会阴3D超声检查对初产妇阴道分娩后盆膈裂孔形态变化的评估价值

Value of perineal 3D ultrasound in assessing the morphological changes of pelvic diaphragm hiatus after vaginal delivery in primipara

目的采用会阴3D超声检查测量初产妇阴道分娩后盆膈裂孔形态变化情况,并评估其预测盆腔脏器脱垂的价值。方法选取2016年10月-2020年2月本院收治的经阴道分娩的初产妇112例(研究组),并选取同期本院体检健康的未育且无生产史女性84例(对照组)。比较两组受试者随访1年盆腔脏器脱垂发生比例、盆膈裂孔各项参数(盆膈裂孔前后径、盆膈裂孔左右径及盆膈裂孔面积)、肛提肌厚度及杨氏模量。绘制受试者特征(ROC)曲线分析研究组各参数对盆腔脏器脱垂的预测效能。结果在静息状态、缩肛状态及Valsalva状态下,研究组与对照组、脱垂亚组和未脱垂亚组受试者盆膈裂孔各项参数及肛提肌厚度、左右侧杨氏模量比较差异有显著性(t=4.645~37.691,P<0.05);ROC曲线分析结果显示,在静息状态下,产后6周研究组受试者经会阴3D超声检查获得的盆膈裂孔前后径、盆膈裂孔左右径、盆膈裂孔面积及肛提肌厚度、左右侧杨氏模量预测盆腔脏器脱垂的cut-off值分别为5.15 cm、3.45 cm、14.99 cm^(2)、0.47 cm、22.15 kPa、20.05 kPa(P<0.05),在缩肛状态下,上述各项指标预测盆腔脏器脱垂的cut-off值分别为4.31 cm、3.39 cm、13.83 cm^(2)、0.68 cm、31.17 kPa、28.34 kPa(P<0.05),而在Valsalva状态之下,上述的各项指标预测盆腔脏器脱垂的cut-off值分别为5.47 cm、4.08 cm、16.82 cm^(2)、0.57 cm、26.88 kPa、25.02 kPa(P<0.05)。结论初产妇阴道分娩后经会阴3D超声检查可准确反映盆膈裂孔形态变化,并可为产后女性盆腔脏器脱垂的预测及制定个性化康复训练等提供参考。

Objective To investigate the morphological changes of pelvic diaphragm hiatus after vaginal delivery in primipara by perineal 3D ultrasound and its value in predicting pelvic organ prolapse.Methods A total of 112 primipara who were admitted to our hospital and had vaginal delivery from October 2016 to February 2020 were enrolled as study group,and 84 healthy women without pregnancy and history of childbirth who underwent physical examination in our hospital during the same period of time were enrolled as control group.The two groups were compared in terms of the proportion of patients with pelvic organ prolapse,parameters of pelvic diaphragm hiatus(anteroposterior diameter,left-right diameter,and area of pelvic diaphragm hiatus),thickness of levator ani muscle,and Young’s modulus after one year follow-up.The receiver operating characteristic(ROC)curve was plotted to analyze the efficacy of various parameters in predicting pelvic organ prolapse.Results There were significant differences in each parameter of pelvic diaphragm hiatus,the thickness of levator ani muscle,and Young’s modulus of the left and right sides under the resting state,the anal contraction state,and the Valsalva state between the study group and the control group and between the prolapse subgroup and the non-prolapse subgroup(t=4.645-37.691,P<0.05).The ROC curve analysis showed that for the subjects in the study group at 6 weeks postpartum,perineal 3D ultrasound at the resting state obtained a cut-off value of 5.15 cm for the anteroposterior diameter of pelvic diaphragm hiatus,3.45 cm for the left-right diameter of pelvic diaphragm hiatus,14.99 cm^(2)for the area of pelvic diaphragm hiatus,0.47 cm for the thickness of levator ani muscle,22.15 kPa for Young’s modulus of the left side,and 20.05 kPa for Young’s modulus of the right side in predicting pelvic organ prolapse(P<0.05);at the anal constriction state,the cut-off values of these indices were 4.31 cm,3.39 cm,13.83 cm^(2),0.68 cm,31.17 kPa,and 28.34 kPa,respectively,in predicting pelvic organ prolapse(P<0.05);at the Valsalva state,the cut-off values of these indices were 5.47 cm,4.08 cm,16.82 cm^(2),0.57 cm,26.88 kPa,and 25.02 kPa,respectively,in predicting pelvic organ prolapse(P<0.05).Conclusion Perineal 3D ultrasound for primipara after vaginal delivery can accurately reflect the morphological changes of pelvic diaphragm hiatus and provide a reference for predicting postpartum pelvic organ prolapse in women and developing individualized rehabilitation training regimens.