会阴三维超声在妊娠及不同分娩方式女性盆底功能评价中作用

Role of three-dimensional perineal ultrasound in evaluating pelvic floor function in patients with pregnancy and different delivery mode

目的探讨会阴三维超声评价妊娠及不同分娩方式女性盆底肌肌力及盆底裂孔面积的价值。方法80例定期行产后复查女性(生育组)根据分娩方式分为阴道顺产组40例和剖宫产组40例,选取未生育健康女性40例为对照组。入选者均行经会阴盆底三维超声检查,测量其盆底肌力及静息状态和Valsalva动作2种状态下盆底肛提肌裂孔前后径(anteroposterior diameter of levator hiatus,LH-A)、左右径(transverse diameter of levator hiatus,LH-D)、盆底裂孔的面积(area of urogenital hiatus,HA)和周长(circumference,C),并进行组间比较。结果生育组盆底肌力≤3级发生率(65%)高于对照组(25%)(P<0.05)。产后6~8周,阴道顺产组盆底肌力[(2.9±0.5)级]低于剖宫产组[(3.4±0.8)级](P<0.05);产后12~14周,阴道顺产组盆底肌力[(4.1±0.9)级]与剖宫产组[(4.3±1.2)级]比较差异无统计学意义(P>0.05)。静息状态及Valsalva动作时,生育组LH-A[(47.9±4.0)、(56.3±3.9)mm]、LH-D[(39.8±2.6)、(45.3±3.6)mm]、HA[(118.3±6.8)、(119.9±6.6)mm2]及C[(10.0±0.5)、(13.5±1.1)mm]均大于对照组[LH-A(43.1±4.4)、(49.5±3.8)mm,LH-D(36.2±2.9)、(40.2±2.7)mm,HA(111.2±7.0)、(112.7±7.0)mm2,C(10.9±0.3)、(11.1±0.6)mm](P<0.05);产后6~8周阴道顺产组LH-A[(43.5±2.5)、(56.8±4.4)mm]、LH-D[(40.2±1.5)、(49.2±3.3)mm]、HA[(117.3±5.8)、(126.8±7.4)mm2]及C[(15.3±7.6)、(15.8±1.4)mm]均大于剖宫产组[LH-A(40.1±2.1)、(50.0±3.9)mm,LH-D(39.1±1.8)、(41.7±3.5)mm,HA(114.6±4.3)、(116.4±6.6)mm2,C(22.1±10.5)、(10.1±0.7)mm](P<0.05)。结论经会阴三维超声检查可清晰显示女性盆底结构,通过分析盆底肌力及盆底裂孔面积可有效评价妊娠及不同分娩方式对盆底功能的影响,为临床提供重要的盆底影像学信息。

Objective To investigate the value of three-dimensional perineal cltrasound to the assessment of pelvic floor muscle strength and pelvic floor hiatus area in patients with pregnancy and different delivery mode. Methods According to the mode of delivery, 80 women(fertility group) were equally divided into vaginal delivery group and cesarean section group, and another 40 healthy women with no fertility were as controls(control group). All three groups underwent three-dimensional penineal ultrasound to measure the pelvic floor muscle strength, as well as the anteroposterior diameter of levator hiatus(LH-A), transverse diameter of levator hiatus(LH-D), area of levator hiatus(HA) and circumference(C) at resting and Valsalva’s maneuver. Results The percentage of pelvic floor muscle strength ≤3 grade was higher in fertility group(65%) than that in control group(25%)(P<0.05). In 6 to 8 weeks after delivery, pelvic floor muscle strength was lower in vaginal delivery group(2.9±0.5) than that in cesarean section group(3.4±0.8)(P<0.05), and showed no significant difference between vaginal delivery group(4.1±0.9) and cesarean section group(4.3±1.2) in 12 to 14 weeks after delivery(P>0.05). At rest and Valsalva’s maneuver, LH-A((47.9±4.0),(56.3±3.9) mm), LH-D((39.8±2.6), (45.3±3.6) mm), HA((118.3±6.8),(119.9±6.6) mm^2) and C((10.0±0.5),(13.5±1.1)mm)in fertility group were larger than those in control group((43.1±4.4),(49.5±3.8)mm;(36.2±2.9),(40.2±2.7)mm;(111.2±7.0),(112.7±7.0)mm2;(10.9±0.3),(11.1±0.6)mm)(P<0.05),and were larger in vaginal delivery group((43.5±2.5),(56.8±4.4)mm;(40.2±1.5),(49.2±3.3)mm;(117.3±5.8),(126.8±7.4)mm2;(15.3±7.6),(15.8±1.4)mm)than those in cesarean section group((40.1±2.1),(50.0±3.9)mm;(39.1±1.8),(41.7±3.5)mm;(114.6±4.3),(116.4±6.6)mm2;(22.1±10.5),(10.1±0.7)mm)at rest and Valsalva's maneuver(P<0.05).Conclusion Three-dimensional perineal ultrasound could show the female pelvic floor structure clearly.The measurment of pelvic floor muscle strength and HA by three-dimensional perineal ultrasound could effectively evaluate the influences of pregnancy and different delivery mode on pelvic floor function,which provides important pelvic floor imaging indicators for clinics.