基于彩超动态观察经阴道分娩后盆腔组织器官解剖参数变化及与盆底功能障碍的关联性  

Color Doppler Ultrasound-based Dynamic Observation of Changes in Anatomical Parameters of Pelvic Tissues andOrgans after Transvaginal Delivery and the Association with Pelvic Floor Dysfunction

作　　者：唐艳荣[1] 甘玲 陈晓菲 韩秀青[1] 陈宝丽[1] TANG Yanrong;GAN Ling;CHEN Xiaofei;HAN Xiuqing;CHEN Baoli(Department of Obstetrics and Gynecology,Tangshan Maternal and Child Health Hospital,Tangshan,Hebei 063000,China;Department of Intensive Care Medicine,Tangshan Workers'Hospital,Tangshan,Hebei 063003,China)

机构地区：[1]唐山市妇幼保健院妇产科,河北唐山063000 [2]唐山市工人医院重症医学科,河北唐山063003

出　　处：《临床误诊误治》2023年第3期123-128,共6页Clinical Misdiagnosis & Mistherapy

基　　金：2022年河北省医学科学研究课题计划(20221760)。

摘　　要：目的 基于彩超动态观察经阴道分娩后盆腔组织器官解剖参数变化,并进一步分析超声参数与盆底功能障碍(PFD)的关联性。方法 选取2020年7月—2022年5月收治的120例经阴道分娩初产妇,根据产后是否发生PFD分为PFD组50例、无PFD组70例。比较2组人口学资料、临床特征、超声参数,采用Pearson相关性分析超声参数与盆底功能障碍问卷(PFDI-20)评分的关系,采用受试者工作特征曲线分析超声参数对PFD的诊断价值,采用RR危险度分析超声参数与PFD的关系。结果 PFD组阴道撕裂较无PFD组严重(P<0.01);PFD组膀胱颈至耻骨联合后下缘的距离、宫颈至耻骨联合后下缘的距离、缩肛时缩短率短于或低于无PFD组,膀胱下降度、宫颈下移、尿道旋转度、静息肛提肌裂孔前后径、缩肛肛提肌裂孔前后径、最大Valsalva动作肛提肌裂孔前后径、最大Valsalva动作伸长率以及PFDI-20评分长于或高于无PFD组(P<0.01)。缩肛时缩短率与PFDI-20评分呈负相关(r=-0.756,P<0.001),膀胱下降度、宫颈下移、尿道旋转度、最大Valsalva动作伸长率与PFDI-20评分呈正相关(r=0.723、0.813、0.734、0.835,P<0.001)。膀胱下降度、宫颈下移、尿道旋转度、缩肛时缩短率、最大Valsalva动作伸长率联合诊断PFD的曲线下面积为0.916,上述指标所致的RR值分别为3.643、3.742、2.511、0.308、3.144。结论 膀胱下降度、宫颈下移、尿道旋转度、缩肛时缩短率、最大Valsalva动作伸长率与PFDI-20评分联系密切,可反映产妇阴道分娩后盆底功能,对PFD的早期诊断、干预具有指导作用。Objective To dynamically observe the changes of anatomical parameters of pelvic tissues and organs after transvaginal delivery based on color Doppler ultrasound and to further analyze the association between ultrasound parameters and pelvic floor dysfunction(PFD).Methods From July 2020 to May 2022,120 primipara who delivered vaginally were selected and divided into PFD group(n=50)and non-PFD group(n=70)according to occurrence of PFD after delivery.Demographic data,clinical characteristics and ultrasonic parameters of the two groups were compared.Pearson correlation was used to analyze the relationship between ultrasonic parameters and pelvic floor distress inventory-20(PFDI-20)scores,receiver operating characteristics(ROC)curve was used to analyze the diagnostic value of ultrasonic parameters for PFD,and RR risk was used to analyze the relationship between ultrasonic parameters and PFD.Results Vaginal tear in PFD group was more serious than that in non-PFD group(P<0.01).The distance between the bladder neck and the posterior and inferior margin of the symphysis pubis,the distance between the cervix and the posterior and inferior margin of the symphysis pubis in the PFD group,and the shortening rate during anal contraction were shorter or lower than those in the non-PFD group,while the descending degree of the bladder,the descending cervix,the rotation degree of urethra,the diameters before and after the hiatus of the levator anal muscle at rest,the diameters before and after the hiatus of the levator anal muscle at contraction,the diameters before and after the hiatus of the levator anal muscle at maximum Valsalva movement,the maximum Valsalva movement elongation and the PFDI-20 score were higher or higher than those in non-PFD group(P<0.01).The shortening rate of anus retraction was negatively correlated with PFDI-20 score(r=-0.756,P<0.001),and the descending degree of the bladder the descending cervix,rotation degree of the urethra,maximum Valsalva movement were positively correlated with PFDI-20 score(r=0.723,

关 键 词：盆底功能障碍 阴道分娩 超声检查 PFDI-20评分 诊断 

分 类 号：R714.46[医药卫生—妇产科学]