本文選題：三維超聲 + 肛提肌損傷　； 參考：《遵義醫(yī)學院》2017年碩士論文

【摘要】：目的:經(jīng)會陰三維超聲測量康復治療前、后肛提肌裂孔各超聲參數(shù),分析其與肛提肌肌力之間的相關關系,探討并評估肛提肌損傷對產(chǎn)后康復療效的影響。方法:(1)收集陰道分娩后盆腔器官脫垂伴肛提肌肌力0-2級患者86例。于產(chǎn)后6-8周在靜息、瓦氏、縮肛狀態(tài)下,對86例患者進行經(jīng)會陰超聲檢查。產(chǎn)后18周再次對86例患者經(jīng)會陰超聲檢查。肛提肌裂孔的面積、左右徑、前后徑由超聲科兩位醫(yī)師雙盲測量。(2)將患者分成兩組:康復組(43例)和對照組(43例);用三維超聲斷層成像方法判斷是否存在肛提肌損傷,將康復組和對照組各再分為肛提肌損傷組和肛提肌未損傷組。產(chǎn)后第8周起,康復組患者開始進行為期8周的盆底電刺激及陰道啞鈴鍛煉的康復治療,對照組患者自行做凱格爾運動8周。均于產(chǎn)后18周復查盆腔器官脫垂情況和肛提肌肌力。結(jié)果:(1)經(jīng)會陰三維超聲斷層成像評估,86例患者中有35例并發(fā)肛提肌損傷;康復治療后,康復組中肛提肌損傷與未損傷組盆腔器官脫垂和肛提肌肌力的康復改善率均高于對照組(P0.05)。(2)康復組:康復治療后,肛提肌損傷組在最大瓦氏、縮肛狀態(tài)下肛提肌裂孔的面積、左右徑、前后徑及靜息狀態(tài)下的面積、前后徑均較康復治療前減小(P0.05);肛提肌未損傷組在靜息、最大瓦氏、縮肛狀態(tài)下肛提肌裂孔的面積、左右徑、前后徑均較康復治療前減小(P0.05);肛提肌未損傷組在最大縮肛狀態(tài)下肛提肌裂孔的面積、左右徑、前后徑均小于損傷組(P0.05)。(3)對照組:產(chǎn)后18周,肛提肌損傷組在最大縮肛狀態(tài)下肛提肌裂孔的前后徑和未損傷組的面積、前后徑較產(chǎn)后6-8周減小(P0.05);肛提肌未損傷組在最大縮肛狀態(tài)下肛提肌裂孔的面積、左右徑、前后徑均較損傷組減小(P0.05)。(4)康復組與對照組比較:康復治療后,康復組中肛提肌損傷組在靜息、最大瓦氏狀態(tài)下肛提肌裂孔的面積、前后徑及最大縮肛狀態(tài)下的面積、左右徑、前后徑均較對照組減小(P0.05);康復組中肛提肌未損傷組在最大瓦氏、縮肛狀態(tài)下肛提肌裂孔的面積、左右徑、前后徑及靜息狀態(tài)下的面積、前后徑均較對照組減小(P0.05)。(5)最大縮肛狀態(tài)下肛提肌裂孔的面積、左右徑、前后徑與肛提肌肌力之間呈中度至較高的負相關關系(R=-0.792,P0.01、R=-0.506,P0.01、R=-0.714,P0.01);靜息和最大縮肛狀態(tài)下肛提肌裂孔的面積差值、左右徑差值與肛提肌肌力之間呈中度的正相關關系(R=0.426,P0.01、R=0.406,P0.01)。結(jié)論:(1)經(jīng)會陰三維超聲斷層成像可有效應用于產(chǎn)后肛提肌損傷的診斷。(2)肛提肌損傷是影響產(chǎn)后康復療效的重要因素,可根據(jù)經(jīng)會陰三維超聲斷層成像下肛提肌是否損傷來預測盆底康復療效。(3)經(jīng)會陰三維超聲可根據(jù)肛提肌裂孔各超聲參數(shù)及差值的動態(tài)變化來評估康復療效,定量評估肛提肌肌力,為臨床評估盆底康復療效提供可靠的影像學依據(jù)。
[Abstract]:Objective: to measure the ultrasonic parameters of posterior levator sphincter fissure before and after rehabilitation, analyze the relationship between the ultrasonic parameters and muscle strength of levator ani muscle, and evaluate the effect of levator ani muscle injury on postpartum rehabilitation. Methods 86 cases of pelvic organ prolapse with levator ani muscle strength 0-2 grade after vaginal delivery were collected. In 6-8 weeks postpartum, 86 patients were examined by transperineal ultrasound under the condition of rest, warts and contraction of anus. At 18 weeks postpartum, 86 patients were examined by perineum ultrasound. The area, left and right diameter and anteroposterior diameter of levator ani muscle fissure were measured by two doctors in ultrasonic department. The patients were divided into two groups: rehabilitation group (n = 43) and control group (n = 43). The rehabilitation group and the control group were subdivided into two groups: the group without injury of levator ani muscle and the group without injury of levator ani muscle. From the 8th week of postpartum, the patients in the rehabilitation group were treated with pelvic floor electrical stimulation and vaginal dumbbell exercise for 8 weeks, while the patients in the control group were given Kegel exercise for 8 weeks. Pelvic organ prolapse and levator ani muscle strength were reviewed at 18 weeks postpartum. Results among 86 patients, 35 cases were complicated with levator ani muscle injury by transperineal three-dimensional ultrasound tomography. The improvement rate of prolapse of pelvic organs and muscle strength of levator ani muscle in the rehabilitation group was higher than that in the control group (P0.05. 2): after rehabilitation treatment, the area of the hiatus of the levator ani muscle in the maximal valva, the area of the fissure of the levator ani muscle in the constricted anal state was higher than that in the control group. The left and right diameters, the anteroposterior diameters and the area under resting state, the anteroposterior diameters were smaller than those before rehabilitation treatment, and the area of the fissure of levator ani muscle in the rest, maximal Watts, contraction of anus, the left and right diameter of the levator ani muscle without injury group, were smaller than those before rehabilitation treatment. The anterior and posterior diameters were smaller than those before rehabilitation, and the area, left and right diameters and anteroposterior diameters of the hiatus of levator ani muscle in the uninjured group were smaller than those in the injured group under the maximum contraction of anus) the control group was 18 weeks postpartum. The anteroposterior diameter of levator ani muscle fissure and the area of uninjured group in the group of levator ani muscle injury were smaller than those in the group of 6-8 weeks postpartum, the area of the hiatus of levator ani muscle in the group without injury of levator ani muscle at the maximum constriction of anus, the area of the hiatus of levator ani muscle, the diameter of left and right levator muscle, The anterior and posterior diameters of the patients in the rehabilitation group were significantly lower than those in the injured group (P 0.05). Compared with the control group, after rehabilitation treatment, the area of the fissure of the levator ani muscle in the rehabilitation group was at rest, the area of the fissure of the levator ani muscle at the maximum Waters state, the area of the anterior and posterior diameter and the area under the maximum contraction of the anus, and the left and right diameters. The anterior and posterior diameters of levator ani muscle in the rehabilitation group were lower than those in the control group, and the area of the fissure of the levator ani muscle, the right and left diameters, the anteroposterior diameter and the area in the resting state of the uninjured levator ani muscle in the maximal valgus and contraction of the anus were all decreased. Compared with the control group, the anterior and posterior diameters decreased the area of the levator sphincter fissure, the right and left diameters, the anteroposterior diameter and the muscle strength of the levator ani muscle under the condition of maximum anal contraction. There was a moderate to high negative correlation between the anteroposterior diameter and the muscle strength of the levator ani muscle. There was a moderate positive correlation between the difference of left and right diameter and muscle strength of levator ani muscle. Conclusion 1) Three-dimensional ultrasound tomography via perineum can be effectively used in the diagnosis of postpartum levator ani muscle injury. The injury of levator ani muscle is an important factor affecting the postpartum rehabilitation effect. The effect of pelvic floor rehabilitation can be predicted according to the injury of levator ani muscle under transperineal three-dimensional ultrasound tomography. The dynamic changes of ultrasonic parameters and differences in the hiatus of levator ani muscle can be used to evaluate the curative effect. Quantitative evaluation of levator ani muscle strength provides a reliable imaging basis for clinical evaluation of pelvic floor rehabilitation.
【學位授予單位】：遵義醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.1;R714.6

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