实时三维盆底超声评估不同分娩方式对产后女性肛提肌裂孔的影响

目的采用经会阴实时三维盆底超声探讨不同分娩方式对产后女性肛提肌裂孔面积的影响。方法选取就诊的80例产后6周女性（病例组）及40例未生育女性（对照组）作为研究对象，病例组又分为经阴道分娩组和选择性剖宫产组，对3组在静息状态下、最大Valsalva动作后肛提肌裂孔面积进行比较，评估不同分娩方式对产后女性肛提肌裂孔的影响，并将不同状态下经阴道分娩组肛提肌裂孔面积与新生儿出生体质量进行相关性分析。结果3组在静息状态下和最大Valsalva动作后肛提肌裂孔面积比较差异有统计学意义（P < 0.01），选择性剖宫产组和对照组均低于经阴道分娩组（P < 0.05~P < 0.01），对照组低于选择性剖宫产组（P < 0.01）；经阴道分娩组在静息状态下、最大Valsalva动作后肛提肌裂孔面积与新生儿出生体质量间均呈正相关关系（r=0.865、0.876）。结论经会阴实时三维盆底超声可以通过测量肛提肌裂孔面积对产后女性盆底结构进行评估，具有无创简便、重复性好等优点，可以作为评估女性盆底功能的常规筛查方法，为临床诊断和治疗效果评价提供依据。

Effect of different delivery ways on postpartum hiatus of levator ani evaluated by real-time three-dimensional pelvic floor ultrasound

ObjectiveTo investigate the effects of different delivery ways on the area of postpartum hiatus of levator ani evaluated by real-time three-dimensional pelvic floor ultrasound.MethodsEighty postpartum 6 weeks women and 40 nulliparous women were divided into the case group and control group, respectively.The case group was subdivided into the transvaginal delivery group and selective cesarean section group.The areas of postpartum hiatus of levator ani at rest and after the maxium Valsalva movement among three groups were compared, the effects of different delivery ways on the area of postpartum hiatus of levator ani were evaluated, and the correlation of the area of hiatus of levator ani in different states with neonatal weight was anlayzed in transvaginal delivery group.ResultsThe differences of the areas of hiatus of levator ani at rest and after the maxium Valsalva movement among three groups were statistically significant(P < 0.01), which in selective cesarean section group and control group was lower than that in transvaginal delivery group(P < 0.05 to P < 0.01), ans which in control group was lower than that in selective cesarean group(P < 0.01).The area of hiatus of levator ani at rest and after the maxium Valsalva movement in transvaginal delivery group was positively correlated with neonatal weight(r=0.865, 0.876).ConclusionsThe transperineal real-time three-dimensional ultrasound in evaluating the postpartum pelvic floor structure by measuring the area of hiatus of levator ani is noninvasive, convenient and repetitive, which can be used as a routine screening method, and provide the basis in the evaluation of clinic diagnosis and treatment effect.