经会阴四维超声评价不同新生儿体质量及分娩方式对产妇盆底结构的近期影响  

Observation of effects on different neonatal weight and different delivery modes on pelvic floor structure by transperineal four-dimensional ultrasound

作　　者：徐英姿[1] 冯泽阳 胡笑玲[1] 李俐[1] 唐海林[1] 

机构地区：[1]浙江省立同德医院超声科,杭州市310012

出　　处：《临床超声医学杂志》2018年第2期127-130,共4页Journal of Clinical Ultrasound in Medicine

基　　金：浙江省卫生医药卫生科技计划项目(2015KYA049)

摘　　要：目的应用经会阴四维超声观察新生儿体质量及分娩方式对产妇产后盆底结构的影响。方法选取在我院生产并于产后第42天复查的初产妇395例,根据新生儿体质量及分娩方式不同进行分组:巨大新生儿自然分娩组40例(A组)、巨大新生儿剖宫产组55例(B组)、正常体质量新生儿自然分娩组150例(C组)及正常体质量新生儿剖宫产组150例(D组)。各组均行二维超声检查并记录静息和最大Valsalva动作时膀胱颈、子宫颈、直肠肛管形态及活动度;应用四维图像重建后观察上述3个时态下肛提肌裂口形态及连续性,测量肛提肌裂口面积,并对各组上述参数进行比较。结果与C组比较,A组膀胱颈活动度和静息、缩肛及最大Valsalva动作时的肛提肌裂口均明显增大,子宫下垂发病率增加,差异均有统计学意义(均P<0.05),而直肠膨出发病率和最大Valsalva动作时膀胱后角、膀胱颈倾斜角及膀胱颈旋转角比较差异均无统计学意义。与D组比较,B组仅膀胱颈活动度和膀胱颈旋转角增大,差异均有统计学意义(均P<0.05),余各指标比较差异均无统计学意义。与B组比较,A组除最大Valsalva动作时下膀胱后角和直肠膨出发病率无统计学差异,余各指标均明显增大,差异均有统计学意义(均P<0.05)。结论巨大新生儿且经自然分娩对产妇盆底结构的近期影响较明显,经会阴四维超声能较好地评估不同体质量的新生儿和分娩方式对产妇盆底结构的近期影响。Objective To observe the effects on different neonatal weight and delivery modes on pelvic floor structure by transperineal four-dimensional ultrasonography.Methods Data were collected from 395 primiparas who delivered a baby in our hospital at the 42 nd day of postpartum.They were divided into four groups according to the neonatal weight and delivery mode：the huge newborns by natural childbirth（40 cases,group A）,the huge newborns by cesarean section（55 cases,group B）,the normal birth weight neonatal by natural childbirth（150 cases,group C）and the normal weight newborn by cesarean section（150 cases,group D）.All the primiparas were inspected by pelvic floor ultrasound to observe and measure the activity of bladder neck,cervix,rectal anal,bladder latter angle,bladder neck tilt angle and bladder neck rotation angle at resting and Valsalva state.Fourdimensional images were reconstructed to observe and measure the area of the pelvic diaphragm hiatus in the resting,contraction and Valsava state.All the results were recorded and compared.Results Compared with group C,the bladder neck activity,the incidence of hysteroptosia and the area of the pelvic diaphragm hiatus in the resting,contraction and Valsava state in group A were increased,there were significant differences（all P0.05）.And the incidence of rectocele,bladder latter angle,bladder neck tilt angle and bladder neck rotation angle at Valsalva state were no different between group A and group C.Compared with group D,the bladder neck activity and bladder neck rotation angle at Valsalva state in group B were increased,there were significant differences（all P0.05）.Compared with group B,there were significant increased in all indicators except the bladder latter angle at Valsava state and incidence of rectocele in group A（all P0.05）.Conclusion The huge newborns by natural childbirth had an obvious impact on the pelvic floor structure.It is a good way to observe pelvic floor structure changes in different neonatal weight and delivery modes

关 键 词：超声检查 四维 经会阴 巨大 新生儿 盆底 

分 类 号：R711.59[医药卫生—妇产科学] R445.1[医药卫生—临床医学]