本文關鍵詞： 女性盆底功能障礙 經會陰盆底超聲 分娩方式 盆底康復治療 壓力性尿失禁　出處：《河北醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:女性盆底功能障礙性疾病(Female Pelvic Floor Dysfunction,FPFD)是盆底支持結構缺陷、損傷與功能障礙造成的不良結果,包括尿失禁、便失禁、盆腔臟器脫垂以及與此相關的性生活障礙,嚴重影響患者的社交活動、體育鍛煉和性生活,被稱為“社交癌”。本研究意在通過會陰超聲檢查探討不同的分娩方式對盆底結構的改變和對盆底功能的影響,并評價盆底康復治療對產后壓力性尿失禁的治療效果,從而為產后評估盆底功能提供可靠的影像學依據(jù),并為產后壓力性尿失禁的治療提供理論依據(jù)。方法:從2015年4月-2015年9月就診于河北醫(yī)科大學第一附屬醫(yī)院婦科、產科及生殖門診的健康育齡女性中,選擇符合條件的未育女性和初產婦360例作為研究對象。其中,未育女性(105例)作為對照組,根據(jù)分娩方式不同將初產婦分為2組:經陰道順產分娩組(129例)和選擇性剖宮產組(126例)。對以上初產婦在產后6周進行經會陰盆底超聲檢查,測量其在靜息和最大valsalva動作下膀胱逼尿肌厚度、尿道膀胱后角、膀胱頸移動度、肛提肌裂孔的面積及其周長等指標,并用同樣的方法測量對照組研究對象的上述指標。使用方差分析比較對照組、經陰道順產分娩組和選擇性剖腹產組的以上測量指標有無顯著性差異,并用SNK法進行兩兩比較,從而判斷不同的分娩方式對女性盆底結構的改變和對盆底功能的影響。同期,從產后6周在河北醫(yī)科大學第一附屬醫(yī)院盆底康復門診被診斷為壓力性尿失禁的患者中收集自愿接受盆底康復治療的患者75例,其中經陰道自然分娩產后患者43例,選擇性剖宮產產后患者32例。治療前后對所有研究對象均行經會陰盆底超聲檢查,測量指標及方法同前,使用配對樣本t檢驗比較治療前后產后壓力性尿失禁患者的各項指標有無顯著性差異,以分析盆底康復治療的效果。結果:1方差分析結果顯示,經陰道自然分娩組、選擇性剖宮產組與對照組三組間膀胱逼尿肌厚度、尿道膀胱后角、膀胱頸移動度、肛提肌裂孔面積及肛提肌裂孔周長的差異均有統(tǒng)計學意義(F值分別為271.88、546.26、455.81、265.17、237.02,P值均小于0.01)。進一步作兩兩比較,結果顯示陰道自然分娩組、選擇性剖宮產組的上述指標均高于對照組,而且陰道自然分娩組的上述指標均高于選擇性剖宮產組。2經陰道自然分娩產后的壓力性尿失禁患者進行盆底康復治療,總有效率為93.02%。治療后,患者的膀胱逼尿肌厚度、尿道膀胱后角、膀胱頸移動度、肛提肌裂孔面積及周長均比治療前減小,差異均有統(tǒng)計學意義(t值分別為9.87、12.24、8.98、8.43、7.23,P值均小于0.05)。選擇性剖宮產產后的壓力性尿失禁患者進行盆底康復治療,總有效率為90.63%。治療后,患者的上述盆底結構和功能相關指標也均比治療前減小,差異均有統(tǒng)計學意義(t值分別為7.91、10.29、6.97、8.16、9.79,P值均小于0.05)。結論:1經會陰盆底超聲對盆底功能障礙性疾病的診斷提供了依據(jù),分娩會對女性盆底結構和功能產生不同程度的損傷,且經陰道自然分娩比選擇性剖宮產對盆底結構和功能造成的損傷更為顯著。2進行盆底康復治療能有效的治療產后壓力性尿失禁,經會陰盆底超聲能完成產后壓力性尿失禁患者的治療效果評價。
[Abstract]:Objective: pelvic floor dysfunction (Female Pelvic Floor Dysfunction, FPFD) is the support structure of pelvic floor defects, resulting in bad injury and dysfunction, including urinary incontinence, urinary incontinence, pelvic organ prolapse and related sexual problems, seriously affecting the patient's social activities, physical exercise and sex life, called "social cancer. This study aims to explore the different delivery methods of perineal sonography effect on pelvic floor structure change and on the pelvic floor function, and evaluation of pelvic floor rehabilitation treatment of incontinence curative effect on postpartum stress urinary, and pelvic floor function to provide imaging evidence for the evaluation of postpartum, and provide theoretical basis for treatment postpartum stress urinary incontinence. Methods: from April 2015 -2015 September in the First Affiliated Hospital of Hebei Medical University Department of Gynecology, obstetrics and reproductive health of women of childbearing age outpatients In accordance with the conditions of nulliparous women and 360 pregnant women were included in the study. Among them, nulliparous women (105 cases) as the control group, according to the different modes of delivery will be divided into 2 groups: early maternal vaginal birth childbirth group (129 cases) and selective cesarean section group (126 cases). For more than 6 weeks postpartum in primipara were transperineal pelvic ultrasonography, measuring the bladder in resting and Valsalva under the action of bladder detrusor thickness, posterior horn, bladder neck mobility, levator hiatus area and perimeter index, and the index of measuring the same method controls the object of study. Using the analysis of variance compared with the control group, the above indicators measuring spontaneous vaginal delivery and selective caesarean delivery group group had no significant difference, and 22 compared with SNK method, to determine the different modes of delivery on the pelvic floor and the change of pelvic floor function The effect of the same period, from 6 weeks postpartum pelvic floor rehabilitation clinic in the First Affiliated Hospital of Hebei Medical University were diagnosed with stress urinary incontinence were collected 75 cases of voluntary pelvic floor rehabilitation of patients, including 43 cases with vaginal delivery postpartum with selective cesarean section postpartum in 32 patients before and after treatment in all the subjects. Underwent transperineal pelvic ultrasonography, with indexes and measuring methods, using paired samples t test to compare the indicators before and after treatment in patients with postpartum stress urinary incontinence had no significant difference, with the analysis of pelvic floor rehabilitation therapy. Results: 1 of the variance analysis results showed that vaginal delivery group and selective cesarean section group the thickness of the bladder detrusor and the control group between the three groups, urinary bladder angle, bladder neck mobility, levator hiatus area and levator hiatus. The differences were statistically significant (F-measure respectively. For 271.88546.26455.81265.17237.02, P values were less than 0.01). Further comparison results show 22, vaginal delivery group, the above indexes of elective cesarean section group were higher than control group, and the index of vaginal delivery group were higher than that of selective cesarean section group.2 by stress urinary incontinence in patients with vaginal delivery postpartum pelvic floor rehabilitation treatment, the total effective rate was 93.02%. after treatment, patients with detrusor thickness, urinary bladder angle, bladder neck mobility, levator hiatus area and Changjun week than before treatment decreased, the differences were statistically significant (t = 9.87,12.24,8.98,8.43,7.23, P < 0.05). Selective cesarean section the stress urinary incontinence in patients with pelvic floor rehabilitation treatment, the total effective rate was 90.63%. after treatment, the pelvic floor structure and function related indexes were also decreased than before treatment, the difference Differences were statistically significant (t = 7.91,10.29,6.97,8.16,9.79, P < 0.05). Conclusion: 1 transperineal ultrasound in diagnosis of pelvic floor dysfunction disease to provide the basis, delivery will produce different degrees of damage to the structure and function of female pelvic floor, and vaginal delivery than elective cesarean section on the pelvic floor structure and the function of the damage caused by the more significant.2 pelvic floor rehabilitation can be effective in the treatment of postpartum stress urinary incontinence, the evaluation of treatment effect of postpartum stress urinary incontinence in patients with pelvic perineal ultrasound.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.6;R445.1

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