目的 了解不同分娩方式对初产妇产后的盆底解剖与功能变化的影响.方法 选取我院妇产科选择性剖宫产(剖宫产组)和经阴道分娩(顺产组)的初产妇各250例,于产后6～8周进行盆底三维超声检查.观察Valsalva动作时前、中、后盆腔有无器官脱垂并测量膀胱颈下移距离、尿道旋转角度等参数,观察静息、缩肛动作、Valsalva动作时肛提肌裂孔的变化并测量其面积.结果 顺产组出现盆腔器官脱垂的病例数明显多于剖宫产组(P＜0.05),且脱垂的严重程度也明显重于剖宫产组(P＜0.05);顺产组在Valsalva动作时,膀胱颈下移距离、尿道旋转角度均大于剖宫产组(P＜0.05);顺产组在静息、缩肛动作及Valsalva动作时其肛提肌裂孔的面积均大于剖宫产组(P＜0.05).结论 经阴道顺产对盆底结构和功能的损伤大于剖宫产组,盆底三维超声是产后筛查盆底功能障碍性疾病的一项客观而简单且值得推广的影像学方法.%Objective To investigate the influence of different modes of delivery on primiparae's pelvic floor structure and function change.Methods 250 cases delivering through caesarean section (C-section group) and 250 cases delivering vaginally (natural labor group) were chosen,then their pelvic floors were checked by three-dimensional uhrasonography 6-8 weeks after the delivery.The signs of anterior,middle,and posterior pelvic prolapse were observed and the bladder neck down distance and the urethral transfer angle were measured during Valsalva maneuver.The changes were observed and the areas of levator hiatal were measured when the patients was in rest,Shrinkage anal maneuver,and Valsalva maneuver.Results More cases occurred more severe pelvic organ prolapse in the natural labor group than in the C-section group (P ＜ 0.05).During Valsalva maneuver,the bladder neck down distance was longer and the urethral teansfer angle was larger in the natural labor group than in the C-section group (P ＜ 0.05).When the patients were in rest,Shrinkage anal maneuver,and Valsalva maneuver,the areas of levator hiatal were larger in the natural labor group than in the C-section group (P ＜ 0.05).Conclusions Natural labor is more harmful to primiparae's pelvic floor structure and function than C-section.Three-dimensional ultrasonography is a simple and objective method for postpartum pelvic floor dysfunction screening and worth being generalized.
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