多模态超声评估产次对会阴体及肛提肌功能影响的研究

Study on the effects of multimodal ultrasound evaluation of parity on the function of the perineal body and the levator ani muscle in parturients

目的运用二维灰阶超声联合实时剪切波弹性成像(SWE)探究产次对自然分娩产后早期会阴体(PB)及肛提肌(LAM)功能的影响。方法选取南充市中心医院产后6~8周自然分娩产妇为研究组,根据产次分为二次经产妇组46例及初产妇组55例。选择同期到本院做检查有性生活史未育的健康女性50例作为对照组。分别测量三组静息和最大收缩状态下会阴体长度、高度、杨氏模量值,静息、最大收缩以及Valsalva状态下双侧肛提肌杨氏模量值,计算差值,比较各组不同状态下超声参数变化情况。结果静息及最大收缩状态下二次经产妇组会阴体长度、高度、收缩幅度和杨氏模量值低于初产妇组和对照组,差异有统计学意义(P<0.05)。三组组间相同状态下肛提肌杨氏模量值与差值比较,差异均有统计学意义(P<0.05),对照组以及初产妇组组内不同状态下肛提肌杨氏模量值差异有统计学意义(P<0.05),二次经产妇组组内最大收缩状态下肛提肌杨氏模量值较Valsalva及静息状态增大,而Valsalva与静息状态比较,差异无统计学意义(P>0.05)。结论二次自然分娩对产后早期会阴体及肛提肌功能的影响较初次自然分娩更明显,二维灰阶超声联合实时剪切波弹性成像技术可以评估自然分娩不同产次会阴体及肛提肌功能的差异性。

Objective To investigate the effect of parity on the function of perineal body(PB)and levator ani muscle(LAM)in early postpartum period of natural childbirth by using two-dimensional gray scale ultrasound combined with real-time shear wave elas-tography(SWE).Methods Natural delivery women(6~8 weeks postpartum)in Nanchong Central Hospital were selected.According to the parity,the study subjects were divided into a secondary multipara group(n=46)and a primipara group(n=55).Another 50 healthy women with history of sexual intercourse and childlessness who came to our hospital for examination during the same period were selected as a control group.The length,height,and Young's modulus of the perineal body in three groups under resting and maximum contraction conditions,as well as the Young's modulus values of the bilateral levator ani muscles under resting,maximum contraction,and Valsalva conditions were measured,The differences were calculated.The changes in ultrasound parameters under different states in each group were compared.Results The perineal body length,height,contraction amplitude,and Young's modulus value of the secondary multipara group in resting-state,and maximum contraction state were all reduced compared with those of the primipara group and the control group(P<0.05).In the same state,the Young's modulus values and the difference of the levator ani muscle among the three groups was statistically significant(P<0.05).In different states,the differences in Young's modulus values of the levator ani muscle between the control group and the primipara group were statistically significant(P<0.05). Young's modulus of the levator ani muscle in maximum contraction state in the secondary multipara group was higher than that of resting-state and Vasalva state.There was no statistically significant difference in Young's modulus between the resting-state and valsalva state in the secondary multipara group(P>0.05).Conclusions The near-term impacts of the second natural childbirth on perineal body and levator ani muscle function are more obvious than those of the first natural delivery.The two-dimensional gray scale ultrasound combined with the real-time shear wave elastography technique can assess the variability of the perineal body and the levator ani muscle function among different parity in natural childbirth.