经会阴三维超声评估不同分娩方式对初产女性盆膈裂孔影响的临床价值  

Clinical value of transvaginal three-dimensional ultrasound in assessing the influence of different delivery methods on the pelvic diaphragm hiatus in primipara

作　　者：陈静[1] 龚国芸[1] 黄晴[1] 练丹[1] 李柳兰[1] 邱洪凤[1] 

机构地区：[1]广西医科大学第四附属医院/柳州市工人医院超声科,柳州545005

出　　处：《重庆医科大学学报》2016年第7期703-707,共5页Journal of Chongqing Medical University

基　　金：广西壮族自治区卫计委自筹科研基金资助项目(编号:z2013615)

摘　　要：目的:应用经会阴三维超声评价分析妊娠晚期女性盆膈裂孔(pelvic hiatus,PH)的形态结构。方法:选择2013年1月至2015年10月出院的剖宫产与经阴道分娩产妇各50例,分别列为剖宫产组与经阴道分娩组,进行经会阴三维超声检查,并选择同期妇科疾病体检的未育女性50例作为对照组,观察正常PH与分娩后PH超声学表现,比较两种不同分娩方式不同时间PH左右径、前后径及面积的变化特征。结果:(1)对照组PH形态:呈"菱形",裂隙样结构;剖宫产组产妇分娩后PH与对照组形态一致24例(48),其余26例PH形态呈"类椭圆形"。经阴道分娩组PH与对照组形态一致0例,均呈"类椭圆形",超声影像提示PH内结构模糊,回声紊乱;(2)剖宫产组、经阴道分娩组产前静息状态、缩肛运动、瓦氏动作时PH左右径、前后径与面积均高于对照组(P<0.05),剖宫产组产后6周、3个月较明显产前缩小(P<0.05),经阴道分娩组产后三种状态下PH左右径、前后径与面积显著增大,3个月后减小,但均大于产前、对照组及剖宫产组(P<0.05),3个月后缩肛运动、瓦氏动作时PH左右径、前后径与面积高于剖宫产组(P<0.05)。结论:经会阴三维超声可清晰观察女性盆底结构,2种分娩方式均对女性PH具有影响,其中经阴道分娩影响较为显著。Objective ：To evaluate the morphological structure of the female pelvic hiatus（PH） in the late pregnancy by transvaginal three-dimensional ultrasound. Methods：Fifty cases of cesarean section delivery and 50 cases of vaginal delivery discharged from the hospital from January 2012 to December 2014 were taken as cesarean section group and vaginal delivery group and were checked by transvaginal three-dimensional ultrasound. Fifty cases of nulliparous women with gynecological diseases examination in the same period were taken as control group. Ultrasound findings of normal PH and PH after delivery were observed. The variation characteris- tics of PH left and right diameter,front back diameter and area between two different delivery methods in different time points were compared. Results：①PH morphology in control group was in diamond-shaped fissure structure;PH morphology of cesarean sec- tion group after delivery was consistent with that of control group （24 cases/48 cases）,and the PI-I morphology of the remaining 26 cases was fuzzy in structure with echo disorder. ②PH left-right diameter, anteroposterior diameter and area at the prenatal resting state,anal contraction movement,and Valsalva maneuver were higher in cesarean section delivery group and vaginal delivery group than in control group（P〈O.05）. In cesarean section delivery group, the above indexes were lower at 6 weeks and 3 months after de- livery than before delivery（P〈O.05）. In vaginal delivery group, the above indexes were increased after delivery and were de- creased from the 3 rd month after delivery;the above indexes were higher in vaginal delivery group after delivery than in vaginal delivery group before delivery, cesarean section delivery group, and control group （P〈0.05）. Conclusion ：Three dimensional ultrasound can clearly observe the female pelvic floor structure. Both delivery modes exert effect on the female pelvic diaphragm hiatus;the effect of the vaginal delivery is more significant.

关 键 词：经会阴三维超声 剖宫产分娩 经阴道分娩 盆膈裂孔 

分 类 号：R445.1[医药卫生—影像医学与核医学]