盆底超声评价不同产次及分娩方式对耻骨直肠肌厚度改变的影响  

Assessment of impact of parity and different delivery modes on thickness of the puborectalis in postpartum women by pelvic ultrasound

作　　者：何莎[1] 赵胜[1] 范建华[1] 高艳多 黄君红[1] 戢秀勤[1] 朱霞[1] He Sha;Zhao Sheng;Fan Jianhua;Gao Yanduo;Huang Junhong;Ji Xiuqin;Zhu Xia(Department of Ultrasound,Hubei Maternal and Child Health Hospital,Wuhan 430070,China)

机构地区：[1]湖北省妇幼保健院超声诊断科,武汉430070

出　　处：《中华医学超声杂志（电子版）》2022年第1期17-22,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：湖北省卫生计生委面上项目(WJ2018H0140)。

摘　　要：目的:通过盆底超声检查评估不同产次及分娩方式对耻骨直肠肌(PR)厚度改变的影响。方法:选择2019年4~12月产后42~60 d复诊的产妇150例,包括初次阴道分娩、二次阴道分娩及剖宫产分娩产妇各50例。所有受检者均接受静息和最大缩肛动作下经会阴腔内二维超声检查:测量左、右侧PR前部、中部及后部的厚度;采用方差分析比较各组间PR厚度的差异,组间两两比较采用t检验。结果:静息状态时,初次及二次阴道分娩组左、右侧PR前部、中部、后部的厚度均小于剖宫产分娩组[左侧:(5.66±1.22)mm vs(6.05±1.05)mm vs(6.73±1.30)mm、(5.88±1.22)mm vs(6.11±1.12)mm vs(6.71±1.08)mm、(5.96±1.13)mm vs(6.15±0.94)mm vs(6.72±1.21)mm;右侧:(5.88±1.34)mm vs(5.80±1.16)mm vs(6.49±0.96)mm、(6.14±1.38)mm vs(6.10±0.95)mm vs(6.81±0.91)mm、(6.22±1.30)mm vs(6.10±1.15)mm vs(7.01±1.22)mm],差异有统计学意义(初次阴道分娩组与剖宫产分娩组比较:左侧,t=4.244、3.602、3.246,P<0.001、<0.001、=0.002;右侧,t=2.617、2.866、3.133,P=0.010、0.005、0.002;二次阴道分娩组与剖宫产分娩组比较:左侧,t=2.877、2.727、2.631,P=0.005、0.008、0.010;右侧,t=3.240、3.816、3.838,P=0.002、<0.001、<0.001)。最大缩肛动作时,初次阴道分娩组产妇左、右侧PR前部、中部、后部的厚度均小于剖宫产分娩组[左侧:(6.83±1.30)mm vs(7.76±1.25)mm、(7.00±1.42)mm vs(7.72±1.05)mm、(7.09±1.36)mm vs(7.83±1.28)mm;右侧:(7.11±1.35)mm vs(7.70±1.20)mm、(7.17±1.25)mm vs(7.89±1.20)mm、(7.33±1.36)mm vs(8.01±1.45)mm],差异具有统计学意义[左侧:t=3.646、2.883、2.802,P<0.001、=0.005、=0.006;右侧:t=2.192、2.310、2.419,P=0.031、0.023、0.017];二次阴道分娩组产妇PR左、右侧前部、中部、后部的厚度分别为(7.32±1.20)mm、(7.28±1.27)mm、(7.56±1.35)mm;(7.23±1.19)mm、(7.44±1.22)mm、(7.51±1.09)mm,与剖宫产分娩组产妇相比较,差异无统计学意义(P>0.05);静息状态及最大缩肛动作时,初次Objective To assess the impact of parity and different delivery modes on the thickness of the puborectalis(PR).Methods A total of 150 postpartum women who visited the hospital 42~60 days after childbirth were selected between April and December 2019.The participants were divided into three groups according to parity and delivery modes:50 women in a first vaginal delivery group,50 in a second vaginal delivery group,and 50 in a cesarean section group.Two dimensional transperineal ultrasound examination was performed in all participants both at rest and in maximal contraction status.The thicknesses of the anterior,middle,and posterior parts of the PR were measured and analyzed by variance analysis among the three groups,and t test was used to analyze the differences between groups.Results At rest,the thicknesses of the anterior,middle,and posterior parts of the PR in both sides of the first and second vaginal delivery groups were significantly thinner than those of the cesarean section group[left:(5.66±1.22)mm and(6.05±1.05)mm vs(6.73±1.30)mm,t=4.244 and 2.877,P<0.001 and P=0.005,(5.88±1.22)mm and(6.11±1.12)mm vs(6.71±1.08)mm,t=3.602 and 2.727,P<0.001 and P=0.008,(5.96±1.13)mm and(6.15±0.94)mm vs(6.72±1.21)mm,t=3.246 and 2.631,P=0.002 and P=0.010,respectively;right:(5.88±1.34)mm and(5.80±1.16)mm vs(6.49±0.96)mm,t=2.617 and 3.240,P=0.010 and P=0.002,(6.14±1.38)mm and(6.10±0.95)mm vs(6.81±0.91)mm,t=2.866 and 3.816,P=0.005 and P<0.001,(6.22±1.30)mm and(6.10±1.15)mm vs(7.01±1.22)mm,t=3.133 and 3.838,P=0.002 and P<0.001,respectively].In maximal contraction status,the thicknesses of the anterior,middle,posterior parts of the PR in both sides of the first vaginal delivery group were significantly thinner than those of the cesarean section group[left:(6.83±1.30)mm vs(7.76±1.25)mm,t=3.646,P<0.001,(7.00±1.42)mm vs(7.72±1.05)mm,t=2.883,P=0.005,(7.09±1.36)mm vs(7.83±1.28)mm,t=2.802,P=0.005,respectively;right:(7.11±1.35)mm vs(7.70±1.20)mm,t=2.192,P=0.031,(7.17±1.25)mm vs(7.89±1.20)mm,t=2.310,P=0.023,(

关 键 词：超声检查 耻骨直肠肌 分娩方式 产次 

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]