盆底超声在产后早期康复治疗疗效评估中的应用

Application of Pelvic Floor Ultrasound in Evaluating Effect in Early Postpartum Rehabilitation Therapy

目的:探讨经会阴实时三维盆底超声测量肛提肌裂孔大小在产后早期康复治疗疗效评估中的应用。方法:选取产后42 d复诊的产妇40人,随机分为治疗组和对照组,每组20人。对照组指导其进行盆底肌肉自主康复训练,治疗组在对照组训练的基础上行生物反馈联合电刺激盆腔治疗。应用经会阴实时三维盆底超声对两组产妇在治疗前、治疗后行盆底超声检查,观察、测量其静息状态、valsalva(瓦氏)状态肛提肌裂孔形态、大小,并进行对比分析。结果:治疗前治疗组与对照组比较,肛提肌裂孔大小相差不大,差异无统计学意义(P>0.05);治疗组:治疗后裂孔大小与治疗前比较差异有统计学意义(P<0.05);对照组:治疗后与治疗前比较,除静息状态下周长比较差异有统计学意义(P<0.05)外,静息状态下的前后径、面积,valsalva状态下的前后径、周长、面积比较差异均无统计学意义(P>0.05);治疗后治疗组与对照组比较,除静息状态下前后径比较差异无统计学意义(P>0.05)外,静息状态和valsalva状态下的周长、面积及valsalva状态下的前后径比较差异均有统计学意义(P<0.05)。结论:经会阴实时三维盆底超声在产后评估盆底功能及早期康复治疗的疗效应用方面,简便、易行,为临床提供了直接、客观的影像学依据,值得推广应用。

Objective:To explore the application of perineal real-time three-dimensional pelvic floor ultrasound measurement of levator ani hiatus in the evaluation of early postpartum rehabilitation therapy.Methods:40 re-visiting patients with POP after vaginal delivery 42 days were collected and then divided into a treatment group and a control group with 20 cases in each group.Patients in the control group received pelvic floor muscle voluntary rehabilitation training,and the treatment group received pelvic floor muscle voluntary rehabilitation training and electrical stimulation combined with biofeedback therapy.The morphological characteristics of pelvic diaphragm hiatus,the perimeter and hiatus area of levator ani muscle were examined by transperineal three-dimensional ultrasound under the state of resting,valsalva before treatment and after treatment,respectively.Results:The sizes of the levator ani muscle hiatus were not much different between the control group and the treatment group before treatment,and the difference was not statistically significant(P>0.05);the treatment group:the sizes of the hiatus after treatment were significantly different from those before treatment(P<0.05);the control group:except for a statistically significant difference in the perimeters in the resting state(P<0.05),there were no significant differences in the anteroposterior diameters and areas in the resting state,nor in the anteroposterior diameters,the perimeters or the areas in the valsalva state(P>0.05)before and after treatment;after treatment,the treatment group and the control group showed no statistically significant difference in the anterior and posterior diameters in the resting state(P>0.05).However,there were statistically significant differences in the perimeters and areas both in the resting and valsalva state,and in the anterior and posterior diameters in the valsalva state(P<0.05).Conclusion:The application of transperineal real-time three-dimensional pelvic floor ultrasound in the evaluation of postpartum female pelvic floor function and early postpartum rehabilitation therapy is simple and feasible,and can provide a direct and objective imaging basis for clinical diagnosis.