经会阴四维盆底超声立体成像检测初产妇盆底肌及盆膈裂孔异常

摘要

目的:应用经会阴四维盆底超声立体成像检测盆膈裂孔及肛提肌损伤,进行盆底肌力异常分级,比较其在初产妇盆底功能障碍(PFD)阴道分娩和选择性剖宫产盆膈裂孔及肛提肌损伤的程度,为临床治疗提供依据.方法:采用数表法随机将270例患有PFD疾病的初产妇分为经阴道分娩组和选择性剖宫产组,每组135例,应用经会阴四维盆底超声立体成像,分别检测两组盆底肌力和盆膈裂孔前后径、横径、面积及肛提肌厚度,并进行组间比较.结果:两组患者中盆底肌力异常162例(占60%),阴道压力异常189例(占70%).盆底肌疲劳度:Ⅰ类肌纤维肌力异常127例(占47%),Ⅱ类肌纤维肌力异常30例(占11%).比较阴道分娩组和选择性剖宫产组的盆底肌力、阴道压力及肌纤维肌力的异常率均无差异.经阴道分娩组的盆膈裂孔前后径、横径及面积均高于选择性剖宫产组,肛提肌厚度小于选择性剖宫产组,两组比较差异具有统计学意义(t=3.730,t=3.467,t=3.826,t=1.809;P<0.05).结论:研究结果表明,经阴道分娩组的盆膈裂孔前后径、横径及面积均高于选择性剖宫产组,肛提肌厚度小于选择性剖宫产组.四维超声立体成像可直观显示出女性盆膈裂孔的形态学特征,为产后PFD的临床诊断和治疗评估提供依据.%Objective:To use the perineum four-dimensional pelvic ultrasound stereo imaging for detecting injury situation of pelvic diaphragm hiatus and anal levator ani muscle. Understand abnormal classification of pelvic floor muscle. investigate the application of four-dimensional pelvic ultrasound stereo imaging in pelvic floor dysfunction (PFD) for primipara in order to provide more accurate data for clinical practice.Methods: 270 primiparas with pelvic floor dysfunction were divided into the vaginal delivery group (135 cases) and selective cesarean group (135 cases) as random number table; pelvic floor muscle strength, "longitudinal diameter, transverse diameter, area" of pelvic diaphragm hiatus and thickness of the anus levator were detected by the perineum four-dimensional pelvic ultrasound stereo imaging, respectively, and then to compare differences between the two groups. Results: In 270 cases, 162 cases (60%) were abnormalities in pelvic floor muscle strength, and 189 cases (70%) were abnormalities in vaginal pressure; the results of pelvic floor muscles fatigue grade situation revealed: 127 cases were abnormal muscle fiber strength ofⅠtype (47%), 30 patients were abnormal muscle fiber strength ofⅡ type (11%). There were no significant differences between the two groups in the abnormal rate of pelvic floor muscle strength, vaginal pressure and muscle fiber strength. Longitudinal diameter, transverse diameter and area of pelvic diaphragm hiatus in the vaginal delivery group were higher than that in the selective cesarean group, while thickness of anal levator were thinner than that in the selective cesarean group with significant differences (t=3.730,t=3.467, t=3.826,t=1.809;P<0.05).Conclusions: The perineum four-dimensional ultrasound diagnosis can intuitively and clearly show morphological characteristics of female pelvic diaphragm hiatus, therefore, it can quickly finish diagnosis, and provide the basis for clinical diagnosis and treatment evaluation of postpartum PFD.