盆底超声对压力性尿失禁初产妇盆膈裂孔的动态观察

摘要

Objective To study the correlation of morphological and functional characteristics of pelvic diaphragm hiatus in postpartum women with stress urinary incontinence(SUI)by transperineal three-dimensional ultrasonography.Methods From July 2015 to June 2017,108 postpartum women underwent transperineal 3-D ultrasound investigation,including 42 postpartum women with SUI and the other 66 postpartum women without SUI.In the mean time,60 normal nulliparous healthy women without SUI and constipation were chosen as control group.The morphological characteristics of pelvic diaphragm hiatus,the perimeter and area of pelvic diaphragm hiatus,pubovisceral muscle thickness were measured at rest,on maximum pelvic floor contraction and maximum Valsalva by 3-D ultrasound,respectively.Results The perimeter and area of pelvic diaphragm hiatus and pubovisceral muscle thickness were significantly increased than those in control group at rest,on maximum pelvic floor contraction and maximum Valsalva respectively(tperimetervalue was 2.61,2.70 and 3.88,respectively,tareavalue was 2.75,2.91 and 4.02, tpubovisceral muscle thicknessvalue was 3.01,3.52 and 2.86,respectively,all P<0.05).And the perimeter and area of pelvic diaphragm hiatus in postpartum women with SUI were increased than those without SUI at three maneuvers(tperimetervalue was 2.69,3.21 and 4.01, tareavalue was 2.91,2.88 and 3.44,all P<0.05).Pubovisceral muscle thickness in postpartum women with SUI was significantly thinner than that without SUI at maximum pelvic floor contraction(t=4.02,P<0.05),but there was no significant difference between postpartum women with SUI and without SUI at rest and on maximum Valsalva in pubovisceral muscle thickness(t value was 1.03 and 0.98,respectively,both P>0.05).Conclusion Transperineal three-dimensional ultrasonography has great value for pelvic diaphragm hiatus change in postpartum women especially those with SUI.%目的 经会阴盆底三维超声动态观察初产妇盆膈裂孔的解剖及功能改变与压力性尿失禁(SUI)的相关性.方法 选取2015年7月至2017年6月在陕西省人民医院妇产科定期行产后复查且此次为单胎初产的女性108例(产后组),其中有SUI症状42例(SUI产后妇女),无SUI症状66例(非SUI产后妇女),同期选取未育的无漏尿及便秘症状健康妇女60例(对照组).比较各组妇女的盆膈裂孔特征,测量各组妇女在静息状态、缩肛动作和Valsalva动作3种状态下的盆膈裂孔周长、面积及耻骨直肠肌厚度.结果 在静息状态、缩肛动作及Valsalva动作3种状态下,产后组妇女的盆膈裂孔周长、面积及耻骨直肠肌厚度均明显大于对照组妇女的盆膈裂孔测值(t周长值分别为2.61、2.70、3.88,t面积值分别为2.75、2.91、4.02,t耻骨直肠肌厚度值分别为3.01、3.52、2.86,均 P<0.05).产后组SUI产妇在3种状态下的盆膈裂孔周长及面积明显大于非SUI产妇(t周长值分别为2.69、3.21、4.01,t面积值分别为2.91、2.88、3.44,均 P<0.05).除在缩肛动作时,SUI产后妇女的耻骨直肠肌厚度明显薄于非SUI产后妇女耻骨直肠肌厚度(t=4.02,P<0.05),其余状态下的耻骨直肠肌厚度两者间比较,差异均无统计学意义(t值分别为1.03、0.98,均P>0.05).结论 经会阴三维超声能有效观察产后女性尤其SUI产后妇女盆底解剖结构与功能的变化.