经会阴超声评估不同分娩方式对产后盆底组织功能的近期影响

目的 应用经会阴超声评价不同分娩方式对产妇盆底支持组织功能产生的近期影响.方法 随机抽取2013年8月～ 2014年4月在产科分娩后6～8周的产妇201例,按照不同分娩方式分为阴道分娩组（74例）与选择性剖宫产组（127例）,分别于检查前进行问卷调查,记录基本情况.应用经会阴超声在安静状态及压力状态下（Valsalva动作）分别测量各组患者的膀胱尿道后角角度（Ar、As）,膀胱颈距耻骨联合下缘距离（Dr、Ds）,膀胱颈角度（θr、θs）,膀胱颈旋转角度（θ）,尿道膀胱连接部移动度（UVJ-M）,宫颈外口距耻骨联合下缘距离（CV-VD）,肛直肠连接部距耻骨联合下缘距离（ARJ-VD）,并对测量结果进行统计学分析.结果 产后6～8周会阴超声结果显示,阴道分娩组与选择性剖宫产组比较,Ar、As、Dr、Ds、θ、UVJ-M均明显增大,差异均有统计学意义（均P＜0.01）;静息期和张力期CV-VD两种分娩方式比较,差异无统计学意义（P＞0.05）;静息期ARJ-VD两种分娩方式比较,差异无统计学意义（P＞0.05）;张力期ARJ-VD两种分娩方式比较,差异有统计学意义（P＜0.05）;选择性剖宫产组盆腔器官脱垂（POP）发生率为28.3％（36/127例）,较阴道分娩组的63.5％（47/74例）低,差异有统计学意义（P＜0.05）.结论 经会阴超声评估不同分娩方式显示,阴道分娩近期对盆底支持组织功能的影响大于选择性剖宫产.

Evaluation of short-term impact of delivery methods on postpartum pelvic floor function using transperineal sonography

Objective To evaluate the short-term impact of delivery methods on postpartum pelvic floor function using transperineal sonography （TPS）. Methods 201 patients were randomly divided into vaginal delivery group （74 cases） and selective cesarean sections group （127 cases）. Transperineal Sonography （TPS） was used to measure the posterior urethrovesiea[ angle （Ar, As）. the distance from bladder neck to inferior margin of pubic symphysis（Dr,Ds） . the angle of bladder neck（θr,θs）, the rotation angle of bladder neck（θ）, mobility of urethrovesieal junction （UVJ-M）, the distance from the cervical mouth to inferior margin of pubic symphysis（CV-VI））, and the distance from anoreetal junction to inferior margin of pubic symphysis（ARJ-VD） under resting and stress （Valsalva movement） state. Results The indicators oi Ar, As, Dr, Ds, θ, and UVJ-M of vaginal delivery group were significantly larger than that of selective cesarean sections group （P〈0.01）. No statistical difference was found between the resting and stress state（P〉0.05）. No statistical difference was found between the resting state and ARJ-VD （P〉0.05）. The significantly statistical difference was found between the stress state and ARJ-VD（P〈0.05）. The incidence of POP in selective cesarean sections group was 28. 3% （36/127） and lower than the that of vaginal delivery group （63.5%, 36/127） （P〈0.05）. Conclusion Compared to elective caesarean section, vaginal delivery affect the pelvic floor function.