三维超声评估女性妊娠晚期及分娩后盆膈裂孔结构变化的研究

摘要

目的 应用三维超声成像技术对女性妊娠期及分娩后盆膈裂孔结构进行观察比较,探讨其盆底结构的变化.方法 选取在我院定期行产前检查并分娩的单胎初产妇80例(观察组),以及同期健康未育女性80例为对照组.采用三维超声观察两组盆膈裂孔在静息状态和Valsalva状态(深吸气后屏气)下盆膈裂孔的形态和内部结构,测量并比较两组不同状态时盆膈裂孔的前后径、左右径及面积.结果 对照组女性盆底裂孔呈菱形,左右对称;观察组妊娠晚期女性的盆膈裂孔形态多呈"菱形"(58.75%),分娩后6~12周盆膈裂孔出现增大呈椭圆形或圆形者占51.25%,类菱形者占41.25%.两种状态下,观察组在分娩后及妊娠晚期盆膈裂孔的左右径、前后径及面积均偏大,与对照组比较差异有统计学意义(均P<0.05),且分娩后较妊娠晚期增大更为明显,差异均有统计学意义(均P<0.05);与静息状态下比较,观察组妊娠晚期及分娩后盆膈裂孔的左右径、前后径及面积大小均较Valsalva状态下增大,差异均有统计学意义(均P<0.05).结论 应用三维超声能够有效地动态观察女性盆膈裂孔的形态结构变化特点,女性在妊娠晚期及分娩后的盆膈裂孔均显著增大,这为产后妇女盆底功能障碍性疾病的早期预测提供可靠的影像学依据.%Objective To compare the anatomic changes of the pelvic diaphragmatic hiatus in women during pregnancy and after childbirth,and to explore discuss the changes of its structure by three-dimensional ultrasound imaging. Methods A total of 80 primiparaes with singleton(observation group) in regular prenatal examination in obstetrics and gynecology of our hospital were selected,with 80 cases of healthy nulliparous women as control group. The morphology and internal structure of the pelvic diaphragm were analyzed by three-dimensional ultrasonography in resting state and Valsalva state(breathless after deep inspiration). The anteroposterior diameter,left-right diameter and the area of pelvic diaphragm hiatus in the two groups were measured and compared. Results The pelvic diaphragmatic hiatus in the control group was rhombic shaped and symmetrical. In observation group,the pelvic hiatus morphology of women was rhombic shaped at about 58.75%in late pregnancy,and the pelvic hiatus extended at 6~12 weeks after delivery appearing oval or spherical at about 51.25%,rhombic at about 41.25%. In different states,the left-right diameter,anteroposterior diameter,and the area of pelvic diaphragm hiatus in observation group were larger than those in the control group,there were significant difference(all P<0.05),and they were larger post delivery than that in late pregnancy,there was significant difference(all P<0.05). Compared with the resting state,the left-right diameter,anteroposterior diameter and area of pelvic diaphragmatic hiatus during late pregnancy and post delivery were larger than those in Valsalva state , there were sifnificant difference(all P<0 . 05). Conclusion The variation of the pelvic diaphragmatic hiatus structure of postpartum women can be observed dynamically by three-dimensional ultrasound imaging,and the diameter of pelvic diaphragmatic hiatus will be significantly increased in the late pregnancy and after childbirth,therefore,this method provides a reliable imaging basis for clinic to predict female pelvic floor dysfunction after delivery.