本文關(guān)鍵詞： 經(jīng)會陰二維盆底超聲 肛提肌 盆底功能障礙性疾病 初產(chǎn)婦　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過經(jīng)會陰盆底超聲觀察初產(chǎn)婦產(chǎn)后早期盆底器官解剖位置及肛提肌增厚率的變化,探討不同分娩方式對初產(chǎn)婦盆底結(jié)構(gòu)及功能的影響;分析盆底器官活動度與肛提肌增厚率的相關(guān)性,進一步探索盆底功能障礙性疾病的發(fā)病機制,為臨床及早采取干預(yù)措施提供影像學(xué)參考。方法:選擇100例于我院住院分娩、產(chǎn)后6-10周的初產(chǎn)婦納入研究組,其中經(jīng)陰道分娩者50例,選擇性剖宮產(chǎn)者50例,同期選擇30例年齡、身高及體重均相匹配的已婚未育女性作為對照組。應(yīng)用二維經(jīng)會陰盆底超聲技術(shù)獲取盆底正中矢狀切面,使恥骨聯(lián)合中軸線與經(jīng)恥骨聯(lián)合下緣的直線呈45°角,分別在靜息及最大Valsalva動作狀態(tài)下,測量尿道傾斜角(urethral tilt angel,UTA)、膀胱尿道后角(posterior urethravesical angel,PUA)、膀胱頸的位置(bladder neck position,BNP)及宮頸外口的位置(cervical mouth position,CMP),并計算尿道旋轉(zhuǎn)角(urethral rotation angel,URA)、膀胱頸移動度(bladder neck descent,BND)、宮頸外口移動度(cervix down distance,CDD),同時觀察尿道內(nèi)口有無漏斗化。將探頭深入陰道內(nèi)2-3cm處,獲取盆底正中矢狀切面肛直腸角部圖像,在靜息及Valsalva動作下,觀察有無直腸前壁膨出(RC)并測量直腸前壁膨出的深度。調(diào)整探頭方向顯示肛提肌長軸切面,分別于靜息及最大收縮狀態(tài)下測量左、右兩側(cè)肛提肌中部的厚度(TN),計算收縮狀態(tài)下肛提肌中部的增厚率(TR)。結(jié)果:1.靜息狀態(tài)下,經(jīng)陰道分娩組BNP低于選擇性剖宮產(chǎn)組,差異具有統(tǒng)計學(xué)意義(p0.05),經(jīng)陰道分娩組UTA、CMP與選擇性剖宮產(chǎn)組比較,差異無統(tǒng)計學(xué)意義(p0.05);經(jīng)陰道分娩組BNP、CMP明顯低于未育組(p0.05),經(jīng)陰道分娩組UTA大于未育組,差異無統(tǒng)計學(xué)意義(p0.05);選擇性剖宮產(chǎn)組BNP低于未育組,差異具有統(tǒng)計學(xué)意義(p0.05),選擇性剖宮產(chǎn)組UTA、CMP與未育組比較,差異無統(tǒng)計學(xué)意義(p0.05)。靜息狀態(tài)下各組間PUA數(shù)值比較,差異均無統(tǒng)計學(xué)意義(p0.05)。2.最大Valsalva狀態(tài)下,經(jīng)陰道分娩組UTA、BNP、CMP數(shù)值與選擇性剖宮產(chǎn)組和未育組相比,差異均具有統(tǒng)計學(xué)意義(p0.05);選擇性剖宮產(chǎn)組BNP、CMP低于未育組,其中CMP差異無統(tǒng)計學(xué)意義(p0.05)。最大Valsalva狀態(tài)下各組間PUA數(shù)值比較,差異均無統(tǒng)計學(xué)意義(p0.05)。3.經(jīng)陰道分娩組URA、BND較未育組明顯增高(p0.05)。選擇性剖宮產(chǎn)組URA、BND與經(jīng)陰道分娩組、未育組比較,無統(tǒng)計學(xué)意義(p0.05)。三組間CDD無顯著差異(p0.05)。4.經(jīng)陰道分娩組、選擇性剖宮產(chǎn)組、未育組尿道內(nèi)口漏斗化發(fā)生率分別為12%、10%、6.7%,差異無統(tǒng)計學(xué)意義(p0.05)。5.經(jīng)陰道分娩組、選擇性剖宮產(chǎn)組及未育組中,均未發(fā)現(xiàn)患有直腸前壁膨出者。6.(1)同一組內(nèi)左、右兩側(cè)TR無明顯差異(p0.05)。未育組左、右兩側(cè)TR明顯大于選擇性剖宮產(chǎn)組和經(jīng)陰道分娩組(p0.05),選擇性剖宮產(chǎn)組兩側(cè)TR大于經(jīng)陰道分娩組,但差異無顯著性(p0.05)。(2)未育組、選擇性剖宮產(chǎn)組中,URA、BND、CDD與TR均呈負相關(guān)(p0.05)。經(jīng)陰道分娩組URA、BND、CDD與TR無明顯相關(guān)性(p0.05)。結(jié)論:1.經(jīng)會陰二維盆底超聲技術(shù)可用于動態(tài)觀察女性盆腔臟器的解剖結(jié)構(gòu)、位置及功能狀態(tài),操作簡便,重復(fù)性好,為初產(chǎn)婦產(chǎn)后早期康復(fù),提供可靠的影像學(xué)依據(jù)。2.妊娠及分娩主要影響前、中盆腔的結(jié)構(gòu)及功能,對前盆腔影響最大,而與后盆腔結(jié)構(gòu)及功能障礙性疾病發(fā)生相關(guān)性不大。3.初產(chǎn)婦兩側(cè)肛提肌TR低于未育女性,影響肛提肌收縮力的主要因素為妊娠本身,而非分娩方式。4.在肛提肌未受明顯損傷的情況下,肛提肌增厚率越大,盆底器官的活動度越小。5.與經(jīng)陰道分娩相比,選擇性剖宮產(chǎn)在產(chǎn)后早期對女性盆底的結(jié)構(gòu)及功能具有一定的保護作用,但并不提倡廣大女性為了減少盆底功能障礙性疾病的發(fā)生而進行剖宮產(chǎn)手術(shù)。
[Abstract]:Objective: through the observation of primipara transperineal pelvic floor ultrasound after early pelvic organ anatomical position and the levator ani muscle thickening rate changes, to explore the influence of different modes of delivery on maternal pelvic floor structure and function; analysis of pelvic organ activity and levator ani muscle thickening rate correlation, to further explore the pathogenesis of pelvic floor dysfunction. Early intervention for clinical, imaging. Methods: 100 patients in our hospital, 6-10 weeks postpartum primipara were included in the study group, including 50 cases of vaginal delivery, 50 cases of cesarean section were compared with 30 cases of age, height and weight were matched married not fertile women as the control group. The application of two-dimensional ultrasound technology to obtain the transperineal pelvic pelvic floor median sagittal section, the axis of the pubic symphysis and straight through the lower edge of pubic symphysis was 45 degrees, respectively at rest and maximum Val The Salva action under the condition of measuring angle (urethral tilt urethral angel, UTA), posterior urethra vesical angle (posterior urethravesical, angel, PUA), bladder neck position (bladder neck position, BNP) and cervix position (cervical mouth position, CMP), and calculate the rotation angle (urethral rotation urethral angel. URA), bladder neck mobility (bladder neck, descent, BND), cervix mobile (cervix down distance, of CDD), and observe the urethral mouth without funnel. The probe deep inside the vagina at 2-3cm, access to the pelvic floor median sagittal anorectal angle images at rest and Valsalva action next, observe whether the anterior wall of the rectum prolapse (RC) and measuring the depth of the rectal wall prolapse. Adjust the direction of the probe showed the levator ani muscle long axis view measurement of left at rest and maximal contraction state respectively, the right side of the levator ani muscle middle thickness (TN), calculation of contraction In the middle of the levator ani muscle thickening rate (TR). Results: 1. of the resting state, the vaginal delivery group BNP was lower than that of selective cesarean section group, the difference was statistically significant (P0.05), vaginal delivery group UTA, CMP and selective cesarean section group, the difference was not statistically significant (P0.05); vaginal delivery group BNP, CMP was significantly lower than the nulliparous group (P0.05), vaginal delivery group UTA greater than the nulliparous group, the difference was not statistically significant (P0.05); selective cesarean section group BNP lower than the nulliparous group, the difference was statistically significant (P0.05), selective cesarean section group UTA, CMP and nonparous groups. There was no statistically significant difference (P0.05). The resting state between the groups of PUA numerical comparison, there were no significant differences (P0.05).2. Valsalva, vaginal delivery group UTA, BNP, CMP compared with numerical and selective cesarean section group and nulliparous group, the differences were statistically significant (P0.05); selective cesarean section delivery group BNP, C MP浣庝簬鏈偛緇，

本文編號：1500217