Clinical significance of early postpartum pelvic floor musclescreening and ultrasonic detection
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摘要:
目的探讨产后早期盆底肌力筛查和三维超声检测的作用及临床意义。 方法选择清远市人民医院2012年9月~2014年6月住院分娩，产后6周复查的初产妇600例，其中阴道分娩组350例，剖宫产组250例，取同期妇科门诊健康未育妇女100例为对照组，分别对其进行盆底肌肉肌力筛查及三维超声经会阴检测，三组在静息和缩肛动作时的盆底裂孔情况和肛提肌厚度。 结果按评定标准将盆底肌力分6个级别，其中Ⅳ级以上为盆底肌力正常，共92例（15.33%），0-Ⅲ级为不正常，共508例（84.67%）；其中剖宫产组正常率为33.6%，阴道分娩组正常率为2.29%，对照组正常率为100%；阴道分娩组与剖宫产组差异有统计学意义；前两组与对照组差异有统计学意义。阴道分娩组与剖宫产组在静息和缩肛动作状态下盆膈裂孔前后径、横径及面积均高于对照组（P < 0.05），肛提肌厚度均小于对照组（P < 0.05）。 结论盆底肌力筛查结合三维超声测量为产后妇女盆底功能障碍性疾病的诊断提供解剖学和功能学方面的依据和为制定指导个体化盆底康复治疗提供最佳治疗效果的方案。 Abstract:ObjectiveDiscussion on early postpartum pelvic floor musclescreening and three-dimensional ultrasound role and clinical significance. MethodsSelected 2012 September to 2014 June in Qingyuan People's Hospital hospital delivery, 600 cases of primipara postpartum 6 weeks, one group of 350 cases of vaginal delivery, cesarean section group 250 cases take over the same period, gynecological clinichealthy nulliparous women 100 cases as control group, separately carried on the pelvic floor muscle strengthscreening and three-dimensional ultrasound transperinealdetection three group, anal contraction movements in resting and pelvic floor hiatus and levator ani muscle thickness. ResultsAccording to the standard of the pelvic floor muscle poweris divided into 6 levels, the IV level and above for pelvic floor muscle strength is normal, a total of 92 cases (15.33%), 0-grade III is not normal, a total of 508 cases (84.67%); wherein the cesarean section group normal rate was 33.6%, the rate of normal vaginal delivery group was 2.29%, control group of normal rate 100%; the difference was statistically significant vaginal delivery and cesarean section group; the first two group and control group had significant difference. Vaginal delivery and cesarean section group in resting and anal contraction movementsunder the condition of pelvic diaphragm hiatusanteroposterior diameter, transverse diameter and area were higher than that of the control group (P < 0.05), levator ani muscle thickness were less than that in control group (P < 0.05). ConclusionPelvic floor muscle strength screening combined with 3D ultrasound measurements provide for the diagnosis ofpostpartum pelvic floor dysfunction of the anatomical and functional aspects of the basis and for formulating guiding individual pelvic floor rehabilitation treatment to provideoptimal treatment scheme. -
Key words:
- postpartum /
- pelvic /
- floor muscle /
- three dimensional ultrasound
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表 1 3组妇女盆底肌肉综合肌力情况比较（例）
分组 例数 0级 Ⅰ级 Ⅱ级 Ⅲ级 Ⅳ级 Ⅴ级 正常率（%） 阴道分娩组 350 11 80 146 115 8 0 2.29 剖宫产组 250 1 5 39 121 82 2 33.6 未生育健康妇女（对照组） 100 0 0 0 0 20 80 100 
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表 2 四组妇女盆膈裂孔前后径、横径、面积及肛提肌厚度比较
分组 例数 横泾(cm) 前后径(cm) 面积(cm2) 肛提肌厚度(cm) 阴道分娩组静息状态 350 4.36±0.69※△ 5.19±0.54※△ 15.33±1.69※△ 0.57±0.13※△ 阴道分娩组缩肛状态 150 4.35±0.55※※△ 4.82±0.66※△ 14.01±1.52※※△ 0.70±0.11※△ 选择性剖宫产组静息状态 150 3.98±0.76※ 5.01±0.72※ 13.91±1.82※ 0.70±0.15※ 选择性剖宫产组缩肛状态 100 4.09±0.39※ 4.46±0.76※ 12.98±1.79※ 0.84±0.11※ 试产剖宫产组静息状态 100 4.17±0.72 5.1±0.63 14.12±1.75 0.63±.014 试产剖宫产组缩肛状态 100 4.22±0.47 4.64±0.71 13.49±1.65 0.77±0.11 对照组（未生育健康妇女）静息状态 100 4.45±0.57 4.68±0.69 13.58±1.93 0.77±0.10 对照组（未生育健康妇女）缩肛状态 100 4.15±0.67 4.43±0.67 12.72±1.75 0.87±0.10 与相同状态对照组比较，※P < 0.05，※※P < 0.01；与选择性剖宫产组相同状态比较，P < 0.05；与相同状态试产剖宫产组比较，P < 0.05；与不同状态相同组比较，△P < 0.01.
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