盆底超声评价产次及分娩方式对前盆腔的影响

Effects of parity and delivery mode on anterior compartment evaluated by pelvic floor ultrasound

目的通过盆底超声检查评估不同产次及分娩方式对前盆腔的影响。方法选择产后42~60 d的产妇250例,包括初次经阴道分娩产妇150例、二次经阴道分娩及剖宫产产妇各50例,行经会阴超声检查,观察静息状态下及最大Valsalva动作时前盆腔结构的变化。结果静息状态下膀胱颈到参考线的距离,对照组>剖宫产组>初次经阴道分娩组>二次经阴道分娩组,各组间差异有统计学意义(P<0.05);各组间膀胱后角未见明显差异。最大Valsalva动作时膀胱颈移动度、尿道旋转角、膀胱后角以及尿道内口漏斗化检出率,二次经阴道分娩组>初次经阴道分娩组>剖宫产组>对照组,各组间差异有统计学意义(P<0.05)。初次及二次经阴道分娩组最大Valsalva动作时,膀胱最低点位于参考线下,两组间差异无统计学意义(P>0.05);剖宫产组及对照组最大Valsalva动作时,膀胱最低点位于参考线上,两组间差异无统计学意义(P>0.05);而经阴道分娩组与剖宫产及对照组间比较,差异有统计学意义(P<0.05)。结论不同产次及分娩方式对女性前盆腔的影响程度不同,盆底超声可早期评估这些结构变化,为盆底功能障碍性疾病(PFD)的筛查和诊断提供可靠依据。

Objective To observe the effects of parity and delivery mode on anterior compartment evaluated by pelvic floor ultrasound.Methods A total of 250 postpartum women at 42~60 days after childbirth were selected,including 150 first vaginal delivery(FVD)women,50 second vaginal delivery(SVD)women and 50 cesarean section(CS)women.The structure changes of anterior compartment were observed at rest state and on maximal Valsalva maneuver by pelvic floor ultrasound.And 120 undelivered women were selected as the control group.Results The bladder neck-symphysis pubis distance(BSD)at rest was statistically significant between each group,with the control group>CS group>FVD group>SVD group.There was no significant difference in retrovesical angle(RA)at rest between each group.The bladder neck descent(BND),urethral rotation angle,RA and the detection rate of bladder neck funneling on maximal Valsalva maneuver were statistically significant between each group,with SVD group>FVD group>CS group>control group.The lowest point of the bladder on maximal Valsalva maneuver was below symphysis pubis in SVD group and FVD group,and the distance was not statistically significant.The lowest point of the bladder on maximal Valsalva maneuver was above symphysis pubis in CS group and control group,and the distance was not statistically significant.However,there was statistically significant between the vaginal delivery groups and the CS and control groups.Conclusion The effects of different parity and different delivery modes on anterior compartment could be evaluated early by pelvic floor ultrasound.And it could provide a reliable basis for the diagnosis and screening of dysfunctional diseases of pelvic floor.