女性盆底松弛综合征患者肛提肌裂隙的动态三维超声研究

目的探讨动态三维超声对盆底松弛综合征患者治疗前后肛提肌裂隙形态结构改变方面的评估价值。方法2011年10月到2012年9月间于南京市中医院便秘专病门诊筛选出盆底松弛综合征所致便秘的40例女性患者，填写克里夫兰便秘评分（CCS评分）量表，并在Valsalva动作时进行动态三维超声检查，测量患者肛提肌裂隙的前后径和左右径。经1个疗程（2周）的生物反馈和针灸治疗后，再次填写治疗后CCS评分量表并复查Valsalva动作时的动态三维超声。结果最终有25例盆底松弛综合征女性患者接受治疗前、后的动态三维超声检查并完成CCS评分量表。与治疗前相比，治疗后Valsalva动作时动态三维超声所测得的肛提肌裂隙纵轴[（5．13±0．82）cm比（4．89±0．89）cm，P〈O．01]、横轴[（4．86±0．74）cm比（4．62±0．75）cm，P〈0．01]和面积[（19．92±6．33）cm。比（18．16±6．42）cm2．P〈0．01]均明显减小，CCS评分亦明显下降[（15．80±3．42）比（9．52±2．50），P〈0．01）。结论使用动态三维超声可以为女性盆底松弛综合征肛提肌裂隙的测定提供一种简单、无创并有效的影像学检测方法。

Dynamic three-dimensional ultrasound study on levator ani muscle fissures for female pelvic floor relaxation syndrome

Objective To explore the value of dynamic three-dimensional ultrasound in detecting the levator ani muscle fissures morphological changes of female pelvic floor relaxation syndrome after biofeedback and acupuncture treatments. Methods Forty female constipation patients with pelvic floor relaxation syndrome were screened from the Constipation Designed Disease Clinic in our hospital between October 2011 and September 2012. Cleveland Constipation Score （CCS） scale was used. Anteroposterior and transverse diameters of the levator ani muscle fissures were measured by dynamic three-dimensional ultrasound in Valsalva maneuver. After a course （10 days） of biofeedback and acupuncture treatments, CCS scale was filled, and dynamic three-dimensional ultrasound was performed in Valsalva maneuver as well. Associated data before and after treatment were compared. Results Twenty-five patients completed the trial. As compared to pre-treatment, the longitudinal axes of levator ani muscle fissure[ （4.89±0.89） cm vs. （5.13±0.82） cm, P〈0.01 ], the horizontal axes of the levator ani muscle fissure [ （4.62±0.75） cm vs. （4.86±0.74） cm, P〈0.01 ], and the area of the levator ani muscle fissure [（18.16±6.42） cm2 vs. （19.92±6.33） cm2, P〈0.01] decreased significantly after treatment, while CCS scale （9.52±2.50 vs. 15.80±3.42, P〈0.01） declined significantly as well. Conclusions The dynamic three-dimensional ultrasound is an effective, simple and non-invasivemethod for the determination of levator ani muscle fissure in female patients with pelvic floor relaxation syndrome.