基于盆底超声分析分娩方式对初产妇产后早期盆底结构的影响

doi:10.3760/cma.j.cn101202-20210415-00101

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摘要目的探讨应用盆底超声检查分析不同分娩方式对初产妇产后早期盆底结构的影响。方法回顾性队列研究。选取2020年4—10月安徽理工大学第一附属医院妇产科门诊就诊的初产妇175例,年龄20~35 (26.8±2.8)岁,均为足月、单胎,产后6~8周。根据分娩方式不同分为两组,其中经阴道分娩组102例、剖宫产组73例。采用盆底超声测量所有产妇静息和Valsalva状态下膀胱逼尿肌厚度、膀胱颈与耻骨联合间的距离、膀胱后角、膀胱颈移动度、尿道旋转角、肛直角、肛提肌平均厚度和肛提肌裂孔面积指标。(1)比较两组产妇的年龄、孕期增长体质量、孕周及新生儿体质量的差异;(2)比较两组产妇盆底受损情况;(3)比较静息和Valsalva状态下两组超声测量指标的差异;(4)比较经阴道分娩组不同盆底功能障碍疾病Valsalva状态下的超声测量指标。结果 (1)两组患者的年龄、孕期增长体质量、孕周及新生儿体质量比较,差值均无统计学差异(P值均＞0.05)。(2)盆底受损情况:阴道分娩组与剖宫产组患者产后子宫脱垂分别为34例(33.3%)和9例(12.3%),差异有统计学意义(χ²=10.129, P＜0.05),压力性尿失禁、尿道漏斗形成、膀胱膨出和直肠膨出差异均无统计学意义(P值均＞0.05)。(3)静息状态下,阴道分娩组膀胱后角、肛直角和肛提肌裂孔面积均大于剖宫产组,差异均有统计学意义(t=3.211、2.658、2.835,P值均＜0.05);Valsalva状态下,阴道分娩组膀胱颈与耻骨联合的距离明显小于剖宫产组,分别为(-8.2±7.9)mm和(6.3±7.0)mm,而膀胱颈移动度、膀胱后角、尿道旋转角和肛提肌裂孔面积均大于剖宫产组,差异均有统计学意义(P值均＜0.05)。(4)子宫脱垂患者的肛提肌裂孔面积、膀胱颈移动度和尿道旋转角大于Ⅱ型膀胱膨出和尿道漏斗形成患者,而尿道漏斗形成的患者膀胱后角最大,差异均有统计学意义(P值均＜0.05)。结论盆底超声清楚地显示产后早期女性盆底结构的变化,阴道分娩者较剖宫产分娩者的盆底损伤严重。

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关键词 ：盆底疾病, 妊娠并发症, 超声检查, 子宫脱垂, 阴道分娩, 剖宫产术

Abstract：Objective To analyze the effect of different delivery modes on the pelvic floor structure of primipara women in the early postpartum period by pelvic floor ultrasound.Methods In this retrospective study, 175 primiparas who were admitted to the obstetrics and gynecology clinic of the First Affiliated Hospital of Anhui University of Science and Technology from April 2020 to October 2020 were selected. The participants were 20-35 years old with an average age of (26.8±2.8) years, single pregnancy, term pregnany, 6-8 weeks postpartum. All subjects underwent pelvic floor ultrasound examination to measure the static and dynamic detrusor of the bladder, the distance between the bladder neck and the pubic symphysis, the posterior angle of the bladder, the movement of the bladder neck, the rotation angle of the urinary tract, the anal right angle, the average thickness of the levator ani muscle, and the area of levator ani muscle hiatus. Statistical analysis was conducted to compare the following: (1) age, gestational weight gain, gestational age, and fetal weight between the two groups; (2) pelvic floor damage between the two groups; (3) ultrasonic measurement indexes in the resting and Valsalva states between the two groups; and (4) the ultrasonic measurement indexes of different pelvic floor dysfunction diseases in the vaginal delivery group.Results (1) No significant differences in age, weight gain during pregnancy, gestational age, and fetal weight were found between the two groups (all P values＞0.05). (2) In the comparison of pelvic floor damage, 34 cases (33.3%) of postpartum uterine prolapse were found in the vaginal delivery group, and 9 cases (12.3%) were found in the cesarean section group, and the difference was statistically significant (χ²=10.129, P＜0.05). No statistically significant differences were found in stress urinary incontinence, urethral funnelation, cystocele, and rectocele (all P values＞0.05). (3) At rest, the posterior angle of bladder, the anal right angle, and the areas of levator ani hiatus in the vaginal delivery group were all larger than those in the cesarean section group; the difference was statistically significant (t=3.211, 2.658, 2.835, all P values＜0.05). In Valsalva state, the distance between the bladder neck and the pubic symphysis in the vaginal delivery group was significantly smaller than that in the cesarean section group, which were (-8.2±7.9) and (6.3±7.0) mm, respectively. The movement of the bladder neck, the posterior angle of the bladder, the rotation angle of the urethra, and the area of the levator anal hiatal were all larger than in the cesarean section group, and the difference was statistically significant (all P values＜0.05). (4) In patients with uterine prolapse, the areas of the levator ani hiatus, the mobility of the bladder neck, and the rotation angle of the urethra were greater than those with Ⅱ cystocele and urethral funnel fromation, whereas the posterior angle of the bladder was largest in patients with urethral funnel fromation; the difference was statistically significant (all P values＜0.05).Conclusions Pelvic floor ultrasound can clearly show the changes of the pelvic floor structure in women with early postpartum. Patients who have vaginal delivery have more serious pelvic floor injuries than those who have cesarean delivery.

Key words： Pelvic floor disorders Pregnancy complications Ultrasonography Pelvic organ prolapse Vaginal delivery Cesarean section

收稿日期: 2021-04-15

基金资助:安徽省卫生健康委科研项目(AHWJ2021b129);淮南市科技局计划(20203068)

通讯作者: 周萍,Email:961459520@qq.com

引用本文:

李茗薇, 刘鑫, 周萍. 基于盆底超声分析分娩方式对初产妇产后早期盆底结构的影响[J]. 中华解剖与临床杂志, 2021, 26(6): 610-615.
Li Mingwei, Liu Xin, Zhou Ping. Effect of delivery mode on the pelvic floor structure of primiparas in the early postpartum period by analysis of pelvic floor ultrasound. Chinese Journal of Anatomy and Clinics, 2021, 26(6): 610-615.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20210415-00101 或 http://www.cjac.com.cn/CN/Y2021/V26/I6/610

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