经会阴三维超声定量评价慢性便秘未育女性肛提肌功能

目的采用经会阴三维超声定量评价慢性便秘未育女性患者肛提肌功能。方法纳入41例慢性便秘未育女性(便秘组)及41名健康未育女性(对照组),采用经会阴超声检查获取其静息状态(静息期)、最大缩肛状态(缩肛期)及最大瓦尔萨尔瓦状态下(瓦尔萨尔瓦期)三维容积数据,测量左、右侧肛提肌厚度(L-LAT、R-LAT)及肛提肌裂孔面积(LHA),比较组间静息期与缩肛期L-LAT、R-LAT及LHA差值(ΔL、ΔR及ΔA),静息期与瓦尔萨尔瓦期L-LAT、R-LAT及LHA差值(ΔL’、ΔR’及ΔA’)的差异;以Pearson相关分析评价便秘组超声参数与病程的相关性。结果便秘组瓦尔萨尔瓦期L-LAT及R-LAT均明显小于对照组(P均<0.05),LHA、ΔL’、ΔR’及ΔA’明显大于对照组(P均<0.05);组间静息期、缩肛期各参数及其差值差异均无统计学意义(P均>0.05)。ΔL’、ΔR’及ΔA’与便秘病程呈正相关(r=0.805、0.717、0.874,P均<0.05)。结论经会阴三维超声可定量评价肛提肌功能;慢性便秘易导致未育女性肛提肌延展性增大、收缩功能降低。

Transperineal three-dimensional ultrasound for quantitation of levator ani muscle function in nulliparous women with chronic constipation

Objective To observe the function of levator ani muscle in nulliparous women with chronic constipation by using transperineal three-dimensional ultrasound. Methods Totally 41 nulliparous women with chronic constipation (constipation group) and 41 healthy nulliparous volunteers (control group) were enrolled. Three-dimensional volumetric images were obtained with transperineal ultrasound under the rest (rest period), the maximum anal contraction (anal retraction period) and the maximum Valsalva (Valsalva period) conditions. The thickness of the left and right levator ani muscle (L-LAT, R-LAT) and levator hiatus area (LHA) were measured. L-LAT, R-LAT and LHA of the rest period and the anal retraction period (ΔL, ΔR, ΔA), also L-LAT, R-LAT and LHA of the rest period and the Valsalva period (ΔL'', ΔR'', ΔA'') were compared between groups. Pearson correlation analysis was used to analyze the correlation of ultrasonic parameters and the clinical courses of chronic constipation in constipation group. Results In Valsalva period, L-LAT and R-LAT of constipation group decreased compared with those of control group (both P<0.05), whereas LHA, ΔL'', ΔR'' and ΔA'' of constipation group increased compared with those of control group (all P<0.05). There was no significant difference of parameters in the rest period nor the anal retraction period (all P>0.05). ΔL'', ΔR'' and ΔA'' of chronic constipation were positively correlated with the clinical courses of constipation (r=0.805, 0.717, 0.874, all P<0.05). Conclusion Transperineal three-dimensional ultrasound could quantitatively evaluate the function of levator ani muscle. Chronic constipation might result in increased extensibility of levator ani muscle and decreased contraction function of levator ani muscle in nulliparous women.