基于经会阴四维超声动态检查的盆底失弛缓综合征盆底解剖结构特征分析  

Analysis of pelvic floor anatomy in pelvic floor dysfunction syndrome based on four-dimensional ultrasonography of the perineum dynamic examination

作　　者：穆靓[1] 徐姣姣[1] 陈浩 南淑良 刘玮 薛宇红 刘莉[1,2] Mu Liang;Xu Jiaojiao;Chen Hao;Nan Shuliang;Liu Wei;Xue Yuhong;Liu Li(Ultrasound Diagnosis Center,Shaanxi Provincial People’s Hospital,Xi’an 710068,Shaanxi,China;Graduate School of Xi’an Medical University,Xi’an 710068,Shaanxi,China)

机构地区：[1]陕西省人民医院超声诊断中心,陕西西安710068 [2]西安医学院研究生院,陕西西安710068

出　　处：《结直肠肛门外科》2023年第2期158-161,共4页Journal of Colorectal & Anal Surgery

基　　金：陕西省科协青年人才托举项目(SWYY202216);陕西省重点研发计划项目(2021SF-199);陕西省卫生健康科研基金项目(2021D028);陕西省人民医院科技人才支持计划菁英人才项目(2022JY-30)。

摘　　要：目的分析基于经会阴四维超声动态检查的盆底失弛缓综合征盆底解剖结构特征。方法选取2019年7月至2022年6月陕西省人民医院收治的50名女性盆底失弛缓综合征患者为观察组研究对象,同期选取本院常规健康体检的60名女性为对照组。两组研究对象均行经会阴四维超声动态检查。分别于静息状态及Valsalva动作时,在盆底正中矢状面测量两组的肛直角(ARA),以及在盆底四维重建图像上测量两组的肛提肌裂孔面积。结果经会阴四维超声动态检查结果显示,两组女性盆底肛提肌裂孔结构完整紧凑,肛提肌裂孔内尿道、阴道、直肠依次排列,两侧肛提肌对称且连续性好。观察组中,Valsalva动作后41例(82%)女性可观察到明显的耻骨直肠肌的反向运动;6例(12%)患者可以观察到直肠前突现象;对照组未观察到明显的耻骨直肠肌的反向运动或直肠前突现象。静息状态时,两组肛提肌裂孔面积、ARA比较差异均无统计学意义(均P>0.05)。Valsal⁃va动作时,两组肛提肌裂孔面积均较静息状态增大,但观察组的肛提肌裂孔面积小于对照组;对照组的ARA较静息状态增大,观察组的ARA较静息状态缩小且小于对照组;两组肛提肌裂孔面积差值及ARA差值均小于对照组(均P<0.05)。结论Valsalva动作检查时,经会阴四维超声动态检查可以清晰展示盆底失弛缓综合征女性肛提肌舒张功能减低,ARA缩小等解剖结构特征,可作为盆底失弛缓综合征简单有效的影像学检查方法。Objectives To analyze the pelvic floor anatomy in pelvic floor dysfunction syndrome based on four-dimensional ul⁃trasonography of the perineum dynamic examination.Methods Fifty female patients with pelvic floor dysfunction syndrome treat⁃ed at Shaanxi Provincial People’s Hospital from July 2019 to June 2022 were selected as the observation group,and 60 healthy female subjects who underwent routine health checkups during the same period were selected as the control group.Both groups underwent four-dimensional ultrasonography of the perineum dynamic examination.The anal rectal angle(ARA)of both groups was measured in the mid-sagittal plane of the pelvic floor at rest and during the Valsalva maneuver,and area of the levator ani hiatus structure was measured on the four-dimensional reconstructed image of the pelvic floor.Results The four-dimensional ul⁃trasonography of the perineum dynamic examination showed that the levator ani hiatus structure was intact and compact in both groups,with the urethra,vagina,and rectum arranged in order,and the levator ani on both sides was symmetrical and continu⁃ous.In the observation group,41(82%)women showed obvious reverse movement of the puborectalis muscle after the Valsalva maneuver,and 6(12%)patients showed rectal prolapse phenomenon;no obvious reverse movement of the puborectalis muscle or rectal prolapse phenomenon was observed in the control group.At rest,the two groups had no significant difference in the area of the levator ani hiatus structure and ARA(P>0.05).During the Valsalva maneuver,the area of the levator ani hiatus structure increased in both groups,but the area of the levator ani hiatus structure of the observation group was smaller than that of the control group;the ARA of the control group increased,while the ARA of the observation group decreased and was smaller than that of the control group;the difference in the area of the levator ani hiatus structure and ARA between the two groups was smaller than that of the control group(P<0.05).Conclusion Four

关 键 词：盆底失弛缓综合征 经会阴四维超声动态检查 解剖结构 

分 类 号：R445.1[医药卫生—影像医学与核医学] R711.5[医药卫生—诊断学]