目的探讨会阴三维超声评价妊娠及不同分娩方式女性盆底肌肌力及盆底裂孔面积的价值。方法80例定期行产后复查女性(生育组)根据分娩方式分为阴道顺产组40例和剖宫产组40例,选取未生育健康女性40例为对照组。入选者均行经会阴盆底三维超...目的探讨会阴三维超声评价妊娠及不同分娩方式女性盆底肌肌力及盆底裂孔面积的价值。方法80例定期行产后复查女性(生育组)根据分娩方式分为阴道顺产组40例和剖宫产组40例,选取未生育健康女性40例为对照组。入选者均行经会阴盆底三维超声检查,测量其盆底肌力及静息状态和Valsalva动作2种状态下盆底肛提肌裂孔前后径(anteroposterior diameter of levator hiatus,LH-A)、左右径(transverse diameter of levator hiatus,LH-D)、盆底裂孔的面积(area of urogenital hiatus,HA)和周长(circumference,C),并进行组间比较。结果生育组盆底肌力≤3级发生率(65%)高于对照组(25%)(P<0.05)。产后6~8周,阴道顺产组盆底肌力[(2.9±0.5)级]低于剖宫产组[(3.4±0.8)级](P<0.05);产后12~14周,阴道顺产组盆底肌力[(4.1±0.9)级]与剖宫产组[(4.3±1.2)级]比较差异无统计学意义(P>0.05)。静息状态及Valsalva动作时,生育组LH-A[(47.9±4.0)、(56.3±3.9)mm]、LH-D[(39.8±2.6)、(45.3±3.6)mm]、HA[(118.3±6.8)、(119.9±6.6)mm2]及C[(10.0±0.5)、(13.5±1.1)mm]均大于对照组[LH-A(43.1±4.4)、(49.5±3.8)mm,LH-D(36.2±2.9)、(40.2±2.7)mm,HA(111.2±7.0)、(112.7±7.0)mm2,C(10.9±0.3)、(11.1±0.6)mm](P<0.05);产后6~8周阴道顺产组LH-A[(43.5±2.5)、(56.8±4.4)mm]、LH-D[(40.2±1.5)、(49.2±3.3)mm]、HA[(117.3±5.8)、(126.8±7.4)mm2]及C[(15.3±7.6)、(15.8±1.4)mm]均大于剖宫产组[LH-A(40.1±2.1)、(50.0±3.9)mm,LH-D(39.1±1.8)、(41.7±3.5)mm,HA(114.6±4.3)、(116.4±6.6)mm2,C(22.1±10.5)、(10.1±0.7)mm](P<0.05)。结论经会阴三维超声检查可清晰显示女性盆底结构,通过分析盆底肌力及盆底裂孔面积可有效评价妊娠及不同分娩方式对盆底功能的影响,为临床提供重要的盆底影像学信息。展开更多
With the aid of immunohistochemistry, the present review attempts to demonstrate the composite fibers and nerve topographical anatomy in the vaginal supportive tissues. Along the tendinous arch of the pelvic fasciae, ...With the aid of immunohistochemistry, the present review attempts to demonstrate the composite fibers and nerve topographical anatomy in the vaginal supportive tissues. Along the tendinous arch of the pelvic fasciae, distal parts of the pelvic plexus extend antero-inferiorly and issue nerves to the internal anal sphincter as well as the cavernous tissues. At the attachment of the levator ani muscle to the rectum, smooth muscles in the endopelvic fascia lining the levator ani merge with the longitudinal smooth muscle layer of the rectum to provide the conjoint longitudinal muscle coat or the longitudinal anal muscle (LAM: smooth muscle). However, at the rectovaginal interface, the longitudinal smooth muscle layer of the rectum continues to the LAM without any contribution of the endopelvic fascia. The bilateral masses of the perineal smooth muscles (PSMs) are connected by the perineal body, and the PSMs receive 1) the longitudinal anal muscle, 2) the internal and external anal sphincters and, 3) the perineal membrane lining the vestibular wall. Tensile stress from the levator ani seems to be transferred to the PSMs via the LAM. Because of their irregularly arrayed muscle fibers, instead of a synchronized contraction in response to nerve impulses, the PSMs are likely to act as a barrier, septum or protector against mechanical stress because, even without innervation, such smooth muscle fibers resist (not absorb) pressure, in accordance with Bayliss’ rule. The external anal sphincter, a strong striated muscle, inserts into the PSMs and seems to play a dynamic role in supporting the rectovaginal interface to maintain the antero-posterior length of the urogenital hiatus. However, we do not think that smooth muscles play an active traction role without cooperation from striated muscle. The fibrous skeleton composed of smooth muscle in the female perineum is explained in terms of a “catamaran” model.展开更多
文摘目的探讨会阴三维超声评价妊娠及不同分娩方式女性盆底肌肌力及盆底裂孔面积的价值。方法80例定期行产后复查女性(生育组)根据分娩方式分为阴道顺产组40例和剖宫产组40例,选取未生育健康女性40例为对照组。入选者均行经会阴盆底三维超声检查,测量其盆底肌力及静息状态和Valsalva动作2种状态下盆底肛提肌裂孔前后径(anteroposterior diameter of levator hiatus,LH-A)、左右径(transverse diameter of levator hiatus,LH-D)、盆底裂孔的面积(area of urogenital hiatus,HA)和周长(circumference,C),并进行组间比较。结果生育组盆底肌力≤3级发生率(65%)高于对照组(25%)(P<0.05)。产后6~8周,阴道顺产组盆底肌力[(2.9±0.5)级]低于剖宫产组[(3.4±0.8)级](P<0.05);产后12~14周,阴道顺产组盆底肌力[(4.1±0.9)级]与剖宫产组[(4.3±1.2)级]比较差异无统计学意义(P>0.05)。静息状态及Valsalva动作时,生育组LH-A[(47.9±4.0)、(56.3±3.9)mm]、LH-D[(39.8±2.6)、(45.3±3.6)mm]、HA[(118.3±6.8)、(119.9±6.6)mm2]及C[(10.0±0.5)、(13.5±1.1)mm]均大于对照组[LH-A(43.1±4.4)、(49.5±3.8)mm,LH-D(36.2±2.9)、(40.2±2.7)mm,HA(111.2±7.0)、(112.7±7.0)mm2,C(10.9±0.3)、(11.1±0.6)mm](P<0.05);产后6~8周阴道顺产组LH-A[(43.5±2.5)、(56.8±4.4)mm]、LH-D[(40.2±1.5)、(49.2±3.3)mm]、HA[(117.3±5.8)、(126.8±7.4)mm2]及C[(15.3±7.6)、(15.8±1.4)mm]均大于剖宫产组[LH-A(40.1±2.1)、(50.0±3.9)mm,LH-D(39.1±1.8)、(41.7±3.5)mm,HA(114.6±4.3)、(116.4±6.6)mm2,C(22.1±10.5)、(10.1±0.7)mm](P<0.05)。结论经会阴三维超声检查可清晰显示女性盆底结构,通过分析盆底肌力及盆底裂孔面积可有效评价妊娠及不同分娩方式对盆底功能的影响,为临床提供重要的盆底影像学信息。
文摘With the aid of immunohistochemistry, the present review attempts to demonstrate the composite fibers and nerve topographical anatomy in the vaginal supportive tissues. Along the tendinous arch of the pelvic fasciae, distal parts of the pelvic plexus extend antero-inferiorly and issue nerves to the internal anal sphincter as well as the cavernous tissues. At the attachment of the levator ani muscle to the rectum, smooth muscles in the endopelvic fascia lining the levator ani merge with the longitudinal smooth muscle layer of the rectum to provide the conjoint longitudinal muscle coat or the longitudinal anal muscle (LAM: smooth muscle). However, at the rectovaginal interface, the longitudinal smooth muscle layer of the rectum continues to the LAM without any contribution of the endopelvic fascia. The bilateral masses of the perineal smooth muscles (PSMs) are connected by the perineal body, and the PSMs receive 1) the longitudinal anal muscle, 2) the internal and external anal sphincters and, 3) the perineal membrane lining the vestibular wall. Tensile stress from the levator ani seems to be transferred to the PSMs via the LAM. Because of their irregularly arrayed muscle fibers, instead of a synchronized contraction in response to nerve impulses, the PSMs are likely to act as a barrier, septum or protector against mechanical stress because, even without innervation, such smooth muscle fibers resist (not absorb) pressure, in accordance with Bayliss’ rule. The external anal sphincter, a strong striated muscle, inserts into the PSMs and seems to play a dynamic role in supporting the rectovaginal interface to maintain the antero-posterior length of the urogenital hiatus. However, we do not think that smooth muscles play an active traction role without cooperation from striated muscle. The fibrous skeleton composed of smooth muscle in the female perineum is explained in terms of a “catamaran” model.
