经会阴三维断层超声成像评估不同分娩方式对肛提肌的影响

Effects of different delivery modes on levator ani:an evaluation based on transperineal three-dimensional tomographic ultrasound imaging

目的应用经会阴三维超声断层成像(TUI)评估不同分娩方式对肛提肌的影响。方法选取60例产后6~8周产妇,根据分娩方式分为剖宫产组和顺产组,各30例,同时选择30例未生育妇女作为对照组。利用经会阴三维TUI技术测量盆膈裂孔的前后径、左右径、面积,评估肛提肌损伤情况。结果顺产组、剖宫产组盆膈裂孔的左右径、面积均大于对照组,且顺产组大于剖宫产组;顺产组盆膈裂孔的前后径分别大于对照组和剖宫产组(均P<0.05)。顺产组肛提肌损伤率高于剖宫产组(P<0.05)。结论相对于剖宫产,阴道分娩对肛提肌的完整性及功能改变更大,可加重肛提肌损伤。经会阴三维TUI可以显示盆膈裂孔的大小、形态,重建盆膈裂孔的多层面横断面图像,因而可用于评估不同分娩方式对肛提肌的影响。

Objective To evaluating the effects of different delivery modes on levator ani by using transperineal three-dimensional tomographic ultrasound imaging(TUI).Methods Sixty puerperae after 6-8 weeks of delivery were selected,and were assigned into cesarean section group(n=30)or spontaneous delivery group(n=30)according to delivery modes;meanwhile,another 30 nulliparae were selected as control group.The three-dimensional TUI technique were employed to measure anterior-posterior diameter,left-right diameter and area of pelvic floor levator hiatus,and to evaluate the condition of levator ani injury.Results The left-right diameter and area of pelvic floor levator hiatus were greater in the spontaneous delivery group and cesarean section group than those in the control group,and the spontaneous delivery group obtained greater those indicators mentioned above as compared with the cesarean section group;the anterior-posterior diameter of pelvic floor levator hiatus were greater in the spontaneous delivery group than that in the control group and the cesarean section(all P<0.05).The rate of levator ani injury in the spontaneous delivery group was higher than that in the cesarean section group(P<0.05).Conclusion Compared to cesarean section,vaginal delivery can bring about a greater change in integrity and function of levator ani,and can aggravate the levator ani injury.Transperineal three-dimensional TUI can display the size and shape of pelvic floor levator hiatus,and reconstruct multiplanar cross-section images of pelvic floor levator hiatus;therefore it can be applied to evaluate the effects of different delivery modes on levator ani.