超声检查评估产后早期女性腹直肌及盆底结构与功能

Ultrasond examination in evaluation of structure and function of rectus abdominis and pelvic floor in early postpartum women

目的探讨超声检查评估产后早期女性腹直肌及盆底结构与功能的价值。方法对产后6~8周的102名初产妇均行经会阴盆底超声检查和腹部超声检查,检测最大瓦氏动作状态下肛提肌裂孔面积,分别测量脐、脐上3 cm及脐下3 cm水平腹直肌间距(IRD),采用Spearman相关性分析观察最大瓦氏动作状态下肛提肌裂孔面积与IRD之间的相关性。结果经会阴盆底超声检查示,102名产妇中47名盆底未见明显异常(无PFD组),55例诊断为PFD(PFD组)。无PFD组最大瓦氏动作下肛提肌裂孔面积为(14.52±2.72)cm 2,PFD组(22.78±5.51)cm 2,组间差异有统计学意义(t=9.81,P<0.05)。无PFD组脐水平IRD小于PFD组(P<0.05),2组脐上3 cm及脐下3 cm水平IRD差异均无统计学意义(P均>0.05)。产妇最大瓦氏动作状态下肛提肌裂孔面积与脐水平IRD呈正相关(r s=0.42,P<0.01)。结论超声检查可有效评估产后早期女性腹直肌及盆底结构与功能;腹直肌间距增加可能对女性盆底结构与功能造成不良影响。

Objective To investigate the value of ultrasound examinations in evaluation on structure and function of rectus abdominis and pelvic floor in early postpartum period.Methods Transperineal pelvic ultrasound and abdominal ultrasound were performed on 102 primiparas 6-8 weeks postpartum.The levator hiatal area was measured under the maximum Valsalva maneuver,and the inter-rectus diatance(IRD)of the level of umbilicus,3 cm above and 3 cm below the umbilicus were tested.Spearman correlation analysis was used to observe the correlation between the levator hiatal area under the maximum Valsalva maneuver and IRD of the umbilicus.Results Transperineal pelvic floor ultrasound showed PFD in 55 women(PFD group),while no PFD was detected in 47 women(non-PFD group).The maximum levator hiatal area in non-PFD group([14.52±2.72]cm 2)was less than that in PFD group([22.78±5.51]cm 2,t=9.81,P<0.05).IRD on the level of umbilicus of non-PFD group was less than PFD group(P<0.05),while no significant difference was found at 3 cm above umbilical level and 3 cm below the umbilical level between 2 groups(both P>0.05).There was positive correlation between the levator hiatal area under the maximum Valsava maneuver and IRD of umbilicus(r s=0.42,P<0.01).Conclusion Ultrasound is of great significance in evaluating postpartum inter-rectus abdominis and pelvic floor structure,indicating that the increase in IRD during early postpartum period can adversely affect the structure and function of pelvic floor.