四维超声成像对不同分娩方式初产妇盆底功能障碍性疾病的早期诊断

Early diagnosis of pelvic floor dysfunction in primipara with different delivery modes by four-dimensional ultrasound

目的探讨四维超声成像在自然分娩及剖宫产初产妇产后早期盆底功能障碍性疾病(PFD)中的应用价值。方法收集产后1年内出现PFD的初产妇56例(PFD组)和同期产后无PFD者70例(对照组),应用四维超声成像检测2组初产妇产后6～8周时膀胱尿道后角、膀胱颈移动度、尿道旋转角、肛提肌厚度及肛提肌裂口面积,分析比较不同分娩方式下2组产妇的超声参数。结果自然分娩产妇静息状态及Valsalva动作下肛提肌裂孔面积分别明显高于剖宫产产妇,且在不同分娩方式下PFD组均明显高于对照组,差异有统计学意义(P<0.05);自然分娩产妇Valsalva动作下肛提厚度明显低于剖宫产产妇,且在不同分娩方式下PFD组明显低于对照组,差异有统计学意义(P<0.05);自然分娩产妇的膀胱颈移动度、尿道旋转角分别明显高于剖宫产产妇,且在不同分娩方式下PFD组均明显高于对照组,差异有统计学意义(P<0.05)。结论四维超声参数可作为诊断初产妇产后早期PFD发病的指示指标,为产后PFD的临床诊断与预防提供依据。

Objective To investigate the application value of four-dimensional ultrasound in early postpartum pelvic floor dysfunction(PFD)in spontoneous labor cesarean section primipara.Methods Fifty-six PFD primipara(PFD group)and 70 non-PFD primipara(control group)within one year after delivery were collected.The posterior urethrovesical angle,mobility of bladder neck,urethra rotation angle,thickness of levator ani and average area of levator hiatus were measured by four-dimensional ultrasound at 6-8 weeks after delivery in two groups of primipara with different delivery methods.The ultrasound parameters of two groups of primipara with different delivery methods were analyzed and compared.Results At rest and Valsalva maneuver,the average area of levator hiatus in spontoneous labor primipara was significantly higher than cesarean section primipara,and the PFD group was significantly higher than the control group in different delivery methods,with statistically significant differences(P<0.05).During Valsalva maneuver,the thickness of levator ani was significantly lower than cesarean section primipara,and the PFD group was significantly lower than the control group in different delivery methods,with statistically significant differences(P<0.05).The mobility of bladder neck and urethra rotation angle in spontoneous labor primipara were significantly higher than cesarean section primipara,and the PFD group was significantly higher than the control group in different delivery methods,with statistically significant differences(P<0.05).Conclusion Four-dimensional ultrasound parameters can be used as indicators for the diagnosis of early postpartum PFD in primipara,and provide a basis for the clinical diagnosis and prevention of postpartum PFD.