经会阴三维超声定量评估初产妇肛提肌裂孔形态参数的价值分析

Value analysis of the morphological parameters of anal levator hiatus of primiparass quantitatively evaluated by transperineal three-dimensional ultrasound

目的:分析经会阴三维超声定量评估初产妇肛提肌裂孔形态价值。方法:回顾性分析2019年1月-2021年12月本院分娩的86例初产妇临床资料,其中52例经阴道分娩(阴道分娩组),34例经剖宫产分娩(剖宫产组),记录两组初产妇产后6周时盆底肌张力分级及经会阴三维超声肛提肌裂孔参数,评估阴道分娩组盆底肌张力分级与肛提肌裂孔参数的相关性;比较两组产后6周、12周经会阴三维超声肛提肌裂孔参数变化情况。结果:产后6周时,阴道分娩组盆底肌张力分级低于剖宫产组,静息及最大Valsalva状态下肛提肌裂孔前后径、左右径及面积均大于剖宫产组,且阴道分娩组盆底肌张力Ⅰ~Ⅲ级者静息及最大Valsalva状态下肛提肌裂孔前后径、左右径及面积均大于Ⅳ~Ⅴ级者(均P<0.05);Spearman秩相关分析,盆底肌张力分级与静息状态下肛提肌裂孔前后径、左右径、面积及最大Valsalva状态下肛提肌裂孔前后径、左右径、面积均呈负相关(均P<0.05)。产后12周时,两组静息及最大Valsalva状态下肛提肌裂孔前后径、左右径及面积均较产后6周缩小(P<0.05),产后12周两组无差异(P>0.05)。结论:经会阴三维超声可通过实时、定量测量初产妇肛提肌裂孔形态,观察盆底功能异常情况,对产后康复训练具有指导作用。

Objective:To analyze the value of the morphological parameters of anal levator hiatus of primiparass quanti-tatively evaluated by transperineal three-dimensional ultrasound.Methods:The clinical data of 86 primiparass who had delivery in the hospital from January 2019 to December 2021 were analyzed retrospectively.In these primiparass,there were 52 cases with vaginal delivery in group A and 34 cases with cesarean delivery in group B.The pelvic floor muscle tension grading and the parameters of anal levator hiatus evaluated by transperineal three-dimensional ultrasound of the primiparass in both groups in the 6th weeks after delivery were recorded.The correlation between the pelvic floor muscle tension grading of the primiparass in group A and their parameters of anal levator hiatus was evaluated.The param-eters changes of anallevator hiatus evaluated by transperineal three-dimensional ultrasound of the primiparass in the 6th week and in the 12th week after delivery were compared between the two groups.Results:The pelvic floor muscle tension grading of the primiparass in group A in the 6th week after delivery was significantly lower than that of the primiparass in group B.The values of anteroposterior diameter,lftright diameter,and area of anal levator hiatus in the resting state and in the maximum Valsalva state of the primiparass in group A were significantly higher than those of the primiparass in group B,and which of the primiparass with pelvic floor muscle tension grade IHII in group A were signifiatly higher than those of the primiparass with pelvic floor muscle tension grade IV-V(all P<0.05).Spearman rank correlation analysis showed that the pelvic floor muscle tension grading of the primiparass was significantly nega-tively correlated with their values of anteroposterior diameter,left right diameter,and area of anal levator hiatus in the resting state and in the maximum Valsalva state(all P<0.05).The values of anteroposterior diameter,left right diameter,and area of anal levator hiatus in the resting state and in the maximum Valsalva state of the primiparass in both groups in the 12th week after delivery were significantly smaller than those of the primiparass in the 6th week after delivery(P<0.05),and which of the primiparass in the 12th week after delivery had no statistical significant differences between the two groups(P->0.05).Conclusion:T ransperineal three-dimensional ultrasound can provide guidance for pos tpartum rehabilitation training of the primiparass by measuring the morphology of anal levator hiatus in real time and quantitatively and by observing the abnormality of pelvic floor function.