【摘要】：目的：應(yīng)用會陰三維超聲觀察初產(chǎn)婦產(chǎn)后早期盆膈裂孔的大小形態(tài)及尿道移動度的運動變化，探討不同分娩方式對盆底功能的影響。 方法：選擇在我院產(chǎn)科定期產(chǎn)檢并分娩的初產(chǎn)婦132例（其中自然分娩組70例，剖宮產(chǎn)組62例）于產(chǎn)后6周左右行盆底三維超聲檢查，同期選擇正常未育女性65例作為對照組。應(yīng)用三維陰道探頭經(jīng)會陰分別獲取靜息期、縮肛動作及Valsalva動作時盆膈裂孔容積數(shù)據(jù)成像并存儲。離線分析測量不同狀態(tài)下盆膈裂孔前后徑（AP）、左右徑（LR）、面積（HA）、肛提肌尿道間距（LUG）及尿道移動度。 結(jié)果：1、不同觀察者對盆膈裂孔各參數(shù)及尿道移動度的測量結(jié)果重復(fù)性高、一致性好，ICC為0.72～0.88。2、自然分娩組HA、LR、AP及LUG在縮肛動作及Valsalva動作時均較對照組增大(P均0.05)，而在靜息期兩組各參數(shù)無明顯差異（P0.05）。3、剖宮產(chǎn)組HA、LR、AP及LUG在三種不同狀態(tài)下與對照組無明顯差異（P均0.05）。4、自然分娩組HA、LR、AP及LUG在縮肛動作及Valsalva動作時均較剖宮產(chǎn)組增大，差異有統(tǒng)計學(xué)意義(P均0.05)，而在靜息期兩組各參數(shù)無明顯差異（P0.05）。5、自然分娩組與剖宮產(chǎn)組比較，前者出現(xiàn)肛提肌裂傷、陰道異常及盆腔器官脫垂的比例明顯提高，差異有統(tǒng)計學(xué)意義(P0.05)。6、Valsalva動作時所有受檢者遠(yuǎn)端尿道移動度均小于近端尿道，差異有統(tǒng)計學(xué)意義（P0.05），，且產(chǎn)后組尿道整體移動度較正對照組增大，差異有統(tǒng)計學(xué)意義（P0.05）。7、自然分娩組U1-5移動度較剖宮產(chǎn)組增大，差異有統(tǒng)計學(xué)意義（P0.05），而兩組尿道U6移動度無明顯差異（P0.05）。 結(jié)論：經(jīng)會陰三維超聲是一種有效的評估女性盆膈裂孔及尿道移動度的影像學(xué)方法。分娩對女性盆膈裂孔及尿道移動度均產(chǎn)生一定的影響，自然分娩者發(fā)生肛提肌裂傷及盆腔器官脫垂的危險性較剖宮產(chǎn)者增大，且前者尿道移動度亦明顯增加，故產(chǎn)后早期的初產(chǎn)婦應(yīng)及時進(jìn)行盆底相關(guān)的康復(fù)訓(xùn)練，減少盆底功能障礙的發(fā)生。
[Abstract]:Objective: to investigate the effect of different delivery modes on pelvic floor function by using perineum three-dimensional ultrasound to observe the size and shape of pelvic diaphragm fissure and the movement of urethra in the early postpartum period. Methods: 132 primipara (70 cases in natural delivery group and 62 cases in cesarean section group) were examined with pelvic floor three dimensional ultrasound about 6 weeks after delivery. 65 normal unbred women were selected as control group at the same time. Three dimensional vaginal probe was used to obtain the volume data of pelvic diaphragm fissure during resting period, anal contraction and Valsalva motion respectively. Off-line analysis was performed to measure the anteroposterior diameter of the pelvic and phrenic fissure (AP),) and the area of (LR), (left and right diameter). The distance between the levator ani muscle and the urethral space (LUG) and the urethral mobility were measured. Results the measurements of the parameters and urethral mobility of pelvic and phrenic fissure by different observers were highly reproducible. HA,LR,AP and LUG in spontaneous delivery group were higher than those in control group in anal contraction and Valsalva movement (P 0.05), but there was no significant difference between two groups in resting period (P0.05). HA,LR,AP and LUG in caesarean section group were different from those in control group in three different states (P0.05). There was no significant difference between the two groups (P0. 05). 4. The HA,LR,AP and LUG in the spontaneous delivery group were significantly higher than those in the caesarean section group during anal contraction and Valsalva movement. The difference was statistically significant (P 0.05), but there was no significant difference between the two groups in the resting period (P0.05). Compared with the cesarean section group, the rate of levator ani laceration, vaginal abnormality and pelvic organ prolapse in the natural delivery group was significantly higher than that in the caesarean section group. The distal urethral mobility of all subjects was lower than that of proximal urethra during Valsalva movement (P0.05), the difference was statistically significant (P0.05), and the overall urethral mobility of postpartum group was higher than that of control group. The difference was statistically significant (P0.05). The U1-5 mobility of the spontaneous delivery group was higher than that of the cesarean section group (P0.05), while the urethral U6 mobility of the two groups had no significant difference (P0.05). Conclusion: transperineal three-dimensional ultrasonography is an effective imaging method for evaluating the pelvic and phrenic hiatus and urethral mobility in women. The risk of laceration of levator ani muscle and prolapse of pelvic organs in spontaneous delivery was higher than that in cesarean section, and the urethral mobility of the former was also significantly increased. Therefore, early postpartum primipara should carry on pelvic floor related rehabilitation training in time to reduce the occurrence of pelvic floor dysfunction.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R714.69

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