三维超声成像技术对未育和已育女性盆膈裂孔的对比研究  

Comparative study of three-dimensional ultrasound imaging of pelvic diaphragm hiatus in nulliparous and procreated women

作　　者：林英姿[1] 高枫[1] 俞波[1] 蒋伟红[1] 宗珍[1] 

机构地区：[1]杭州师范大学附属医院超声科,310015

出　　处：《浙江医学》2011年第9期1300-1303,1319,共5页Zhejiang Medical Journal

摘　　要：目的 应用三维超声成像技术对未育和已育女性盆膈裂孔进行对比研究,探讨经产妇盆底解剖结构的改变.方法 选取2009年3月至2011年1月收治的未生育女性（对照组）、选择性剖宫产组、经阴道顺产组各50例.使用三维容积探头对受检者经会阴部进行探查,分别在静息状态和深吸气后屏气时（Valsalva状态）获得盆膈裂孔三维超声声像图,测量不同状态时盆膈裂孔的大小、面积、耻骨内脏肌的厚度,比较3组间各指标差异及相关性.结果 ⑴静息状态和Valsalva状态时,盆膈裂孔的左右径、前后径和面积均是阴道顺产组最大,对照组最小,阴道顺产组与另外两组进行比较,3个指标差异均有统计学意义（P＜0.05或0.01）.而选择性剖宫产组和对照组比较,静息状态时左右径差异有统计学意义（P＜0.05）,Valsalva状态时面积差异有统计学意义（P＜0.05）.⑵3组在Valsalva状态时,盆膈裂孔的3个指标均大于静息状态,差异均有统计学意义（均P＜0.01）,Valsalva状态时左右两侧的耻骨内脏肌厚度均小于静息状态,差异均有统计学意义（均P＜0.01）.⑶无论是静息状态还是Valsalva状态,3组间左右两侧的耻骨内脏肌厚度差异均无统计学意义（均P ＞0.05）,3组内左侧的耻骨内脏肌厚度均大于右侧,差异均有统计学意义（均P＜0.01）.⑷不同组别静息状态和Valsalva状态盆膈裂孔左右径与前后径均无相关关系（均P ＞0.05）,左右径和前后径两个指标均与面积存在相关关系（均P＜0.01）.不同组别静息状态和Valsalva状态时耻骨内脏肌左侧与右侧厚度均存在明显相关关系（均P＜0.01）.结论 妊娠及经阴道分娩均对盆底结构造成损伤,经阴道顺产者较选择性剖宫产造成的损伤更大.因此无论是阴道顺产还是选择性剖宫产的女性,产后均应及时进行盆底肌的康复锻炼,以防止盆底功能障碍性疾病的发生.Objective To compare the anatomic changes of pelvic floor in procreated women with nulliparous women using three-dimensional u）trasound imaging. Methods Fifty nulliparous women, 50 women with cesarean section and 50 women with vaginal delivery from March 2009 to January 2011 were enrolled in this study. Perineum of three groups was examined using three-dimensional volume transducer at both resting position and valsalva position. The three-dimensional ultrasonic tomograms of size, area of pelvic diaphragm hiatus and thickness of pubis visceral muscle were measured, Results The left-right （L-R） diameter, axial diameters and area of pelvic diaphragm hiatus in vaginal delivery group were the largest at resting and valsalva positions, and those in nulliparous group were the least （ P 〈0.05 or 0.01）. The L-R diameter at resting position and area at valsalva position of cesarean section group were larger than those of nulliparous group （P〈0.05）. All three indexes of pelvic diaphragm hiatus in 3 groups at valsatva position were larger than those at resting position （P〈0.01）. The pubis visceral muscle thickness on both sides at valsalva position was smaller than that at resting position （P〈0.01）. There were no significant differences in pubis visceral muscle thickness on both sides at resting position or valsalva position among three groups （P 〉0.05）. The left pubis visceral muscle was thicker than that of right one in all there groups （P〈0.01）. There was no correlation between L-R diameter and axial diameters at two positions among different groups （P 〉 0.05）. The L-R diameter and axial diameters were correlated with area （P〈0.01）. There was significant correlation in pubis visceral muscle thickness of both sides in 3 groups at resting position and valsalva position （P〈0.01）. Conclusion Pregnancy and vaginal delivery would affect pelvic floor texture, it is necessary for puerperae to perform rehabilitation exercises of pelvic floor muscle postpartum timely.

关 键 词：三维超声 盆膈生殖泌尿裂孔 未育 选择性剖宫产 阴道顺产 

分 类 号：R445[医药卫生—影像医学与核医学]