肛提肌应变率评估初产妇盆底肌收缩及拉伸功能的研究

Evaluation of Pelvic Floor Muscle Contraction and Stretching Function of Primipara by Using Strain Rate of Levator Ani Muscle

目的应用四维盆底超声技术检测初产妇产后6~8周的肛提肌应变率,以评估盆底肌的收缩和拉伸功能,并对不同分娩方式的结果进行对比研究。方法选取103例初产妇(顺产组63例、剖宫产组40例)和30例健康未育妇女(对照组)作为研究对象。采集静息状态、最大缩肛状态及最大Valsalva状态下盆底轴平面肛提肌裂孔图像,并测量裂孔面积(A)、周长(C)。统计肛提肌静息状态与收缩状态的A、C差值(ΔA1、ΔC1),计算收缩应变率(ε1);统计肛提肌最大Valsalva状态与静息状态的A、C差值(ΔA2、ΔC2),计算拉伸应变率(ε2),比较不同组别间差异。结果缩肛状态下,对照组ΔA1、ε1高于顺产组及剖宫产组,ΔC1高于顺产组(P<0.05);剖宫产组ΔA1、ε1、ΔC1均高于顺产组(P<0.05)。Valsalva状态下,对照组ΔA2、ε2、ΔC2均低于顺产组及剖宫产组(P<0.05);剖宫产组与顺产组ΔA2、ΔC2、ε2比较差异无统计学意义(P>0.05)。结论经阴道分娩和选择性剖宫产在产后早期均对肛提肌的收缩和拉伸功能造成影响,选择性剖宫产对肛提肌收缩功能的影响较小,两者对肛提肌拉伸功能的影响无差异。盆底超声能量化评估肌提肌收缩与拉伸功能。

Objective The strain rate of levator ani muscle of primipara was measured by four-dimensional pelvic floor ultrasound at 6-8 weeks postpartum to evaluate the contraction and stretching function of pelvic floor muscle,and the results of different delivery methods were compared.Methods A total of 103 primiparas(63 in the normal birth group and 40 in the cesarean section group)and 30 healthy childless women(control group)were selected as subjects.Images of hiatus of levator ani muscle at the pelvic floor axis plane were collected under the resting state,maximum anal contraction state and maximum Valsalva state,and hole area(A)and circumference(C)were measured.The difference values of A and C(ΔA1 andΔC1)and the contraction strain rate(ε1)between the contraction and resting states of levator ani were calculated.The difference of A and C(ΔA2 andΔC2)and the tensile strain rate(ε2)between the maximum Valsalva state and resting state of levator ani muscle were calculated and compared among different groups.Results Under anal retraction,ΔA1 andε1 in control group were higher than those in vaginal delivery group and cesarean section group,ΔC1 was higher than those in vaginal delivery group(P<0.05).TheΔA1,ε1 andΔC1 in cesarean section group were higher than those in vaginal delivery group(P<0.05).In Valsalva state,ΔA2,ε2 andΔC2 in control group were lower than those in normal delivery group and cesarean section group(P<0.05).There was no significant difference inΔA2,ΔC2 andε2 between cesarean section group and vaginal delivery group(P>0.05).Conclusions Both vaginal delivery and elective cesarean delivery affect the contraction and stretching function of the levator ani muscle in the early postpartum period.Selective cesarean section had little effect on the contractile function of the levator ani muscle,and there was no difference between the two on the stretching function of the levator ani muscle.Pelvic floor ultrasound can quantitatively evaluate levator ani muscle contraction and stretching function.