本文選題：超聲 + 盆底功能障礙�。� 參考：《遵義醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的： 應(yīng)用會(huì)陰超聲觀察康復(fù)治療對(duì)產(chǎn)后女性盆底結(jié)構(gòu)的影響,試探全面評(píng)價(jià)盆底功能障礙康復(fù)療效的影像學(xué)指標(biāo)，為臨床提供直觀、可靠的影像學(xué)依據(jù)。 方法： （1）收集2013年1月至2013年12月，在我院產(chǎn)后保健門診診斷的67例產(chǎn)后（Female pelvic floor dysfunction,FPFD）患者。所有病例隨機(jī)分2組：康復(fù)組(35例)和對(duì)照組(32例)，兩組病例均采取自身對(duì)照分析。 （2）康復(fù)組產(chǎn)后8周開始在我院盆底康復(fù)中心進(jìn)行盆底康復(fù)治療，療程8周；對(duì)照組產(chǎn)后只進(jìn)行一般的健康教育和產(chǎn)后保健操�？祻�(fù)組分別在產(chǎn)后6－8周和盆底康復(fù)治療后經(jīng)會(huì)陰超聲檢查；對(duì)照組分別在產(chǎn)后6－8周和產(chǎn)后20周經(jīng)會(huì)陰超聲檢查。 （3）應(yīng)用會(huì)陰超聲分別在靜息、縮肛、瓦氏動(dòng)作時(shí)動(dòng)態(tài)觀察產(chǎn)后康復(fù)治療對(duì)FPFD盆底結(jié)構(gòu)的影響，獲得膀胱頸移動(dòng)度（bladder neck descen,BND），存儲(chǔ)三維容積數(shù)據(jù)，脫機(jī)應(yīng)用4Dview軟件后處理，測量盆膈裂孔面積、周長、前后徑、左右徑和恥骨直腸肌的寬度，并對(duì)上述參數(shù)進(jìn)行統(tǒng)計(jì)分析。 結(jié)果： （1）康復(fù)組：靜息和瓦氏動(dòng)作時(shí)康復(fù)治療后的盆膈裂孔面積、周長、前后徑較康復(fù)治療前（產(chǎn)后6-8周）縮小,有統(tǒng)計(jì)學(xué)意義（p＜0.05），左右徑、恥骨直腸肌寬度均未見明顯改變（p＞0.05），BND較康復(fù)治療前減小，有統(tǒng)計(jì)學(xué)差異（p＜0.05）；縮肛時(shí)康復(fù)治療后的盆膈裂孔面積、周長、前后徑和左右徑均小于康復(fù)治療前（p＜0.05），恥骨直腸肌寬度稍大于康復(fù)治療前（p＜0.05），有統(tǒng)計(jì)學(xué)意義。 （2）對(duì)照組：產(chǎn)后20周，靜息和瓦氏動(dòng)作時(shí)盆膈裂孔面積、周長、前后徑、恥骨直腸肌寬度及BND與產(chǎn)后6-8周比較均無明顯變化（p＞0.05），靜息時(shí)盆膈裂孔左右徑無統(tǒng)計(jì)學(xué)意義（p＞0.05），瓦氏動(dòng)作時(shí)盆膈裂孔左右徑比產(chǎn)后6-8周時(shí)增大（p＜0.05）；縮肛時(shí)產(chǎn)后20周的盆膈裂孔面積、周長、前后徑和左右徑均小于產(chǎn)后6-8周（p＜0.05），恥骨直腸肌寬度與產(chǎn)后6-8周比較未見明顯差異（p＞0.05）。 （3）康復(fù)組與對(duì)照組各參數(shù)對(duì)比：靜息和瓦氏動(dòng)作時(shí)，康復(fù)組盆膈裂孔面積、周長、前后徑、左右徑及BND均比對(duì)照組變小，有統(tǒng)計(jì)學(xué)意義（p＜0.05），靜息時(shí)恥骨直腸肌無明顯變化；瓦氏動(dòng)作時(shí)，康復(fù)組恥骨直腸肌寬度比對(duì)照組稍寬(p＜0.05）；縮肛時(shí)盆膈裂孔面積、周長、前后徑和左右徑和恥骨直腸肌，兩組病例比較未見明顯差異。 （4）康復(fù)組與對(duì)照組各參數(shù)差值比較：靜息時(shí)的盆膈裂孔面積、周長、前后徑和左右徑和恥骨直腸肌的差值，兩組病例比較均無明顯變化（p＞0.05），，瓦氏動(dòng)作時(shí)兩組病例盆膈裂孔面積、周長、前后徑和左右徑的差值均有差異（p＜0.05），恥骨直腸肌的差值無明顯變化（p＞0.05），康復(fù)組與對(duì)照組BND差值比較有差異（p＜0.05）；縮肛時(shí)兩組病例盆膈裂孔面積、前后徑和左右徑的差值有差異（p＜0.05），周長和恥骨直腸肌的差值無明顯變化（p＞0.05）。 結(jié)論： （1）本課題研究證實(shí)了妊娠和分娩對(duì)女性盆底結(jié)構(gòu)造成不同程度的損傷，是引發(fā)產(chǎn)后早期FPFD的重要危險(xiǎn)因素；會(huì)陰超聲可以推廣應(yīng)用于產(chǎn)后FPFD的診斷篩查、定量評(píng)估和康復(fù)療效的評(píng)價(jià)，是一項(xiàng)具有重要臨床價(jià)值的影像學(xué)技術(shù)。 （2）經(jīng)會(huì)陰超聲動(dòng)態(tài)觀察盆底康復(fù)治療前后盆底結(jié)構(gòu)的各參數(shù)變化，統(tǒng)計(jì)分析認(rèn)為盆膈裂孔、恥骨直腸肌和BND能全面和動(dòng)態(tài)反映盆底結(jié)構(gòu)、功能的變化,可作為評(píng)價(jià)盆底康復(fù)療效的重要影像學(xué)指標(biāo)，來進(jìn)行盆底形態(tài)學(xué)和功能學(xué)的評(píng)價(jià)，為臨床提供真實(shí)、可靠的影像學(xué)依據(jù)。
[Abstract]:Objective:
Objective To observe the effect of rehabilitation therapy on postpartum female pelvic floor structure by perineal ultrasound, and to explore the imaging indexes of pelvic floor dysfunction in order to provide intuitive and reliable imaging evidence for clinical practice.
Method:
(1) 67 cases of Female pelvic floor dysfunction (FPFD) diagnosed in our hospital from January 2013 to December 2013 were collected. All cases were randomly divided into 2 groups: rehabilitation group (35 cases) and control group (32 cases), two cases were self controlled analysis.
(2) the rehabilitation group started 8 weeks postpartum pelvic floor rehabilitation in the rehabilitation center of our hospital, 8 weeks; the control group only routine postpartum health education and postpartum health care. The rehabilitation group were at 6-8 weeks postpartum pelvic floor rehabilitation after treatment and transperineal ultrasonography; the control group respectively at 6-8 weeks postpartum and 20 weeks postpartum perineal ultrasonography.
(3) the application of perineal ultrasound in resting anal contraction, respectively, Valsalva maneuver dynamic observation of postpartum rehabilitation therapy on FPFD pelvic floor structure, obtain the bladder neck mobility (bladder neck, descen, BND), three-dimensional data storage, offline application of 4Dview postprocessing software, measuring the hiatus area, perimeter, diameter, diameter and puborectalis width, and the above parameters were analyzed.
Result:
(1) the rehabilitation group: resting and Valsalva maneuver rehabilitation after treatment of pelvic diaphragm hiatus area, perimeter, diameter compared with before treatment (6-8 weeks postpartum) reduced, with statistical significance (P < 0.05), diameter, width of puborectalis muscle showed no significant changes (P > 0.05), BND before treatment decreased, there was significant difference (P < 0.05); anal contraction rehabilitation after treatment of pelvic diaphragm hiatus area, perimeter, posterior diameter and left-right diameter were less than before treatment (P < 0.05), puborectalis muscle width slightly larger than before treatment (P < 0.05), there was statistical significance.
(2) control group: 20 weeks postpartum, resting and Valsalva maneuver when the hiatus area, perimeter, diameter, puborectalis width and BND and 6-8 weeks postpartum had no significant change (P > 0.05), resting hiatus diameter was not statistically significant (P > 0.05). Valsalva maneuver when hiatus diameter than 6-8 weeks postpartum increased (P < 0.05); anal contraction during and after 20 weeks of pelvic diaphragm hiatus area, perimeter, posterior diameter and left-right diameter were less than 6-8 weeks postpartum (P < 0.05), puborectalis muscle width and 6-8 weeks postpartum compared no significant difference (P > 0.05).
(3) rehabilitation group and control group comparing the parameters of resting and Valsalva maneuver, rehabilitation group hiatus area, perimeter, diameter, diameter and BND were smaller than the control group, was statistically significant (P < 0.05), resting puborectal muscle had no obvious change; Valsalva maneuver. The rehabilitation group than the control group of puborectal muscle width slightly wider (P < 0.05); when the levator hiatus area, perimeter, diameter and diameter and puborectalis muscle, two cases were no obvious difference.
(4) rehabilitation group and control group each parameter difference: the pelvic diaphragm hiatus resting area, perimeter, diameter and diameter and the difference about the puborectalis muscle, two cases had no significant change (P > 0.05), when the Valsalva maneuver group two cases of pelvic diaphragm hiatus area, perimeter. Posterior diameter and left-right diameter difference difference (P < 0.05), the difference of the puborectalis muscle did not change significantly (P > 0.05), the rehabilitation group and the control group BND difference difference (P < 0.05); two cases of levator hiatus area, posterior diameter and left-right diameter difference there are differences (P < 0.05), the difference between the perimeter and the puborectalis muscle did not change significantly (P > 0.05).
Conclusion:
(1) this study confirmed that pregnancy and childbirth cause of female pelvic floor structure damage is an important risk factor of FPFD caused early postpartum perineal ultrasound diagnosis; can be applied to the screening for postpartum FPFD evaluation, quantitative evaluation and rehabilitation treatment, is a technology has important clinical value in imaging.
(2) the dynamic observation of pelvic floor rehabilitation of perineal ultrasound parameters in pelvic floor structure before and after the treatment, the statistic analysis of pelvic diaphragm hiatus, rectal muscle and BND can fully reflect the dynamic and pubic pelvic floor structures, function changes, can be used as an important imaging evaluation of pelvic floor rehabilitation treatment index to evaluate the morphology and function of pelvic floor the basis for clinical provide true, reliable imaging.

【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R714.6

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