不同分娩方式产后早期盆底功能障碍的盆底超声评估

Pelvic floor ultrasound evaluation of early postpartum pelvic floor dysfunction in different delivery modes

目的应用经会阴盆底超声观察阴道分娩和剖宫产初产妇产后早期前、中、后3个盆腔的盆底功能障碍的改变及差异。方法收集成都市第一人民医院分娩的初产妇235例(阴道分娩120例、选择性剖宫产115例),应用盆底超声测量膀胱颈移动度、尿道旋转角、膀胱尿道后角,观察评估是否有尿道内口漏斗状扩张、膀胱颈移动度增大、膀胱膨出、子宫脱垂、直肠膨出,并测量器官脱垂的距离,比较阴道分娩和剖宫产的差异。结果阴道分娩组的膀胱颈移动度、尿道旋转角大于剖宫产组(P<0.05)。阴道分娩组压力性尿失禁、尿道内口漏斗状扩张、膀胱颈移动度增大、膀胱膨出的发生率大于剖宫产组(P<0.05),而子宫脱垂、直肠前壁膨出的发生率比较,差异无统计学意义(P>0.05)。阴道分娩组的膀胱膨出距离大于剖宫产组(P<0.05),而子宫脱垂距离、直肠膨出高度比较,差异无统计学意义(P>0.05)。结论盆底超声可评估产后盆底结构的改变,阴道自然分娩对前盆腔的损伤大于选择性剖宫产,两者在中盆腔及后盆腔的损伤无明显差异。

Objective To observe the changes and differences of the pelvic floor dysfunction in the anterior,middle and posterior pelvic cavities in early primiparous women of spontaneous vaginal delivery and selective cesarean section using transperineal pelvic floor ultrasound.Methods Totally 235 postpartum women(120 underwent spontaneous vaginal delivery and 115 underwent selective cesarean delivery)in Department of Ultrasound of Chengdu First People’s Hospital were examined by pelvic ultrasound.The mobility of bladder neck,the urethral rotation angle and bladder-urethral posterior angle were measured by application of pelvic floor ultrasound measurement.The existence of bladder neck funneling,the increase of mobility of bladder neck,cystocele,uterine prolapse and rectocele were observed and the distance of organ prolapse were measured.Finally the differences of vaginal delivery and cesarean delivery were compared.Results The mobility of bladder neck and the urethral rotation angle in vaginal delivery group were higher than those in cesarean delivery(P<0.05).The rates of stress urinary incontinenc,bladder neck funneling,increase of mobility of bladder neck and cystocele were higher in vaginal delivery group(P<0.05);and There was no statistical difference in the rate of uterine prolapse and rectocele(P>0.05).The distance of cystocele was lager in vaginal delivery group than that in cesarean delivery(P<0.05),and there was no statistical difference in distance of uterine prolapse and rectocele,there was no statistical difference(P>0.05).Conclusion The pelvic floor ultrasound could evaluate the change of postpartum pelvic structure.The damage of spontaneous vaginal delivery in the anterior pelvic cavity was greater than selective cesarean delivery,but there were no statistical differences in middle and posterior pelvic cavities.