目的：通过经会阴盆底超声观察初产妇产后早期盆底器官解剖位置及肛提肌增厚率的变化，探讨不同分娩方式对初产妇盆底结构及功能的影响。方法：选择产后6~10周的初产妇100例（经阴道分娩者50例，选择性剖宫产者50例）纳入研究组，同期选择30例健康未育女性作为对照组。应用二维经会阴盆底超声技术分别在静息及最大Valsalva动作状态下，测量尿道倾斜角（UTA）、膀胱尿道后角（PUA）、膀胱颈的位置（BNP）及宫颈外口的位置（CMP），并计算尿道旋转角（URA）、膀胱颈移动度（BND）、宫颈外口移动度（CDD），同时观察尿道内口有无漏斗化。另于静息及最大收缩状态下，测量左、右两侧肛提肌中部的厚度（TN），计算收缩状态下肛提肌中部的增厚率（TR）。结果：初产妇与未育女性相比，BNP、CMP位置降低，UTA增大，URA、BND、CDD活动度增加，肛提肌TR降低，尤以经阴道分娩者中表现明显。未育组、选择性剖宫产组的URA、BND、CDD与TR均呈负相关（P＜0.05）。经阴道分娩组URA、BND、CDD与TR无明显相关性（P＞0.05）。结论：经会阴二维盆底超声技术可用于动态观察女性盆腔脏器的解剖结构、位置及功能状态，初产妇盆底结构及功能的主要影响因素是妊娠本身，而非分娩方式。
Abstract
Objective: This study aimed to observe the changes of the anatomical position of the pelvic floor and the thickening rate of the levator ani muscle in the early stage of postpartum, and to explore the effect of different delivery modes on the pelvic floor structure and function in primipara. Methods: One hundred cases(including 50 cases of vaginal delivery and 50 cases of selective cesarean section) of primipara postpartum 6~10 weeks were selected as the study group. Thirty cases of nulliparous women were selected as the control group. The urethral tilt angel(UTA), posterior urethrovesical angel(PUA), bladder neck position(BNP) and cervical mouth position(CMP) were measured at rest and maximum Valsalva operation by two-dimensional perineal pelvic ultrasonography, respectively. The urethral rotation angel(URA), bladder neck descent(BND), cervix down distance(CDD) were calculated and meanwhile the mouth of the urethra was evaluated to be funnel-shaped or not. In addition, the thickness(TN) of the middle levator ani muscle was measured at rest and the maximum contraction state, and the thickening rate(TR) in the middle levator ani muscle was calculated. Results: Compared with nulliparous women, the position of BNP and CMP moved downward, UTA increased, URA, BND and CDD became more mobile, and the levator muscle TR decreased in the primipara, especially in vaginal delivery women. There was a negative correlation between URA, BND, CDD and TR in the control group and the selective cesarean section group. There was no significant correlation between URA, BND, CDD and TR in vaginal delivery group. Conclusion: The perineal pelvic ultrasonography can be used to observe the anatomical structure, location and function of female pelvic organs dynamically.
关键词
骨盆底 /
超声检查 /
多普勒 /
彩色
Key words
Pelvic Floor /
Ultrasonography, Doppler, color
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Dietz HP, Valeria L. Levator trauma after vaginal delivery[J]. Obstet Gynecol, 2005, 106(4): 707-712.
[2]Dietz HP, Steensma AB. The prevalence of major abnormalities of the levator ani in urogynaecological patients[J]. BJOG, 2006, 113(2): 225-230.
[3]South MM, Stinnett SS, Sanders DB, et a1． Levator ani denervation and reinnervation 6 months after childbirth[J]. Am J Obstet Gynecol, 2009, 200(5): 519. e1-7.
[4]Kenton K, Mueller E, Brubaker L. Continent women have better urethral neuromuscular function than those with stress incontinence[J]. Intern Urogynecol J, 2011, 22(12): 1479-1484.
[5]Reisinger E, Stummvoll W. Visualization of the endopelvic fascia by transrectal three-dimensional ultrasound[J]. Int Urogynecol J Pelvic Floor Dysfunct, 2006, 17(2): 165-169.
[6]孙贝贝，王志莲. 浅论导致女性发生盆腔器官脱垂的危险因素[J]. 当代医药论丛，2015，（15）：260-261.
[7]Barbosa AM, Marini G, Piculo F, et al. Prevalence of urinary incontinence and pelvic floor muscle dysfunction in primiparae two years after cesarean section: cross-sectional study[J]. Sao Paulo Med J, 2013, 131(2): 95-99.
[8]Wallner C, van Wissen J, Maas CP, et al. The contribution of the levator ani nerve and the pudendal nerve to the innervation of the levator ani muscles: a study in human fetuses[J]. Eur Urol, 2008, 54(5): 1136-1142.
[9]Dragoo JL, Padrez K, Workman R, et al. The effect of relaxin on the female anterior cruciate ligament: Analysis of mechanical properties in an amimal model[J]. Knee, 2009, 16(1): 69-72.
[10]Shek KL, Kruger J, Dietz HP. The effect of pregnancy on hiatal dimensions and urethral mobility: an observational study[J]. Intern Urogynecol J, 2012, 23(11): 1561-1567.
[11]李勤，应涛，徐莲，等. 妊娠晚期女性盆膈裂孔的超声影像学表现[J]. 中华超声影像学杂志，2012，21（6）：496-499.
[12]Dietz HP. Quantification of major morphological abnormalities of the levator ani[J]. Ultrasound Obstet Gynecol, 2007, 29(3): 329-334.
[13]Dietz HP, Shek C. Levator avulsion and grading of pelvic floor muscle strength[J]. Intern Urogynecol Pelvic Floor Dysfunc, 2008, 19(5): 633-636.
[14]Ashton-Miller JA, DeLancey JO. Functional anatomy of the female pelvic floor[J]. Ann New York Acad Sci, 2007, 1101: 266-296.
[15]Sultan AH. The role of anal endosonography in obstetrics[J]. Ultrasound Obstet Gynaecol, 2003, 22(6): 559-560.
