目的：应用经会阴三维超声评价女性的肛提肌的功能，探索女性雌激素水平与肛提肌功能的相关性。方法：排除生育因素及内分泌因素的影响，选取受检者71人。根据月经史及年龄将受检者分为绝经前组（n=39）及绝经组（n=32）。对所有受检者进行经会阴三维超声检查，分别采集静息状态及Valsalva状态下肛提肌裂孔的图像。测量肛提肌裂孔的前后径（L）、面积（A）及肛提肌的长度（C）。计算出：肛提肌Valsalva状态下肛提肌裂孔前后径改变量（ΔL）、面积改变量（ΔA）、肛提肌的应变率（ε）。同时检测受检者的雌激素水平（E2），并与超声测量及计算数据进行相关性分析。结果：绝经前组中Valsalva状态下肛提肌裂孔的面积、前后径、肛提肌长度及ΔA与雌激素水平呈负性相关（r=-0.418、-0.367、-0.346、-0.458），差异有统计学意义（P<0.05）。ΔL、ε与雌激素水平无相关性，差异无统计学意义（P>0.05）。绝经组所有盆底测量数据与雌激素水平无相关性，差异无统计学意义（P>0.05）。结论：经会阴三维超声可以评价肛提肌的功能。绝经前肛提肌功能随着雌激素水平降低而下降，绝经后雌激素水平对肛提肌功能影响不明显。
Abstract
Objective: Evaluation of the function of female levator ani muscle by using perineal three-dimensional ultrasonography, and to explore the correlation between the level of female estrogen and the levator ani muscle function. Methods: Excluding the influence of fertility factors and endocrine factors, 71 subjects were selected. According to menstrual history and age, the subjects were divided into premenopausal group(n=39) and menopause group(n=32). All subjects were subjected to perineal ultrasonography, and images of the anal sphincter in resting state and in Valsalva state were collected. Measure the levator hiatus anteroposterior diameter, levator hiatus area and length of the levator ani muscle. Calculate the change of levator hiatus anteroposterior diameter(ΔL), the change of levator hiatus area(ΔA), and the strain rate of the levator ani muscle in the Valsalva states. The estrogen levels(E2) of the subjects were measured, and the correlation analysis was made between the ultrasonic measurements and the estrogen levels. Results: Premenopausal group of levator hiatus area during Valsalva maneuver,levator hiatus anteroposterior diameter during Valsalva maneuver, levator ani muscle length during Valsalva maneuver and ΔA were negatively correlated(r=-0.418, -0.367, -0.346, -0.458), the difference was statistically significant(P<0.05). There was no correlation in ΔL, ε and the estrogen level, the difference was not statistically significant(P>0.05). All pelvic floor measurements in the menopause group were not associated with estrogen levels, the difference was not statistically significant(P>0.05). Conclusion: The three-dimensional transperineal ultrasonography can evaluate the function of levator ani muscle. Premenopausal levator ani muscle function decreased with estrogen levels. Postmenopausal estrogen levels have no significant effect on levator ani muscle function.
关键词
雌激素类 /
超声检查 /
多普勒 /
彩色
Key words
Estrogens /
Ultrasonography, Doppler, color
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参考文献
[1]Delancey JO. Anatomy and biomechanics of genital prolapse[J]. Clin Obstet Gynecol, 1994, 36(4): 897-909.
[2]Grady D, Brown JS, Vittinghoff E, et al. Postmenopausal hormones and incontinence: the heart and Estrogen/Progestin Replacement Study[J]. Obstet Gynecol, 2001, 97(1): 116-120.
[3]Samuelsson E, Victor A, Svardsudd K. Determinants of urinary incontinence in a population of young and middle-aged women[J]. Acta Obstet Gynecol Scand, 2009, 79(3): 208-215.
[4]Berek JS, Novak. 妇科学[M]. 段涛，译. 13版. 北京：人民卫生出版社，2004：761.
[5]Yalcin OT, Hassa H, Ozalp S. Effectiveness of ultrasonographic parameters for documenting the severity of anatomic stress incontinence[J]. Acta Obstet Gynecol Scand, 2000, 79(5): 421-426.
[6]Lammers K, Kluivers KB, Vierhout ME, et al. Inter- and intraobserver reliability for diagnosing levator ani changes on magnetic resonance imaging[J]. Ultrasound Obstet Gynecol, 2013, 42(3): 347-352.
[7]Methfessel HD, Richter H, Seliger E, et al. Estrogen and progesterone receptors in mesenchymal structures of the female urogenital tract[J]. Zentralbl Gynakol, 1989, 111(8): 503-506.
[8]Copas P, Bukovsky A, Asbury B, et al. Estrogen, progesterone, and and estrogen receptor expression in levator ani muscle and fascia[J]. J Womens Health Gend Based Med, 2001, 10(8): 785-795.
[9]Kerkhof MH, Hendriks L, Br?觟lmann HAM. Changes in connective tissue in patients with pelvic organ prolapse—a review of the current literature[J]. Int Urogynecol J Pelvic Floor Dysfunct, 2009, 20(4): 461-474.
[10]Reay Jones NH, Healy JC, King LJ, et al. Pelvic connective tissue resilience decreases with vaginal delivery, menopause and uterine prolapse[J]. Br J Surg, 2003, 90(4): 466-472.
[11]Trutnovsky G, Guzmanrojas R, Martin A, et al. Pelvic floor dysfunction—does menopause duration matter?[J]. Maturitas, 2013, 76(2):134-138.
[12]载毓欣，朱兰，郎景和. 盆腔器官脱垂相关因素研究进展[J]. 中国实用妇科与产科杂志，2009，25（5）：392-394.
[13]陆瑜，郎景和，朱兰. 女性压力性尿失禁患者盆底结构的雌激素受体[J]. 中国医学科学院学报，2007，29（3）：402-406.
