经会阴超声评估阴道分娩与剖宫产分娩对经产妇产后早期盆底脏器脱垂的影响

Perineal ultrasound in evaluation of the effects of different delivery methods on pelvic floor organ prolapse in early postpartum period

目的通过经会阴盆底超声观察经产妇产后早期盆底器官解剖位置的变化,探讨阴道分娩与剖宫产分娩对经产妇盆底脏器脱垂的影响。方法选择2018年1月至2019年1月于梅州市人民医院门诊检查的产后5~10周的经产妇110例(阴道分娩组55例,剖宫产组55例)纳入研究组,同期选择30例健康未育女性作为对照组。应用二维经会阴盆底超声技术分别在静息状态及最大Valsalva动作状态下,测量膀胱尿道后角(PUA)、膀胱颈的位置(BNP)及宫颈外口的位置(CMP),并计算尿道旋转角(URA)、膀胱颈移动度(BND)、宫颈外口移动度(CDD),同时观察尿道内口有无漏斗化。结果阴道分娩组、剖宫产组与对照组相比,BNP、CMP位置降低,URA、BND、CDD活动度增加,差异有统计学意义(P<0.05);阴道分娩组BNP、CMP位置及URA、BND、CDD活动度增加情况与剖宫产组比较,差异未见统计学意义(P>0.05)。结论经会阴二维盆底超声技术可用于动态观察女性盆腔脏器的解剖结构、位置及功能状态,评估经产妇产后早期盆底脏器脱垂程度;经产妇盆底结构及功能的主要影响因素是妊娠本身,而非分娩方式。

Objective To observe the changes of the anatomical position of pelvic floor organs in the early postpartum period by transperineal pelvic floor ultrasound, so as to investigate the influence of vaginal delivery and cesarean section on prolapse of pelvic floor organs in transineal women. Methods A total of 110 perinatal women (55 cases in transvaginal delivery group and 55 cases in cesarean section group) at 5 to 10 weeks after delivery who were examined in the Outpatient Department of Meizhou People’s Hospital from January 2018 to January 2019 were selected as the study group, and 30 healthy and childless women were selected as the control group during the same period. Two-dimensional transperineal pelvic floor ultrasound was used to measure posterior urethrovesical angle (PUA), bladder neck position (BNP), cervical mouth position (CMP), urethral rotation angel (URA), bladder neck descent (BND), cervix down distance (CDD). And the infundibulation of the urethra was observed. Results Compared with control group, BNP and CMP position decreased in vaginal delivery group and cesarean section group, however, URA, BND and CDD activity increased in vaginal delivery group and cesarean section group, and the difference was statistically significant (P<0.05). There was no significant difference between the vaginal delivery group and the selective cesarean section group in BNP, CMP, URA, BND and CDD activity (P>0.05). Conclusions Transperineal two-dimensional pelvic floor ultrasound can be used to observe the anatomical structure, position and functional status of female pelvic organs dynamically, and evaluate the degree of early pelvic floor organ prolapse in postpartum women. The main influencing factor of pelvic floor structure and function of multipara is pregnancy, nor delivery mode.