阴道分娩与剖宫产对产妇提肛肌形态、盆底肌力和阴道黏膜神经分布的影响

Comparison of the effects of vaginal delivery and cesarean section on the levator ani muscle morphology,pelvic floor muscle strength,and vaginal mucosal nerve distribution of puerperae

目的:探究阴道分娩与剖宫产对产妇提肛肌形态、盆底肌力和阴道黏膜神经分布的影响。方法:选取2018年12月-2020年12月本院收治的产后42d产妇354例作为研究对象,依据分娩方式分为阴道分娩组(n=248例)和剖宫产组(n=106例),产后42d检测两组产妇的提肛肌形态、盆底肌力和阴道黏膜神经分布。结果:静息状态下,两组产妇的生殖裂孔水平夹角、直径、面积、横径比较均无差异(P>0.05);收缩状态下,阴道分娩组生殖裂孔水平夹角小于剖宫产组,生殖裂孔直径、面积、横径大于剖宫产组(P<0.05);Valsalva状态下,两组生殖裂孔水平夹角比较无差异(P>0.05),阴道分娩组生殖裂孔直径、面积、横径均大于剖宫产组(P<0.05);在静息与收缩状态下,阴道分娩组水平夹角改变量、裂孔直径改变量、裂孔面积改变量及膀胱颈移动度均小于剖宫产组(P<0.05);阴道分娩组Ⅰ型肌纤维与Ⅱ型肌纤维的肌力均小于剖宫产组(P<0.05),两组疲劳度无差异(P>0.05);阴道分娩组阴道前壁固有层血管活性肠肽及神经肽Y神经纤维分布均少于剖宫产组,后壁上皮层9.5蛋白基因产物及固有层VIP神经纤维分布均少于剖宫产组(均P<0.05),余各处阴道神经分布比较未见差异(P>0.05)。结论:无论是阴道分娩还是剖宫产均会对产妇的盆底功能有一定损害,应加强对产妇盆底的保护。

Objective:To explore the effects of vaginal delivery and cesarean section on the levator ani muscle morphology,pelvic floor muscle strength,and vaginal mucosal nerve distribution of puerperae.Methods:354puerperae were selected as the research subjects between December 2018and December 2020.According to the delivery methods,these puerperae were divided into group A(248puerperae with vaginal delivery)and group B(106puerperae with cesarean section).In the 42th day after delivery,the levator ani muscle morphology,the pelvic floor muscle strength,and the vaginal mucosal nerve distribution of the puerperae were compared between the two groups.Results:In the rest state,there were no significant differences in the horizontal contained angle,diameter,area,and transverse diameter of the reproductive hiatus of the puerperae between the two groups(P>0.05).In the contraction state,the value of the horizontal contained angle reproductive hiatus of the puerperae in group A was significantly lower than that of the puerperae in group B,and the values of the diameter,the area,and the transverse diameter of reproductive hiatus of the puerperae in group A were significantly higher than those of the puerperae in group B(P<0.05).In Valsalva A state,there was no significant difference in the horizontal contained angle of the reproductive hiatus of the puerperae between the two groups(P>0.05).The values of the diameter,the area,and the transverse diameter of the reproductive hiatus of the puerperae in group A were significantly higher than those of the puerperae in group B(P<0.05).The changes of the values of the horizontal contained angle,the diameter,and the area,and the bladder neck movement of the puerperae in group A were significantly less than those of the puerperae in group B in the rest and contraction states(P<0.05).The muscle strength of typeⅠor typeⅡmuscle fibers of the puerperae in group A was significantly lower than that of the puerperae in group B(P<0.05),and there was no significant difference in the fatigue of typeⅠand typeⅡmuscle fibers of the puerperae between the two groups(P>0.05).The distribution of nerve fiber distribution status of vasoactive intestinal peptide(VIP)and neuropeptide Y(NPY)in the anterior vaginal wall lamina propria of the puerperae in group A was significantly less than that of the puerperae in group B,and the distribution of 9.5protein gene products and VIP nerve fibers in the posterior cortical lamina propria of the puerperae in group A was significantly less than that of the puerperae in group B(all P<0.05).There were no significant differences in the distributions of the other vaginal nerves of the puerperae between the two groups(P>0.05).Conclusion:Both vaginal delivery and cesarean section will damage the pelvic floor function of the puerperae,thus it is necessary to strengthen the protection of the pelvic floor of the puerperae.