经会阴三维超声断层成像评估盆腔器官脱垂患者肛提肌损伤的康复疗效  

Evaluating the effects of levator ani muscle injury with pelvic organ prolapsed rehabilitation ef?cacy by transperineal three-dimensional tomographic ultrasonography imaging

作　　者：刘丽[1] 刘静华[1] 蒋莹[1] 郑洪平[1] 林李梅[1] 宋金爽 徐烨 Liu Li;Liu Jinghua;Jiang Ying;Zheng Hongping;Lin Limei;Song Jinshuang;Xu Ye(Department of Ultrasound,Maternity and Child health Care Hospital of Longgang District in Shenzhen,Shenzhen 518172,China)

机构地区：[1]深圳市龙岗区妇幼保健院超声一科,518172

出　　处：《中华医学超声杂志（电子版）》2019年第1期54-60,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：深圳市龙岗区科技发展资金项目(YLWS20150515112804137)

摘　　要：目的使用经会阴三维超声断层成像(TUI)测量产后盆腔器官脱垂(POP)患者肛提肌裂孔各超声参数,评估盆腔器官脱垂患者肛提肌损伤的康复疗效。方法选取2016年3月至2016年10月深圳市龙岗区妇幼保健院收治的阴道分娩后POP患者86例。根据患者是否进行盆底康复治疗的意愿,将患者分成康复治疗组和功能锻炼组,各43例。康复治疗前用TUI方法判断POP患者是否存在肛提肌损伤,再将康复治疗组和功能锻炼组各分为肛提肌未损伤组和肛提肌损伤组2个亚组(R0、R1和F0、F1)。产后第8周起,康复治疗组患者开始进行为期8周的盆底电刺激及家庭阴道哑铃锻炼的康复治疗,功能锻炼组患者在家自行做凯格尔盆底功能锻炼8周。分别于产后6～8周(康复治疗前)和产后18周(康复治疗后)在静息、瓦氏、缩肛状态下,对86例患者进行经会阴三维超声检查。并对肛提肌裂孔的面积、左右径、前后径测量值进行统计学分析。结果 TUI成像显示,康复治疗前有35例POP患者并发肛提肌损伤,康复治疗组和功能锻炼组肛提肌损伤发生率比较(41.9%vs 39.5%),差异无统计学意义(χ~2=0.048,P=0.826)。康复治疗前肛提肌损伤组(R1、F1亚组)与肛提肌未损伤组(R0、F0亚组)之间盆腔器官脱垂定量(POP-Q)分度,差异无统计学意义(P均>0.05)。康复治疗后,康复治疗组及R1、R0亚组的POP改善率,显著高于功能锻炼组及F1、F0亚组,差异均有统计学意义(χ~2=15.480、7.441、8.632,P均<0.01)。R1亚组在静息、最大瓦氏状态下肛提肌裂孔的面积,最大瓦氏状态下前后径以及最大缩肛状态下肛提肌裂孔的面积、左右径、前后径均小于F1亚组,差异均有统计学意义(t=-3.285、-3.423、-2.328、-3.706、-2.221、-3.810,P均<0.05);R0亚组在静息状态下肛提肌裂孔的面积、前后径以及最大瓦氏、最大缩肛状态下肛提肌裂孔的面积、左右径、前后径均小于F0亚组,差异均�Objective To evaluate the rehabilitation efficacy on levator ani muscle(LAM) injury with the measurements of ultrasonic parameters of the hiatus of LAM by transperineal three dimensional ultrasound tomography (TUI) in patients with postpartum POP. Methods From March 2016 to October 2016, 86 patients with POP after vaginal delivery in Maternity and Child health Care Hospital of Longgang District were collected. Patients were divided into rehabilitation group (R) and functional exercise group (F) according to their preference on pelvic floor rehabilitation treatment (43 cases in each group). TUI method was used to determine the presence of LAM injury, and then all patients were divided into two subgroups: the non-injury group and the injury group (R0, R1 and F0, F1). After eighth weeks postpartum, the patients in group R began to undergo 8 weeks of pelvic floor electrical stimulation and family vaginal dumbbell exercise. The patients in group F underwent the pelvic floor exercise for 8 weeks at home. Patients were examined by transperineal three-dimensional ultrasound under the state of resting, valsalva, and contraction after 6~8 weeks postpartum (before treatment) and 18 weeks postpartum (after treatment) respectively. Results TUI imaging showed that 35 cases were complicated with LAM injury. There was no significant difference in the incidence of LAM injury between the group R and group F (41.9% vs 39.5%,χ^2=0.048, P=0.826). There was no significant difference (all P>0.05) in the POP-Q degree between the injury group (R1, F1) and the non-injury group (R0, F0) on 6-8 weeks postpartum (before treatment). The improvement rates of POP in group R, R0, R1 were significantly higher than that in group F, F0, F1 (χ^2=15.480, 7.441, 8.632;all P<0.01). After treatment, the levator hiatal area under the states of resting and valsalva;the anteroposterior diameter under the states of valsalva;and the levator hiatal area, left-right diameter, anteroposterior diameter under the state of contraction in subgroup R1 were less th

关 键 词：超声检查 盆腔器官脱垂 肛提肌 康复 

分 类 号：R445.1[医药卫生—影像医学与核医学] R711.2[医药卫生—诊断学]