盆底四维超声联合盆底表面肌电图评估不同分娩方式初产妇膀胱脱垂的临床价值

Clinical value of four dimensional ultrasound of pelvic floor combined with surface electromyography of pelvic floor in evaluating the prolapse of bladder in primipara with different delivery modes

目的探讨四维超声联合盆底表面肌电图评估不同分娩方式初产妇膀胱脱垂的临床价值。方法选择2021年10月至2023年9月在海南医学院第二附属医院产科门诊就诊的单胎足月分娩产后6~8周的初产妇413例,分为自然分娩组(349例)和剖宫产组(64例),分析并总结两组四维盆底超声特点。将有盆底表面肌电图检查结果的64例初产妇分为膀胱脱垂组(46例)和无膀胱脱垂组(18例),分析两组盆底四维超声联合盆底表面肌电图检查的特点,同时分析膀胱脱垂的相关危险因素。结果自然分娩组膀胱颈移动度、尿道旋转角大于剖宫产组(均P<0.05)。与剖宫产组相比,自然分娩组明显脱垂、尿道漏斗形成发生率较高,而轻度脱垂发生率低于剖宫产组(均P<0.05)。膀胱脱垂组的膀胱颈移动度、尿道旋转角、裂孔面积大于无膀胱脱垂组(均P<0.05)。膀胱脱垂组快肌阶段最大值、慢肌阶段平均值低于无脱垂组(均P<0.05)。单因素Logistic回归分析发现婴儿出生体重增加、自然分娩、膀胱颈移动度增加、膀胱后角开放、尿道旋转角增大、裂孔面积增大、快肌阶段最大值减低、慢肌阶段平均值减低是膀胱脱垂的危险因素。多变量Logistic回归分析结果显示,肛提肌裂孔面积增大(OR=2.216,P=0.015)、快肌阶段最大值减低(OR=0.847,P=0.035)是膀胱脱垂的危险因素。结论盆底超声联合盆底表面肌电图可定性、定量评估产后女性的盆底肌结构和功能变化,对膀胱脱垂及其程度进行诊断。肛提肌裂孔面积增大、快肌阶段最大值减低可能是初产妇产后6~8周发生膀胱脱垂发生的危险因素。

Objective To evaluate the clinical value of four dimensional ultrasound combined with pelvic floor surface electromyography in the assessment of bladder prolapse in primipara with different delivery modes.Methods A total of 413 primipara 6-8 weeks after full-term delivery were selected from the obstetrics clinic of the Second Affiliated Hospital of Hainan Medical College from October 2021 to September 2023.They were divided into natural delivery group(349 cases)and cesarean section group(64 cases).The characteristics of 4D pelvic floor ultrasound in the two groups were analyzed and summarized.Then 64 cases of primipara with pelvic floor surface electromyography were divided into bladder prolapse group(46 cases)and no bladder prolapse group(18 cases).The characteristics of four dimension ultrasound combined with pelvic floor surface electromyography in the two groups were analyzed,and the related risk factors of bladder prolapse were analyzed.Results The bladder neck mobility and urethral rotation angle in the natural delivery group were higher than those in the cesarean section group(all P<0.05).Compared with the cesarean section group,the incidence of obvious prolapse and urethral infundibulation was higher in the natural delivery group,while the incidence of mild prolapse was lower than that in the cesarean section group(all P<0.05).Bladder neck mobility,urethral rotation angle and levator ani hiatal area in the prolapsed bladder group were higher than those in the non-prolapsed bladder group(all P<0.05).The maximum value of fast muscle stage and the mean value of slow muscle stage in the group with prolapse were lower than those in the group without prolapse(both P<0.05).Univariate Logistic regression analysis found that the risk factors for bladder prolapse were increased birth weight,natural delivery,increased bladder neck mobility,posterior bladder angle was opened,increased urethral rotation angle,increased levator ani hiatal area,decreased maximum value of fast muscle stage and decreased mean value of slow muscle stage.Multivariate Logistic regression analysis showed that increased ani hiatal area(OR=2.216,P=0.015)and decreased maximum value of tater muscle stage(OR=0.847,P=0.035)were risk factors for bladder prolapse.Conclusions Pelvic floor ultrasound combine with pelvic floor surface electromyography can qualitatively and quantitatively evaluate the changes of pelvic floor muscle structure and function in postpartum women,and diagnose bladder prolapse and its degree.The increase of levator ani hiatal area and the decrease of maximum value of tater stage may be the risk factors for bladder prolapse at 6-8 weeks postpartum in primiparas.