摘要
目的采用四维盆底超声联合实时剪切波弹性成像评价初产妇不同分娩方式对产后盆腔功能的影响。方法采取前瞻性研究方法,选择2018年1月至2020年12月进行产后复查的初产妇120例,年龄23~29岁,平均年龄27.22岁;产后时间4~6周,平均产后时间5.02周;胎儿出生体质量0.63~4.74 kg,平均体质量3.25 kg。根据分娩方式将其分为阴道分娩组(66例)、剖宫产组(54例)。采用四维盆底超声和实时剪切波弹性成像观察盆底结构,比较两组患者静息屏气状态和缩肛状态肛提肌裂孔、弹性情况和肛门括约肌复合体之间的差异。结果阴道分娩组患者静息屏气状态下肛提肌裂孔的前后径、左右直径和其面积显著高于剖宫产组[(5.02±0.56)cm vs(4.38±0.50)cm、(4.12±0.43)cm vs(3.75±0.40)cm、(14.12±1.25)cm^(2)vs(13.15±1.10)cm^(2)],厚度显著低于剖宫产组[(0.59±0.12)cm vs(0.70±0.16)cm](P<0.05);阴道分娩组患者缩肛状态下肛提肌裂孔的前后径、左右直径和其面积显著高于剖宫产组[(3.80±0.30)cm vs(3.53±0.25)cm、(3.68±0.27)cm vs(3.41±0.22)cm、(8.75±0.88)cm^(2)vs(8.05±0.80)cm^(2)],厚度显著低于剖宫产组[(0.48±0.11)cm vs(0.60±0.13)cm](P<0.05)。在近端平面,阴道分娩组患者6点、12点方向肛门内括约肌的厚度显著低于剖宫产组;在中部平面,阴道分娩组患者12点方向肛门内括约肌的厚度显著低于剖宫产组;在远端平面,阴道分娩组患者6点、12点肛门外括约肌厚度显著低于剖宫产组(P<0.05);阴道分娩组患者静息屏气左侧、静息屏气右侧、缩肛左侧、缩肛右侧的弹性显著低于剖宫产组[(23.69±1.55)kPa vs(36.88±0.80)kPa、(22.02±2.37)kPa vs(40.21±1.92)kPa、(39.95±2.97)kPa vs(69.64±2.00)kPa、(38.77±1.92)kPa vs(66.93±2.67)kPa](P<0.05)。结论四维盆底超声和实时剪切波弹性成像联合诊断,对于初产妇产后盆腔功能的评价具有显著的临床意义。
Objective To evaluate the effect of different delivery modes on postpartum pelvic function in primipara by fourdimensional pelvic floor ultrasound combined with real-time shear wave elastography.Methods From January 2018 to December 2020,a total of 120 primiparas were enrolled in prospective study,which aged 23-29 years old with mean age of27.22 years old;postpartum time was 4-6 weeks with mean postpartum time of 5.02-week;birth mass of fetus was 0.63-4.74 kg with mean mass of 3.25 kg.According to delivery mode,all of the primiparas were divided into vaginal delivery group(n=66)and cesarean section group(n=54).Four-dimensional pelvic floor ultrasound and real-time shear wave elastography were performed to observe pelvic floor structure,differences of levator hiatus,elastic profile and anal sphincter complex at resting breath-hold and retracted states between 2 groups were compared.Results At resting breath-hold state,the anteriorposterior diameters,left-right diameters and area of levator hiatus in vaginal delivery group were significantly higher than those in cesarean section group[(5.02±0.56)cm vs(4.38±0.50)cm,(4.12±0.43)cm vs(3.75±0.40)cm,(14.12±1.25)cm^(2)vs(13.15±1.10)cm^(2)],and thickness was significantly lower than that in cesarean section group[(0.59±0.12)cm vs(0.70±0.16)cm](P<0.05).At retracted state,the anterior-posterior diameters,left-right diameters and area of levator hiatus in vaginal delivery group were significantly higher than those in cesarean section group[(3.80±0.30)cm vs(3.53±0.25)cm,(3.68±0.27)cm vs(3.41±0.22)cm,(8.75±0.88)cm^(2)vs(8.05±0.80)cm^(2)],and thickness was significantly lower than that in cesarean section group[(0.48±0.11)cm vs(0.60±0.13)cm](P<0.05).In proximal plane,the thickness of internal anal sphincter at posterior and anterior in vaginal delivery group was significantly lower than that in cesarean section group,in middle plane,the thickness of internal anal sphincter at anterior in vaginal delivery group was significantly lower than that in cesarean section
作者
朱一平
郭道宁
王丹
黄兴华
李晨希
田黎
ZHU Yi-ping;GUO Dao-ning;WANG Dan;HUANG Xing-hua;LI Chen-xi;TIAN Li(Department of Ultrasound Medicine,School of Medicine,University of Electronic Science and Technology of China,Mianyang 621000,Sichuan,China;Department of Obstetrics and Gynecology,Mianyang Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Mianyang 621000,Sichuan,China)
出处
《生物医学工程与临床》
CAS
2023年第1期47-52,共6页
Biomedical Engineering and Clinical Medicine
关键词
四维盆底超声
实时剪切波弹性成像
光学增强内镜
盆膈裂孔
肛门括约肌复合体
盆底肌收缩
four dimensional pelvic floor ultrasound
real time shear wave elastography
optical enhanced endoscopy
pelvic diaphragm hiatus
anal sphincter complex
pelvic floor muscle contraction
