盆底二维超声观察产后便秘妇女肛提肌裂孔形态改变

Morphological Change of Levator Hiatus in Primiparas with Postpartum Constipation Using Twodimensional Ultrasound

目的通过盆底二维超声成像相关参数评估产后便秘妇女的肛提肌裂孔形态改变,比较不同分娩方式对初产妇肛提肌裂孔及排便功能的影响。方法选取286例在我院进行产后6~12周盆底超声检查、临床诊断便秘的初产妇进行回顾性分析,分为经阴道分娩组和选择性剖宫产组,并选取同期无便秘症状的经阴道分娩和选择性剖宫产的初产妇各100例作为对照组。在正中矢状切面测量所有产妇静息状态和有效Valsalva状态下肛提肌裂孔前后径及其变化值,采用方差分析比较各组间的差异,并对观察者内及不同观察者间测量数据进行一致性分析。结果静息状态和Valsalva状态下产后便秘妇女肛提肌裂孔前后径均明显大于对照组(P<0.05),经阴道分娩组产后便秘妇女的肛提肌裂孔前后径大于选择性剖宫产组。各组间肛提肌前后径变化值差异无统计学意义。一致性分析结果显示,观察者内及观察者间肛提肌裂孔前后径相关性良好(ICC>0.8)。结论经会阴二维超声测量肛提肌裂孔前后径是一种可重复性高且易于获得和使用的方法。产后便秘妇女盆底裂孔前后径较无便秘产妇显著增大,该参数可有效评估产妇肛提肌裂孔的形态学改变与便秘的关系,更适合应用于广大基层医院。

Objectives To evaluate the morphological change of levator hiatus in primiparous women with postpartum constipation using twodimensional(2D)pelvic ultrasonography.Methods A total of 286 primiparous women with clinically-diagnosed constipation were enrolled in this retrospective cohort study.Cases were subdivided into two groups(vaginal delivery group and planned Cesarean delivery group).For each subgroup,100 primiparas without constipation were selected as control.All women underwent a pelvic ultrasound scan in the postpartum period,and the anteroposterior(AP)hiatal diameter was measured at rest and on Valsalva in the mid-sagittal plane.Results The mean AP hiatal diameter was significantly larger in constipated primiparas than in the control group(P<0.05).Women who underwent vaginal delivery were more likely to have a larger size levator hiatus than those undergoing cesarean delivery.The AP hiatal diameter showed the best repeatability(ICC>0.8).Conclusion Constipation can be evaluated by measuring hiatal AP diameter with 2D transtibial ultrasound,which is inexpensive and easy to perform.A larger AP hiatal diameter can be found in women with postpartum constipation.