经会阴二维超声动态观察和评估产后女性盆底功能的改变
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摘要
目的探讨经会阴二维超声动态观察和评估产后女性盆底功能改变的价值,为女性盆底功能障碍性疾病(PFD)的诊断提供影像学依据。方法选取2016年1至12月期间在宁波市鄞州区第二医院经阴道分娩的产妇100例(实验组),正常门诊体检的育龄期妇女50例(对照组),对照组在体检时、分娩产妇在产后3d和产后42d时进行会阴二维超声检查,分别测量静息期、缩肛期及张力期,以耻骨联合下缘水平线为X轴和以人体中轴为Y轴上的膀胱角旋转度,膀胱尿道后角值及膀胱颈移动度等相关数据。结果静息期、缩肛期和张力期,患者产后3d和产后42d时膀胱颈在Y轴上的位置(Dy)、膀胱颈在X轴上的位置(Dx)、膀胱角的位置(β)及膀胱尿道后角值(α)的测量参数均大于对照组相应时相的测量值(静息期:产后3d与对照组t值分别为7.19、5.76、18.50、13.49,产后42d与对照组t值分别为4.29、4.22、9.36、6.07;缩肛期:产后3d与对照组t值分别为6.85、6.07、23.34、17.69,产后42d与对照组t值分别为3.83、3.77、6.61、5.58;张力期:产后3d与对照组t值分别为4.67、4.37、7.49、5.41,产后42d与对照组t值分别为8.43、2.75、15.97、10.90,均P<0.05),且患者产后3d上述参数值大于产后42d(静息期:t值分别为3.11、2.81、11.99、9.81;缩肛期:t值分别为3.15、3.58、21.48、12.71;张力期:t值分别为5.45、2.18、12.02、5.69,均P<0.05);患者产后3d和产后42d时,膀胱颈在Y轴上的移动度(△Dy),膀胱颈在X轴上的移动度(△Dx),膀胱角的位置(△β)及膀胱颈移动度结果均大于对照组(产后3d与对照组t值分别为7.64、20.50、28.23、4.68,产后42d与对照组t值分别为8.12、29.13、16.75、6.07,均P<0.05),且患者产后3d上述参数值大于产后42d(t值分别为3.59、11.31、11.40、2.90,均P<0.05)。结论经阴道生产后女性盆底功能明显存在结构损伤,经会阴二维超声检查可动态观察及评估产后女性盆底功能改变,为PFD的早期发现及诊断提供参考依据。
Objective To observe the value of transperineal two-dimensional ultrasound in assessment of pelvic function after delivery and to help diagnose pelvic floor dysfunction(PFD)with ultrasound imaging.Methods We selected 100 women after vaginal delivery(experimental group)and 50 childbearing age women undergoing normal medical examination(control group).Transperineal two-dimensional ultrasound was given during physical examination in control group and at 3 d and 42 d postpartum in experimental group.Rotation degree of bladder on both X-axis(horizontal line of lower margin of pubic bone)and Y-axis(central axis of human body),posterior urethrovesical angle and cervical mobility of bladder during shrinking resting period,shrinking anus period and tension period were measured.Results Position of neck of bladder on Y-axis(Dy),position of neck of bladder on X-axis(Dx),position of bladder angle(β)and posterior urethrovesical angle(α)during shrinking resting period,shrinking anus period and tension period in patients at 3 d and 42 d postpartum were all greater in experimental group than those during corresponding period in control group(comparison of indexes during shrinking resting period in patients at 3 dpostpartum with those in control group:t value was 7.19,5.76,18.50,and 13.49;at 42 dpostpartum with those in control group:t value was4.29,4.22,9.36 and 6.07;comparison of indexes during shrinking anus period in patients at 3 dpostpartum with those in control group:t value was 6.85,6.07,23.34 and 17.69;at 42 d postpartum with those in control group:t value was 3.83,3.77,6.61 and 5.58;comparison of indexes during tension period in patients at 3 dpostpartum with those in control group:t value was 4.67,4.37,7.49 and 5.41;at 42 d postpartum with those in control group:t value was 8.43,2.75,15.97 and 10.90,all P<0.05).These indexes in puerperants at 3 d after delivery were greater than those at 42 d after delivery(shrinking resting period:t value was 3.11,2.81,11.99 and 9.81;shrinking anus period:t value was 3.15,3.58,21.48 and 12.71;tension period:t value was 5.45,2.18,12.02 and 5.69,all P<0.05).Movement of bladder neck on Y-axis(△Dy),movement of bladder neck on X-axis(△Dx),position of bladder angle(△β)and movement of bladder neck in postpartum women at 3 d and 42 d after delivery were all greater than those in control group(indexes at 3 d after delivery with those in control group:t value was 7.64,20.50,28.23 and 4.68;at 42 dafter delivery with those in control group:t value was 8.12,29.13,16.75 and 6.07,all P<0.05),and these indexes in puerperants at 3 d after delivery were greater than those at 42 d after delivery(t value was 3.59,11.31,11.40 and 2.90,all P<0.05).Conclusion Structural damage of pelvic floor is found obviously in postpartum female.Transperineal two-dimensional ultrasound can dynamically observe and assess changes in pelvic floor function after delivery,and provide references for early detection of PFD.
Objective To observe the value of transperineal two-dimensional ultrasound in assessment of pelvic function after delivery and to help diagnose pelvic floor dysfunction(PFD)with ultrasound imaging.Methods We selected 100 women after vaginal delivery(experimental group)and 50 childbearing age women undergoing normal medical examination(control group).Transperineal two-dimensional ultrasound was given during physical examination in control group and at 3 d and 42 d postpartum in experimental group.Rotation degree of bladder on both X-axis(horizontal line of lower margin of pubic bone)and Y-axis(central axis of human body),posterior urethrovesical angle and cervical mobility of bladder during shrinking resting period,shrinking anus period and tension period were measured.Results Position of neck of bladder on Y-axis(Dy),position of neck of bladder on X-axis(Dx),position of bladder angle(β)and posterior urethrovesical angle(α)during shrinking resting period,shrinking anus period and tension period in patients at 3 d and 42 d postpartum were all greater in experimental group than those during corresponding period in control group(comparison of indexes during shrinking resting period in patients at 3 dpostpartum with those in control group:t value was 7.19,5.76,18.50,and 13.49;at 42 dpostpartum with those in control group:t value was4.29,4.22,9.36 and 6.07;comparison of indexes during shrinking anus period in patients at 3 dpostpartum with those in control group:t value was 6.85,6.07,23.34 and 17.69;at 42 d postpartum with those in control group:t value was 3.83,3.77,6.61 and 5.58;comparison of indexes during tension period in patients at 3 dpostpartum with those in control group:t value was 4.67,4.37,7.49 and 5.41;at 42 d postpartum with those in control group:t value was 8.43,2.75,15.97 and 10.90,all P<0.05).These indexes in puerperants at 3 d after delivery were greater than those at 42 d after delivery(shrinking resting period:t value was 3.11,2.81,11.99 and 9.81;shrinking anus period:t value was 3.15,3.58,21.48 and 12.71;tension period:t value was 5.45,2.18,12.02 and 5.69,all P<0.05).Movement of bladder neck on Y-axis(△Dy),movement of bladder neck on X-axis(△Dx),position of bladder angle(△β)and movement of bladder neck in postpartum women at 3 d and 42 d after delivery were all greater than those in control group(indexes at 3 d after delivery with those in control group:t value was 7.64,20.50,28.23 and 4.68;at 42 dafter delivery with those in control group:t value was 8.12,29.13,16.75 and 6.07,all P<0.05),and these indexes in puerperants at 3 d after delivery were greater than those at 42 d after delivery(t value was 3.59,11.31,11.40 and 2.90,all P<0.05).Conclusion Structural damage of pelvic floor is found obviously in postpartum female.Transperineal two-dimensional ultrasound can dynamically observe and assess changes in pelvic floor function after delivery,and provide references for early detection of PFD.
引文
[1]Rogers R G,Leeman L M,Borders N,et al.Contribution of the second stage of labour to pelvic floor dysfunction:aprospective cohort comparison of nulliparous women[J].BJOG:An International Journal of Obstetrics&Gynaecology,2014,121(9):1145-1154.
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[5]Li-Yun-Fong R J,Larouche M,Hyakutake M,et al.Is pelvic floor dysfunction an independent threat to sexual function?A cross-sectional study in women with pelvic floor dysfunction[J].The journal of sexual medicine,2017,14(2):226-237.
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[7]Hock M,Bodis J,Garai J.Pelvic floor dysfunction:does hormone deficiency matter?[J].Maturitas,2014,78(1):70.
[8]Seth J,Naaseri S,Solomon E,et al.Correlation of MRIfeatures of urethral diverticulum and stress urinary incontinence[J].European Urology Supplements,2017,16(3):e1775-e1776.
[9]孙秀丽,王建六.盆底功能障碍性疾病诊治中辅助检查的规范应用[J].中国妇产科临床杂志,2015,16(2):97-99.
[10]冯娅琴,谢丽丹,陈方红,等.经会阴超声评估对产后女性盆底功能康复治疗的分析[J].中国妇幼健康研究,2017,2017,28(6):700-703
[11]韩劲松,陈永康,刘剑羽,等.磁共振成像在盆底结构异常中的诊断意义[J].中国实用妇科与产科杂志,2017,33(10):1018-1025.
[12]Erekson E A,Fried T R,Martin D K,et al.Frailty,cognitive impairment,and functional disability in older women with female pelvic floor dysfunction[J].International urogynecology journal,2015,26(6):823-830.
[13]Dietz H P.Pelvic floor ultrasound[J].Current Surgery Reports,2013,1(3):167-181.
[14]Youssef A,Montaguti E,Cariello L,et al.OC09.08:Reliability of a novel 3D ultrasound technique for pelvic hiatal area in women with symptoms of pelvic floor dysfunction[J].Ultrasound in Obstetrics&Gynecology,2014,44(S1):23.
[15]Youssef A,Raimondo D,Forno S,et al.OC26.03:Pelvic floor dysfunction at three‐dimensional transperineal ultrasound in women affected by deep infiltrating endometriosis[J].Ultrasound in Obstetrics&Gynecology,2016,48(S1):47.
[16]杨晓,刘玉玲.盆底肌肉训练对产后盆底功能障碍的效果分析[J].国际妇产科学杂志,2013,40(2):164-166.
[17]孙智晶,朱兰,郎景和,等.产后盆底康复锻炼对女性盆底功能障碍性疾病的预防作用[J].中华妇产科杂志,2015,50(6):420-427.
[18]朱兰.中国女性盆底肌肉锻炼的状况与未来[J].中国实用妇科与产科杂志,2017,33(1):19-20.
[2]Delft K,Sultan A H,Thakar R,et al.The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction[J].BJOG:An International Journal of Obstetrics&Gynaecology,2014,121(9):1164-1172.
[3]Jundt K,Peschers U,Kentenich H.The investigation and treatment of female pelvic floor dysfunction[J].Deutschesrzteblatt International,2015,112(33-34):564.
[4]谭燕萍,谭健坤,李色薇.妊娠后盆底功能障碍性疾病和盆底肌收缩力的相关性研究[J].中国妇幼健康研究,2015,26(6):1254-1256.
[5]Li-Yun-Fong R J,Larouche M,Hyakutake M,et al.Is pelvic floor dysfunction an independent threat to sexual function?A cross-sectional study in women with pelvic floor dysfunction[J].The journal of sexual medicine,2017,14(2):226-237.
[6]Hartmann D,Sarton J.Chronic pelvic floor dysfunction[J].Best Practice&Research Clinical Obstetrics&Gynaecology,2014,28(7):977-990.
[7]Hock M,Bodis J,Garai J.Pelvic floor dysfunction:does hormone deficiency matter?[J].Maturitas,2014,78(1):70.
[8]Seth J,Naaseri S,Solomon E,et al.Correlation of MRIfeatures of urethral diverticulum and stress urinary incontinence[J].European Urology Supplements,2017,16(3):e1775-e1776.
[9]孙秀丽,王建六.盆底功能障碍性疾病诊治中辅助检查的规范应用[J].中国妇产科临床杂志,2015,16(2):97-99.
[10]冯娅琴,谢丽丹,陈方红,等.经会阴超声评估对产后女性盆底功能康复治疗的分析[J].中国妇幼健康研究,2017,2017,28(6):700-703
[11]韩劲松,陈永康,刘剑羽,等.磁共振成像在盆底结构异常中的诊断意义[J].中国实用妇科与产科杂志,2017,33(10):1018-1025.
[12]Erekson E A,Fried T R,Martin D K,et al.Frailty,cognitive impairment,and functional disability in older women with female pelvic floor dysfunction[J].International urogynecology journal,2015,26(6):823-830.
[13]Dietz H P.Pelvic floor ultrasound[J].Current Surgery Reports,2013,1(3):167-181.
[14]Youssef A,Montaguti E,Cariello L,et al.OC09.08:Reliability of a novel 3D ultrasound technique for pelvic hiatal area in women with symptoms of pelvic floor dysfunction[J].Ultrasound in Obstetrics&Gynecology,2014,44(S1):23.
[15]Youssef A,Raimondo D,Forno S,et al.OC26.03:Pelvic floor dysfunction at three‐dimensional transperineal ultrasound in women affected by deep infiltrating endometriosis[J].Ultrasound in Obstetrics&Gynecology,2016,48(S1):47.
[16]杨晓,刘玉玲.盆底肌肉训练对产后盆底功能障碍的效果分析[J].国际妇产科学杂志,2013,40(2):164-166.
[17]孙智晶,朱兰,郎景和,等.产后盆底康复锻炼对女性盆底功能障碍性疾病的预防作用[J].中华妇产科杂志,2015,50(6):420-427.
[18]朱兰.中国女性盆底肌肉锻炼的状况与未来[J].中国实用妇科与产科杂志,2017,33(1):19-20.