经会阴三维超声联合剪切波弹性成像评估经阴道分娩对肛提肌的影响

Evaluation on the influence of transvaginal delivery on levator ani muscle by transperineal three-dimensional ultrasound combined with shear wave elastography

目的应用经会阴三维超声联合实时剪切波弹性成像(SWE)定量评估初产妇肛提肌裂孔面积(LHA)变化及耻骨直肠肌的弹性,探讨两种检查方法在诊断盆底功能障碍性疾病中的临床应用价值。方法选取在我院经阴道分娩产后6~8周行盆底超声检查的初产妇50例(产后组)及同期健康未育女性41例(对照组)为研究对象,应用经会阴三维超声测量两组静息及最大缩肛状态下LHA,结果进行比较分析;应用SWE分别在静息及最大缩肛状态下测量耻骨直肠肌前部的杨氏模量值,比较两组耻骨直肠肌弹性及收缩功能的差异。结果产后组静息及最大缩肛状态下LHA均较对照组增大,差异均有统计学意义(均P<0.05)。产后组静息及最大缩肛状态下弹性参数均较对照组减小,差异均有统计学意义(均P<0.05)。结论经会阴三维超声联合SWE评估初产妇耻骨直肠肌功能具有一定可行性,可为盆底功能障碍性疾病的早诊断、早治疗提供理论指导和临床思路,具有较好的临床应用价值。

Objective To quantitatively evaluate the changes of levator ani hiatus area(LHA)and elasticity of puborectalis muscle by transperineal three-dimensional ultrasound combined with shear wave elastography(SWE),and to explore the clinical application value of two methods in diagnosis of pelvic floor dysfunction disease.Methods Totally 50 primiparas and 41 healthy infertile women were enrolled in and devided into the postpartum group and the control group,respectively.Pelvic floor ultrasound examination were performed at 6~8 weeks after vaginal delivery.The LHA at rest state and maximum annal contraction state were measured by transperineal three-dimensional ultrasound.The Young’s modulus of the front of the puborectalis muscle at rest state and maximum annal contraction state were measured by SWE.The difference of muscle elasticity and contractile function between the two groups were compared.Results In the postpartum group,LHA at rest state and maximum anal contraction state were increased compared with the control group,and the differences were statistically significant(both P<0.05).The Young’s modulus of postpartum group at rest state and maximum anal contraction state were decreased compared with control group,and the differences were statistically significant(both P<0.05).Conclusion Transperineal three-dimensional ultrasound combined with SWE is feasible to evaluate the function of puborectal muscle of primipara,which is potentially to be used in early diagnosis and pelvic floor dysfunction diseases therapeutic strategy.