肛提肌未发生撕脱的盆腔脏器脱垂初产妇肛提肌裂孔形态变化的研究  

Morphological changes of levator hiatus in primiparas with pelvic organ prolapse without levator avulsion

作　　者：赵津艺 刘莱 刘婷[1] 李颐 胥卉苹 熊雯[2] ZHAO Jin-Yi;LIU Lai;LIU Ting;LI Yi;XU Hui-ping;XIONG Wen(Department of Ultrasound Medicine,Wenjiang Hospital,Sichuan Provincial People's Hospital,Chengdu 610000,China;Department of Ultrasound Medicine,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital,Chengdu 610072,China)

机构地区：[1]四川省人民医院温江医院超声医学科,四川成都610000 [2]四川省医学科学院·四川省人民医院超声医学科,四川成都610072

出　　处：《实用医院临床杂志》2024年第2期74-77,共4页Practical Journal of Clinical Medicine

基　　金：成都市卫健委医学科研课题资助项目(编号:202309023808)。

摘　　要：目的探讨肛提肌未发生撕脱时,盆腔脏器脱垂(pelvic organ prolapse,POP)的初产妇肛提肌裂孔形态是否发生异常改变。方法收集经阴道分娩且肛提肌未发生撕脱的初产妇107例,出现POP的65例为POP组,未出现POP的42例为对照组。应用经会阴4D盆底超声采集在静息、最大瓦氏状态下两组初产妇肛提肌裂孔形态参数:肛提肌裂孔前后径(LHAP)、肛提肌裂孔左右径(LHLD)、肛提肌裂孔周径(LHC)、肛提肌裂孔面积(LHA)。结果静息状态下POP组及对照组LHAP、LHLD、LHC、LHA比较,差异无统计学意义(P>0.05);最大瓦氏状态下POP组的LHAP、LHLD、LHC、LHA较对照组均增大,差异有统计学意义(P<0.05),当最大瓦氏状态下LHA>18.84 cm^(2),诊断初产妇发生POP的敏感度为73.8%,特异度95.2%,AUC为0.912。结论肛提肌未撕脱的初次经阴道分娩的POP产妇也会发生肛提肌损伤。4D盆底超声下肛提肌裂孔形态的改变可反映肛提肌有无损伤及损伤程度,尤其最大瓦氏状态下肛提肌裂孔的面积与POP相关性很好。Objective To explore the abnormal changes in the hiatus morphology of the levator anal muscle in women with pelvic organ prolapse(POP)without avulsion.Methods One hundred and seven primiparas who delivered vaginally without avulsion of the levator anal muscle were collected.Of these patients,65 primiparas with POP were divided into a maternal POP group and 42 primiparas without POP were divided into a maternal control group.The morphological parameters of anal levator hiatus of the parturient women under the states of rest and maximum Valsalva were collected by perineal 4D pelvic floor ultrasound.The parameters included anterior and posterior diameter of anal levator hiatus(LHAP),left and right diameter of anal levator hiatus(LHLD),circumferential diameter of anal levator hiatus(LHC)and anal levator hiatus area(LHA).Results There was no statistical significance in LHAP,LHLD,LHC and LHA between the two groups under the rest state(P>0.05).The LHAP,LHLD,LHC and LHA in the maternal POP group were higher than those in the control group under the state of maximum Valsalva(P<0.05).When LHA>18.84 cm^(2)under the state of the maximum Valsalva,the sensitivity of POP was 73.8%,the specificity was 95.2%and the AUC of ROC curve was 0.912.Conclusions The levator anal muscle may be damaged in the first vaginal delivery of POP primipara who do not have avulsion of levator anal muscle.The morphological changes of the levator anal muscle hiatus under 4D pelvic floor ultrasound can reflect whether the levator anal muscle is injured and the degree of injury.especially the area of the levator anal muscle hiatus under the maximum Valsalva state has a good correlation with POP.

关 键 词：4D盆底超声 盆腔脏器脱垂 肛提肌 

分 类 号：R445.1[医药卫生—影像医学与核医学]