经会阴三维超声评估女性产后肛提肌损伤的分析研究  

Analysis on three-dimensional transperineal sonography for assessing female postpartum levator ani muscle injury

作　　者：吴海燕[1] 张伟[1] 向双[1] 尹慧[1] 刘琳琳[1] 陈少雷[1] 李文红[2] 

机构地区：[1]湖北省十堰市湖北医药学院附属东风总医院超声科,442000 [2]湖北省十堰市湖北医药学院附属东风总医院妇科,442000

出　　处：《检验医学与临床》2017年第7期920-922,共3页Laboratory Medicine and Clinic

基　　金：湖北省教育厅2014年指导性项目(B201464)

摘　　要：目的研究经会阴三维超声评估女性产后肛提肌损伤。方法选取经阴道分娩3~21个月并在此期间没有再次受孕或分娩的初产妇104例作为研究对象。首先由一位具有丰富超声检查经验的医师对所有患者进行经会阴三维超声检查,保存检查结果;再由另一位熟悉女性盆底结构且具有丰富专业知识的妇产科临床医师对104例初产妇分别进行临床检查,2位检查医师均对另一种检查结果不知情;经会阴三维超声检查在冠状面观察到耻骨内脏肌最前内侧部分有中断或变形时,即诊断为肛提肌损伤。临床检查包括对会阴外观进行评估、触诊评估盆底肌肌肉情况,组织质量及是否存在间隙或不对称的迹象;继而使用改良牛津评分表对盆底肌张力强度进行评估,最后凭借最大程度盆底肌收缩保持时间来确定肌肉耐力情况。采用统计学软件SPSS19.0进行统计学处理。结果 104例初产妇经会阴三维超声检查发现有23例(22.1%)为肛提肌损伤;触诊评估发现40例(38.5%)呈肌肉组织不对称,其中经三维超声检查发现有26例无肛提肌损伤,且较无肛提肌损伤而言,肛提肌损伤患者其肌肉组织不对称出现率(60.9%)显著偏高,差异有统计学意义(P<0.05),肌肉张力强度和肌肉耐力在无肛提肌损和肛提肌损伤两者差异无统计学意义(P>0.05)。结论肛提肌损伤患者出现肌肉组织不对称的风险更大,肌肉组织不对称与肛提肌损伤有显著关联,肌肉强度、肌肉耐力与肛提肌损伤无显著关联。Objective To investigate the three-dimensional transperineal sonography for evaluating female postpartum levator ani muscle iniury. Methods One hundred and four primiparas at 3-21 months after transvaginal delivery, without re-pregnancy or delivery were selected as the research subjects. Firstly a physician with abundant ultrasound examination experience conducted per- formed the transperineal three-dimensional ultrasound examination in all subjects（three-dimensional ultrasound） and the inspection results were preserved ; then another clinical doctor of gynecology and obstetrics familiar with female pelvic floor structure and pos- sessing abundant professional knowledge performed the clinical examination in 104 primiparas,two doctors knew nothing about an- other examination results;the levator ani muscle injury was diagnosed by observing the interruption or deformation in the most an- terior medial part of pubic visceral muscles during transperineal three-dimensional ultrasound examination. The clinical examination included the assessment of perineal appearance,palpation assessment of pelvic floor muscles, tissue quality and signs of gap exist- ence or asymmetry;secondarily the modified Oxford scale（Oxford） was used to assess the strength of pelvic floor muscle tension, and finally the muscle endurance situation was determined by using the holding time of largest degree of pelvic floor muscle contrac- tion. The statistical processing was performed by using statistical software SPSS19.0. Results Among 104 primiparas, 23 cases （22.1 %） of levator ani muscle injury were found by transperineal three-dimensional ultrasound examinations40 casea（38.5 % ） of muscle tissue asymmetry were found by the palpation assessment,in which 26 eases of no levator ani muscle injury were found by 3D ultrasound examination, moreover compared with no levator ani muscle injury, the occurrence rate of muscle tissue asymmetry in the patients with levator ani muscle injury was 60.9 % ,which was on the significantly high side

关 键 词：三维超声 临床检查 肛提肌损伤 盆底肌 

分 类 号：R169.41[医药卫生—公共卫生与预防医学]