三维超声断层显像评价不同分娩方式对盆底的损害

目的 采用三维超声断层显像（TUI）技术评价采用不同方式分娩后盆底结构的损伤情况。方法 将于产后6~7周时接受产后复查的初产妇60例（研究组） 进一步分为选择性剖宫产组（研究组A，30例）和经阴道自然分娩组（研究组B，30例），选择同期健康未育妇女30名作为对照组。行三维超声扫查，分别在静息、加压和肛提肌最大收缩状态下获取容积数据；用QLab处理软件，以2.5 mm层间距获取3层轴位图像，测量最小生殖裂口（LH）前后径（L）、横径（W）、周长（P）、面积（A）、肛提肌厚度（T），并观察耻骨直肠肌连续性。结果 3种状态下，研究组A、研究组B的LH各径线均大于对照组，肛提肌T均值小于对照组（P均<0.05）。研究组B的LH各径线及耻骨直肠肌离断率均大于研究组A，肛提肌T小于研究组A（P<0.05）。结论 产后6~7周时观察显示，经阴道自然分娩对盆底的损伤较选择性剖宫产严重。

Three-dimensional tomographic ultrasound imaging for evaluation on damage of pelvic floor caused by different delivery modes

Objective To evaluate damage of pelvic floor structure with tomographic ultrasonic imaging (TUI) early after delivery with different modes. Methods Sixty primiparas who were checked at the 6-7 weeks after delivery (study group) and 30 healthy nulliparous women (control group) were enrolled. Primiparas in study group were divided into elective cesarean section group (subgroup A, n=30) and spontaneous delivery group (subgroup B, n=30) according to delivery mode. All subjects were checked with three-dimensional ultrasound. The volume data were obtained with TUI at rest, valsalva and levator ani muscle maximum contraction state. Tomographic ultrasound slices at intervals of 2.5 mm were obtained using QLab software to measure anteroposterior diameter of levator hiatus (L), transverse diameter of levator hiatus (W), perimeter of levator hiatus (P), area of levator hiatus (A) and the thickness of levator ani muscle (T), and the continuity of pubovisceral muscle was observed. Results Under different states, all the lines of levator hiatus in study group were larger than those in control group, T of levator ani muscle was thinner in study group than in control group (all P<0.05). All the lines of levator hiatus and damage rate of pubovisceral muscle were larger in sub group B than in sub group A, T of levator ani muscle was thinner in sub group B than in sub group A (P<0.05). Conclusion Damage of pelvic floor structure is more serious with spontaneous delivery than elective cesarean section at the 6-7 weeks.