实时三维超声评估产后女性盆底器官运动及肛提肌裂孔

目的 采用经会阴实时三维超声动态观察和评估产后女性盆底三腔室器官的位置及肛提肌裂孔面积。方法 选取年龄、体质量指数匹配的60名产妇（产后组）和35名未育女性（对照组），采用经会阴超声分别在静息状态及瓦氏动作下测量膀胱、子宫颈、直肠壶腹部的最低点与参考线（耻骨联合后下缘的水平线）之间的距离，采用实时三维超声测量瓦氏动作下肛提肌裂孔面积，并进行统计学分析。结果 产后组在静息状态和瓦氏动作下膀胱及子宫颈的最低点位置均低于对照组（P均<0.05），直肠壶腹部位置在静息状态下两组差异无统计学意义（t=0.405，P=0.398），在瓦氏动作下产后组低于对照组（t=17.378，P<0.001）。产后组在静息状态和瓦氏动作下肛提肌裂孔面积均大于对照组（t=11.253、9.625，P均<0.001）。结论 经会阴实时三维超声可动态观察女性盆底三腔室器官的位置、运动情况及肛提肌裂孔面积，从而评价妊娠和分娩对盆底支持组织的影响。

Real time three-dimensional ultrasound in assessment of pelvic floor organ movement and levator hiatus in postpartum women

Objective To observe and evaluate the location of the three compartments of the pelvic floor organ and levator hiatus area in the postpartum women by transperineal real time three-dimensional ultrasound. Methods Sixty cases of maternal with the matching age and body mass index (BMI; postpartum group) and 35 non-fertile women (control group) were selected. The distance between the lower edge and the reference line was measured by the transperineal ultrasound at rest and Valsalva movement in the lowest point of bladder, cervix and rectum. Meanwhile, the area of levator hiatus under Valsalva action was measured by real time 3-dimensional ultrasound. The differences were compared between two groups. Results In the postpartum group, the lowest point of the bladder and cervix was lower than the control group at rest and Valsalva movemen (both P<0.05). Rectum location in the rest state difference between the two groups had no statistical significance (t=0.405,P=0.398). The area of the levator hiatus of the postpartum group was significantly larger than that of the control group at the rest and Valsalva movement (t=11.253, 9.625, P<0.001). Conclusion Transperineal real time 3-dimensional ultrasound can dynamically observe the position, movement of pelvic floor organ and the area of levator hiatusin of the female. To evaluate the pregnancy and childbirth have obvious effect on the pelvic floor support tissues.