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目的应用经会阴三维超声研究不同分娩方式产后女性盆膈裂孔形态变化以及下尿路膀胱颈移动度,以评估产后早期女性盆底恢复情况。方法对170例初产妇(分为经阴道分娩及剖宫产)及35例已婚未育女性进行盆底超声检查,获得静息、Valsalva及缩肛时人体盆底正中矢状切面及盆底轴切面重建图像,测量一系列生物参数。结果产后6~8周在缩肛状态下经阴道分娩组盆膈裂孔纵径测值大于未育组(P<0.05);而剖宫产组盆膈裂孔参数与未育组间比较差异无统计学意义(P>0.05)。膀胱颈移动度在Valsalva时表现为经阴道分娩者大于剖宫产组及未育组(P<0.05),而剖宫产组仅背侧运动大于未育组(P<0.05)。产后6~8周剖宫产组压力性尿失禁发生率4.5%(3/66),经阴道分娩组压力性尿失禁发生率9.6%(10/104),而两者间差异无统计学意义(P>0.05)。结论经阴道分娩后产妇盆底组织结构改变较剖宫产者明显。膀胱颈移动度及盆膈裂孔纵径是评估盆底肌收缩能力的重要指标,且后者更敏感,可以作为观察产后盆底肌恢复与否的观察指标。
Objective To study the morphological changes of pelvic diaphragm foramen and the movement of lower urinary bladder neck in different postpartum women through three-dimensional ultrasound of the perineum to evaluate the pelvic floor recovery in early postpartum women. Methods 170 cases of primiparous women (divided into vaginal delivery and cesarean section) and 35 cases of married women were enrolled in pelvic floor ultrasound examination to obtain resting, Valsalva and anal at the pelvic floor when the median sagittal section and pelvic floor Axial section reconstructs the image and measures a series of biological parameters. Results The longitudinal measurement of diaphragmatic foramina in vaginal delivery in 6 to 8 weeks postpartum was greater than that in non-fertile group (P <0.05). There was no statistical difference in the parameters between the diaphragm and the non-sterile group in cesarean section Significance (P> 0.05). The bladder neck mobility in Valsalva was significantly higher in vaginal delivery than in cesarean section and non-fertile group (P <0.05), while only in dorsal side of cesarean section was greater than that in non-fertile group (P <0.05). Postpartum 6 to 8 weeks cesarean section stress incontinence rate was 4.5% (3/66), vaginal delivery group pressure urinary incontinence rate was 9.6% (10/104), but there was no significant difference between the two groups (P> 0.05). Conclusions Transvaginal delivery changes of pelvic floor maternal tissue structure than cesarean obviously. The mobility of the bladder neck and the vertical length of the pelvic diaphragm were important indexes for assessing the contractility of the pelvic floor muscles. The latter was more sensitive and could be used as an index to observe the recovery of the pelvic floor muscles after delivery.