本文選題：經(jīng)會(huì)陰三維超聲 + 盆底功能障礙性疾病��； 參考：《中南大學(xué)》2014年碩士論文

【摘要】：目的探討經(jīng)會(huì)陰三維超聲對(duì)產(chǎn)后早期無(wú)盆底功能障礙女性盆膈裂孔形態(tài)及功能評(píng)價(jià)的價(jià)值。 方法選擇2013年5月～2014年2月于產(chǎn)后6-8周在本院進(jìn)行產(chǎn)后復(fù)查的初產(chǎn)婦共65例為實(shí)驗(yàn)組,其中選擇性剖宮產(chǎn)(剖宮產(chǎn)組)31例,陰道自然分娩(順產(chǎn)組)34例,對(duì)照組30例,同期于本院產(chǎn)科就診,年齡、身高、體重指數(shù)均相匹配的無(wú)生育流產(chǎn)史婦女。陰道指診檢測(cè)肛提肌收縮時(shí)肌力,按照Oxford肌力分級(jí)法對(duì)肛提肌的肌力進(jìn)行評(píng)分；采用美國(guó)GE公司的Voluson E8型彩色多普勒三維超聲診斷儀分別于靜息狀態(tài)或縮肛狀態(tài)對(duì)受檢者進(jìn)行三維盆底超聲檢查,獲得兩種狀態(tài)下盆膈裂孔三維聲像圖并測(cè)量盆膈裂孔大小包括前后徑(AP)、左右徑(LR)、面積(HA)；根據(jù)公式計(jì)算縮肛期盆膈裂孔大小變化量,即盆膈裂孔面積該變量(As)、前后徑該變量(Ps)、左右徑該變量(Rs)；對(duì)比觀察產(chǎn)后早期女性(包括順產(chǎn)組與剖宮產(chǎn)組)與正常未育女盆膈裂孔三維聲超聲聲像表現(xiàn),比較盆膈裂孔內(nèi)、外部結(jié)構(gòu)改變發(fā)生率在順產(chǎn)組與剖宮產(chǎn)組之間差異,比較盆膈裂孔大小(HA、AP、LR)、縮肛期盆隔裂孔大小變化量(As、Ps、Rs)以及肛提肌肌力分級(jí)在對(duì)照組、順產(chǎn)組、剖宮產(chǎn)組之間差異,分析縮肛期盆隔裂孔大小改變量與Oxford肌力分級(jí)評(píng)分之間相關(guān)性。 結(jié)果①經(jīng)會(huì)陰三維超聲檢查可清晰顯示產(chǎn)后女性盆底解剖結(jié)構(gòu),產(chǎn)后早期盆膈裂孔異常包括：盆膈裂孔形態(tài)異常、肛提肌形態(tài)、走行異常以及盆底器官橫斷面形態(tài)異常等；②順產(chǎn)組盆底內(nèi)、外部結(jié)構(gòu)異常發(fā)生率均高于剖宮產(chǎn)組,差異有統(tǒng)計(jì)學(xué)意義,P0.05；③靜息狀態(tài)或縮肛狀態(tài)下,順產(chǎn)組、剖宮產(chǎn)組盆膈裂孔均大于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義,P0.05,縮肛狀態(tài)下,順產(chǎn)組盆膈裂孔大于剖宮產(chǎn)組,差異有統(tǒng)計(jì)學(xué)意義,P0.05,靜息狀態(tài)下,順產(chǎn)組盆膈裂孔大于剖宮產(chǎn)組,但差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05；④順產(chǎn)組、剖宮產(chǎn)組縮肛期盆膈裂孔大小變化量均小于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義P0.05,順產(chǎn)組縮肛期盆膈裂孔大小變化量小于剖宮產(chǎn)組,差異有統(tǒng)計(jì)學(xué)意義P之0.05；⑤順產(chǎn)組、剖宮產(chǎn)組肌力較對(duì)照組減弱,順產(chǎn)組肌力較剖宮產(chǎn)組減弱,差異有統(tǒng)計(jì)學(xué)意義,P0.05；⑥縮肛期盆膈裂孔面積變化量(As)前后徑變化量(Ps)左右徑變化量(Rs)均與oxford肌力分級(jí)法呈正相關(guān),相關(guān)系數(shù)0.40至0.53。 結(jié)論①三維盆底超聲具有多平面成像功能,能夠客觀、清晰顯示產(chǎn)后早期盆膈裂孔及其內(nèi)部結(jié)構(gòu)的形態(tài)變化,可作為早期篩查產(chǎn)后盆底疾病的影像學(xué)檢查技術(shù)。②肛提肌收縮能力的三維超聲評(píng)估法能有效評(píng)估肛提肌不同收縮功能狀態(tài),可預(yù)測(cè)產(chǎn)后盆底疾病的發(fā)生趨勢(shì),具有一定的臨床應(yīng)用前景。
[Abstract]:Objective to evaluate the value of transperineal three-dimensional ultrasound in evaluating the shape and function of pelvic diaphragm hiatus in women without pelvic floor dysfunction in early postpartum period. Methods Sixty-five primipara who underwent postpartum reexamination in our hospital from May 2013 to February 2014 were selected as experimental group, including 31 cases of cesarean section (caesarean section group), 34 cases of spontaneous vaginal delivery (spontaneous delivery group) and 30 cases of control group (control group). At the same time in our hospital obstetrical visit, age, height, body mass index matching matched non-abortion women. The muscle strength of levator ani muscle was measured by vagina finger examination, and the muscle strength of levator ani muscle was graded according to Oxford method. Using Voluson E8 color Doppler three dimensional ultrasound diagnostic instrument of GE Company in USA, the patients were examined by three dimensional pelvic floor ultrasound in resting state or anal contraction state, respectively. Three dimensional sonograms of the pelvic diaphragm hole were obtained and the size of the pelvic diaphragm hole including the anterior and posterior diameters, the left and right diameters, the LRN, the area of the diaphragm hiatus were obtained, and the changes of the size of the pelvic phrenic holes during the anus contraction period were calculated according to the formula. That is, the area of the pelvic diaphragm hiatus is a variable, the anteroposterior diameter is Psl, and the diameter of the left and right is Rs.Three dimensional sonographic features of the pelvic diaphragm hole in the early postpartum women (including the normal delivery group and the cesarean section group) were compared with those in the normal female patients, and the results in the pelvic diaphragm fissure were compared. The incidence of external structural changes was different between the normal delivery group and the cesarean section group. The size of the pelvic diaphragm hiatus was compared between the two groups. The size of the pelvic septum and the size of the pelvic septum in the constrictive period were compared. The muscle strength of levator ani muscle was graded in the control group, the normal delivery group, and the cesarean section group, and the difference was also found between the control group, the normal labor group and the cesarean section group. To analyze the correlation between the change of the size of the pelvic septal hole and the Oxford muscle strength score in the anus contraction period. Results 1the postpartum female pelvic floor anatomical structure could be clearly displayed by transperineal three-dimensional ultrasound examination. The early postpartum abnormal pelvic and phrenic hiatus included: the shape of the pelvic and phrenic hiatus, the shape of the levator ani muscle, the abnormal walking and the abnormal cross-sectional shape of the pelvic floor organ. (2) the incidence of abnormal pelvic floor and external structure in the normal delivery group was higher than that in the cesarean section group. The difference was statistically significant under the resting or anal contraction status of the normal delivery group and the cesarean section group, and the pelvic diaphragm hole in the normal delivery group and the cesarean section group was higher than that in the control group. The difference was statistically significant (P 0.05). Under the condition of constriction of anus, the pelvic diaphragm hiatus in the normal delivery group was larger than that in the cesarean section group, and the difference was statistically significant (P 0.05). At rest, the pelvic diaphragm fissure in the normal delivery group was greater than that in the cesarean section group, but the difference was not statistically significant in the normal delivery group. The changes of the size of the pelvic and phrenic holes in the caesarean section group were smaller than those in the control group (P 0.05), and the changes in the size of the pelvic fissure hole in the constricting anal phase of the normal delivery group were smaller than those in the cesarean section group (P < 0.05), and the difference was significant in the normal delivery group (P < 0.05). The muscle strength of cesarean section group was weaker than that of control group, and that of normal delivery group was lower than that of cesarean section group. The difference was statistically significant (P 0.05). The correlation coefficient is 0.40 to 0.53. Conclusion 1Three-dimensional pelvic floor ultrasound has the function of multiplanar imaging and can clearly display the morphological changes of the pelvic diaphragm fissure and its internal structure in the early postpartum period. As an early imaging technique for screening postpartum pelvic floor diseases, the three-dimensional ultrasonic evaluation method of levator ani muscle contraction ability can effectively evaluate the different contraction function of levator ani muscle, and can predict the occurrence trend of postpartum pelvic floor disease. It has certain clinical application prospect.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 楊欣;王建六;;美國(guó)婦產(chǎn)科學(xué)院盆腔器官脫垂臨床實(shí)踐指南(2009年)解讀[J];中國(guó)婦產(chǎn)科臨床雜志;2011年02期

2 徐繁華;王慧芳;鄭靜;李華峰;陳華;;經(jīng)會(huì)陰三維超聲評(píng)價(jià)女性盆底肌肉形態(tài)及功能[J];中國(guó)介入影像與治療學(xué);2013年06期

3 丁克;崔勇;李靜;霍勇軍;王本軍;;磁共振排糞造影對(duì)盆底功能障礙的診斷價(jià)值[J];中國(guó)中西醫(yī)結(jié)合影像學(xué)雜志;2013年02期

4 蔡香然;劉瓊;羅新;邱麟;吳何嘉;劉斯?jié)?;靜動(dòng)態(tài)MRI及DTI對(duì)盆腔器官脫垂患者肛提肌形態(tài)和功能的評(píng)估[J];臨床放射學(xué)雜志;2013年08期

5 莫玉瑤,趙小平,韋向軍,蘭素瓊;桂林市社區(qū)婦女病普查普治效果分析[J];腫瘤防治雜志;2001年02期

6 海寧;朱蘭;郎景和;;盆底障礙性疾病盆底自主收縮肌肉力量研究[J];生殖醫(yī)學(xué)雜志;2008年05期

7 蔣吉鵬;王琨;肖莎;吳細(xì)香;唐纓;;經(jīng)會(huì)陰三維超聲對(duì)盆底功能障礙性疾病的診斷價(jià)值[J];山東醫(yī)藥;2012年19期

8 黃暖英;;婦女盆底功能障礙性疾病的治療進(jìn)展[J];醫(yī)學(xué)理論與實(shí)踐;2012年12期

9 唐穎英;14180例已婚婦女婦科普查情況分析[J];醫(yī)學(xué)文選;2001年05期

10 林亨麗;王琳;曹曉焱;黃偉欣;孫志偉;;經(jīng)會(huì)陰三維超聲評(píng)價(jià)壓力性尿失禁患者盆底功能及其對(duì)手術(shù)的指導(dǎo)意義[J];中國(guó)醫(yī)藥導(dǎo)報(bào);2012年19期

，

本文編號(hào)：1982825