were divided into vaginal delivery group （ n = 47） and cesarean section group（ n =43）. Another 47 healthy women were selected as control group. Pelvic floor levator hiatus areas and sagittal levator hiatus lengths were compared among the three groups. Then the detection rate and accuracy of pelvic prolapse in the vaginaldelivery group and cesarean section group were compared with the transperineal three - dimensional ultrasound. Results Pelvic floor levator hiatus area and sagittal levator hiatus lengths in resting state, Valsalva action state, and under levator ani muscle shrinking condition of three groups were compared, and the results showed that the area and the length of vaginal delivery group and cesarean section group were larger than that of the control group（ P 〈 0. 05 ） ; Pelvic floor levator hiatus areas and sagittal levator hiatus lengths in resting state, Valsalva action state, and under levator ani muscle shrinking condition of vaginal delivery group and cesarean section group had no significant difference （ P 〉 0. 05 ） ; The detection rate and accuracy of pelvic prolapse were 97.87 % and 95.74 % in the vaginal delivery group and were 97.67 % and 95.34 % in cesarean section group, with no significant difference （ P 〉 0. 05 ）. Conclusion Transperineal three - dimensional ultrasound imaging can better display the pelvic anatomic structure, improve the accuracy of the diagnosis of pelvic organ prolapse, which can provide reliable imaging data for clinical treatment plan.