经阴道二维腔内超声观察产后女性盆底耻骨直肠肌的临床价值  

Transvaginal Two-dimension Sonography:Lts Role in Observing the Puborectalis in Postpartum Women

作　　者：陈秋香[1] 王慧芳[1] 王诗雅[1] 陈华[1] 郭娟[1] 邓晓双 

机构地区：[1]深圳大学第一附属医院深圳市第二人民医院超声科,广东省深圳市518035

出　　处：《中国超声医学杂志》2017年第11期1012-1016,共5页Chinese Journal of Ultrasound in Medicine

基　　金：基金项目:盆底超声智能定位及自动测量评级系统的研发和临床应用(No.201601027)

摘　　要：目的应用经阴道二维腔内超声观察经阴道分娩后女性耻骨直肠肌形态结构和收缩力度改变,判断耻骨直肠肌有无损伤,并与MRI进行比较分析,探讨经阴道二维腔内超声在观察耻骨直肠肌损伤中临床应用的可行性。方法回顾性分析在我院进行盆底超声检查的经阴道分娩后女性2 271例,分析经阴道二维腔内超声获取双侧耻骨直肠肌图像,观察耻骨直肠肌在静息和缩肛动作下的形态及收缩力度改变,诊断耻骨直肠肌损伤,总结出耻骨直肠肌完全性损伤后二维超声声像图改变,并与MRI进行比较分析,同时通过计算组内相关系数评估不同观察者间测量结果的一致性。结果经阴道二维腔内超声可以显示正常耻骨直肠肌形态及走行。2 271例经阴道分娩后女性中,经阴道二维腔内超声显示32例耻骨直肠肌完全性损伤:静息状态下,32例患者显示一侧或双侧耻骨直肠肌形态异常;缩肛动作下,31例患者显示一侧或双侧耻骨直肠肌形态及收缩力度异常,1例患者无法行有效缩肛动作。均经MRI证实。耻骨直肠肌部分性损伤:二维腔内超声诊断9例,MRI诊断14例。不同观察者在静息和缩肛动作下分析耻骨直肠肌具有很高的一致性,组内相关系数分别为0.87和0.81。结论经阴道二维腔内超声能观察耻骨直肠肌形态结构和收缩力度改变,判断耻骨直肠肌有无损伤,方法简便,重复性好,适于在临床推广应用。Objective To observe morphological changes of the puborectalis between they are at rest and contrac- ting for their trauma estimation and summarize the ultrasonographic changes in puborectalis muscle when there exists the complete avulsion. And we are also aiming at obtaining the results from comparing these above-mentioned changes with those in magnetic resonance imaging（MRI）. We want to evaluate the value and feasibility of transvaginal two-di- mension sonography in observation of puborectalis muscle trauma. Methods We reviewed a total of 2271 datasets of postpartum women by vaginal delivery seen between in our hospital. The images of bilateral puborectalis muscle ob- tained by transvaginal two-dimension sonography were analyzed. We observed morphological changes of the puborec- talis between they were at rest and contracting. And we summarized the ultrasonographic changes in puborectalis,uscle when there exists the complete avulsion. And we also compare these above-mentioned changes with those in MRI. We found out some skills and＇tips of transvaginal two-dimension sonography to scan puborectalis. Interclass correlation co- efficient was calculated to evaluate the compatibility between different observers. Results From 2271 eligible data- sets, the puborectalis muscle of 2230 patients were showed clearly as hypoechoic zone with even-distributed hyperecho- ic lines inside and uniform thickness. Also, we could see clearly the attachment of puborectalis to the lateral walls of pelvis and the puborectalis running from ventally to dorsally to rectoanal juction. Totally, 32 patients with complete a- vulsion were diagnosed by transvaginal two-dimensional sonography. There were morphologic changes of unilateral or bilateral puborectalis of all the 32 patients at rest. At contraction, the morphology and contractile strength of 31 pa- tients was abnormal while 1 patient could not contract the pelvic muscle effectively. All cases were verified as complete puborectalis avulsion by MRI. In addition, 9 cases of puborec

关 键 词：腔内超声 经阴道分娩 耻骨直肠肌 损伤 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714[医药卫生—诊断学]