经会阴三维超声联合SWE评估分娩方式对初产妇肛提肌的影响  

The Effects of Different Delivery Methods on Levator Ani Muscle of Primipara were Evaluated by Three-dimensional Perineal Ultrasonography Combined with Shear-wave Elastography

作　　者：董佳文 史莉玲[2] 张美丽 白肖梅 李建丽 DONG Jiawen;SHI Liling;ZHANG Meili(Department of Medical Imaging,Shanxi Medical University,Shanxi 030001,China;不详)

机构地区：[1]山西医科大学医学影像系,太原030001 [2]山西省妇幼保健院综合检验科,太原030013

出　　处：《医学研究杂志》2024年第9期127-131,共5页Journal of Medical Research

基　　金：山西省科学技术厅自然科学研究面上项目(202103021224433)。

摘　　要：目的探讨经会阴三维超声联合剪切波弹性成像技术(shear wave elastography,SWE)在评估分娩方式对初产妇肛提肌形态及功能影响中的应用价值,为早期诊断盆底功能障碍性疾病(pelvic floor disorders,PFD)提供新方法。方法选取在笔者医院分娩后6~8周复查的92例初产妇为产后组,根据其分娩方式分为经阴道分娩组(n=45)和剖宫产组(n=47),选取同期健康未育女性作为对照组(n=43)。采用经会阴三维超声联合SWE进行检查,比较各组间不同状态下肛提肌裂孔形态参数及弹性参数的差异。结果经阴道分娩组在静息、最大缩肛及最大Valsalva状态下肛提肌裂孔面积(levator ani hiatus area,LHA)均大于剖宫产组和对照组,剖宫产组大于对照组,差异有统计学意义(P<0.01);经阴道分娩组在静息及最大缩肛状态下弹性参数较对照组、剖宫产组均减小,差异有统计学意义(P<0.01);而剖宫产组与对照组弹性参数比较,差异无统计学意义(P>0.05);最大Valsalva状态与静息状态下LHA差值(ΔA′)与双侧PR杨氏模量值收缩前后的差值(ΔE)呈显著负相关(左侧r=-0.444,P=0.008;右侧r=-0.488,P=0.002)。结论经会阴三维超声联合SWE可定量评估肛提肌的形态及功能,为PFD的早期诊断提供依据。Objective To explore the application value of transperineal three-dimensional ultrasound combined with SWE in evaluating the effect of delivery mode on the morphology and function of levator ANI muscle in primipara,and to provide a new method for early diagnosis of pelvic floor dysfunction(PFD).Methods A total of 92 primiparas who were re-examined 6-8 weeks after delivery in our hospital were selected as postpartum group,and divided into vaginal delivery group(n=45)and cesarean section group(n=47)according to their delivery mode,and healthy women without childbirth at the same period were selected as control group(n=43).Transperineal three-dimensional ultrasound combined with SWE was used to examine the differences in the morphological parameters and elastic parameters of levator anal hiatus in different states among all groups.Results The hiatus area of levator anal muscle(LHA)at rest,maximum anal retraction and maximum Valsalva in the vaginal delivery group was greater than that in the cesarean section group and control group,and the cesarean section group was greater than the control group,the differences were statistically significant(P<0.01).Compared with control group and cesarean section group,the elastic parameters of vaginal delivery group at rest and maximum anal retraction were decreased,the difference was statistically significant(P<0.01).There was no significant difference in elastic parameters between the cesarean section group and the control group(P>0.05).The difference between maximum Valsalva state and resting state LHA(ΔA′)was negatively correlated with the difference before and after contraction of bilateral PR Young′s modulus(ΔE)(left r=-0.444,P=0.008;Right r=0.488,P=0.002).Conclusion Three-dimensional perineal ultrasonography combined with SWE can quantitatively evaluate the morphology and function of levator ANI muscle,and provide evidence for the early diagnosis of PFD.

关 键 词：分娩方式 肛提肌 耻骨直肠肌 剪切波弹性成像 杨氏模量值 

分 类 号：R711[医药卫生—妇产科学]