超声观察不同妊娠时期和分娩方式所致盆底组织功能变化  

Ultrasonic observation on changes of pelvic floor function in different pregnancy periods and delivery modes

作　　者：张晓艳[1] 邬雪山[2] ZHANG Xiaoyan;WU Xueshan(Department of Ultrasound Diagnosis,the 82nd Army Hospital of the Chinese People's Liberation Army,Baoding 071000,China;Department of Statistics,Department of Medicine,Hebei University,Baoding 071000,China)

机构地区：[1]中国人民解放军陆军第八十二集团军医院超声诊断科,河北保定071000 [2]河北大学医学部统计教研室,河北保定071000

出　　处：《中国医学影像技术》2021年第11期1698-1701,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的以超声观察不同妊娠时期及分娩方式所致盆底组织结构及功能改变。方法选取50名接受规律产前检查的单胎初产妇,根据分娩方式分为阴道分娩组(n=26)和剖宫产组(n=24),以经会阴超声观察其孕早期(孕6~8周)、孕中期(孕24~28周)、孕晚期(孕37周~分娩前)及产后6~8周和12~14周盆底结构,测量静息态和最大瓦尔萨尔瓦动作时膀胱颈距离耻骨联合后下缘距离(BSD)、尿道倾斜角及膀胱尿道后角,观察尿道内口漏斗是否形成及有无膀胱脱垂,并进行比较、分析。结果孕早、中及晚期,BSD、尿道倾斜角、膀胱尿道后角差异均有统计学意义(P均<0.05);孕晚期BSD、尿道倾斜角、膀胱尿道后角与孕早、中期比较差异均有统计学意义(P均<0.05)。最大瓦尔萨尔瓦动作下,孕早期无尿道内口漏斗形成及膀胱脱垂,孕中期尿道内口漏斗形成6例、膀胱脱垂1例,孕晚期尿道内口漏斗形成21例、膀胱脱垂19例。组间比较,产后6~8周,静息态下,BSD、尿道倾斜角及膀胱尿道后角差异均无统计学意义(P均>0.05),而最大瓦尔萨尔瓦动作下上述参数差异均有统计学意义(P均<0.05);产后12~14周,静息态下及最大瓦尔萨尔瓦动作下BSD、尿道倾斜角及膀胱尿道后角差异均无统计学意义(P均>0.05);产后6~8周和12~14周,压力性尿失禁和膀胱脱垂发生率差异均无统计学意义(P均>0.05)。结论孕晚期盆底组织损伤较严重;不同分娩方式所致盆底组织损伤存在差异;随时间延长,产后盆底结构损伤可逐渐修复。Objective To observe the structure and function changes of pelvic floor in different stages of pregnancy and delivery methods.Methods Fifty single-fetal primiparas who underwent regular prenatal examinations were selected and divided into vaginal group(n=26)and cesarean section group(n=24)according to delivery methods.Pelvic floor structures were observed with perineal ultrasound in early pregnancy(6—8 weeks of pregnancy),pregnant metaphase(24—28 weeks of pregnancy)and late pregnancy(37 weeks of pregnancy—before delivery),as well as 6—8 weeks and 12—14 weeks postpartum.The bladder neck-symphyseal distance(BSD),urethral tilt angle and bladder urethral poster angle were measured under resting state and the maximum Valsalva maneuver.The formation of the urethra funnel and the presence or absence of bladder urethral poster angle were compared and analyzed.Results There were significant differences of BSD,urethral tilt angle and bladder urethral poster angle among different stages of pregnancy(all P<0.05).BSD,urethral tilt angle and bladder urethral poster angle in late pregnancy were significantly different from those in early,middle pregnancy(all P<0.05).Under the maximum Valsalva maneuver,no urethral funnel formation nor bladder prolapsed was detected in early pregnancy,while 6 cases of urethral funnel formation and 1 case of bladder prolapsed were noticed in pregnant metaphase,and 21 cases of urethral funnel formation and 19 cases of bladder prolapsed were found in late pregnancy.There was no significant difference of BSD,urethral tilt angle nor bladder urethral angle under resting-state(all P>0.05),while significant differences were found between groups under the maximum Valsalva maneuver 6—8 weeks postpartum(all P<0.05).There was no significant difference of BSD,urethral tilt angle nor bladder urethral angle 12—14 weeks postpartum between groups under both resting-state and the maximum Valsalva maneuver(all P>0.05).There was no significant difference of the incidence of stress incontinence nor blad

关 键 词：尿失禁 压力性 剖宫产术 骨盆底 超声检查 

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