摘要
目的:探讨剪切波弹性成像及盆底表面肌电联合盆底超声对不同分娩方式的产妇产后早期盆底功能的评估价值.方法:纳入 2022 年 12 月—2023 年 5 月于产后 6～8 周内在苏州大学附属独墅湖医院行盆底超声及盆底表面肌电检查的女性受检者 221 例,其中阴道分娩者 160 例,剖宫产者 61 例,收集受检者的临床、剪切波弹性成像、盆底表面肌电及盆底超声资料并对上述指标进行统计学分析.结果:组间年龄、体质量指数、孕期体质量涨幅、产次及新生儿出生体质量的差异均无统计学意义(P均>0.05);阴道分娩组静息状态下及最大缩肛状态下耻骨直肠肌杨氏模量值平均值(Emean)均小于剖宫产组(P均<0.05);阴道分娩组 5 个不同阶段盆底表面肌电值均小于剖宫产组(P<0.05);相关性分析显示,前静息阶段盆底表面肌电值平均值与静息状态下双侧耻骨直肠肌Emean之间呈正相关(r=0.450,P<0.05),后静息阶段盆底表面肌电值平均值与静息状态下双侧耻骨直肠肌Emean之间呈正相关(r=0.422,P<0.05);阴道分娩组膀胱颈移动度、尿道旋转角大于剖宫产组(P<0.05);阴道分娩组在 3 种不同状态下的肛提肌裂孔各参数(前后径、左右径、周长、面积)均大于剖宫产组(P均<0.05);阴道分娩组产后膀胱膨出、会阴体过度运动的发生率大于剖宫产组(P<0.05);阴道分娩组与剖宫产组产后尿道内口漏斗形成、子宫脱垂及直肠膨出发生率的差异无统计学意义(P>0.05).结论:剖宫产组产妇产后早期盆底肌较阴道分娩组硬度大、张力高,易导致急迫性尿失禁的发生,但剖宫产对膀胱膨出具有一定的保护作用,实际应用中应根据孕妇情况选择合适的分娩方式.
Abstract
Objective:To investigate the value of shear wave elastography and pelvic floor surface myoelectricity combined with pelvic floor ultrasound in the assessment of early postpartum pelvic floor function in women with different delivery modes.Methods:The clinical,shear wave elastography,pelvic floor surface myoelectricity and pelvic floor ultrasound data was col-lected from December 2022 to May 2023 from 221 women who underwent pelvic floor ultrasound and pelvic floor surface electromyography examinations within 6～8 weeks after delivery at Dushu Lake Hospital Affiliated to Soochow University,in-cluding 160 vaginal deliveries and 61 cesarean deliveries.Results:There were no statistically significant differences in age,body mass index,gestational weight gain,number of deliveries and neonatal birth weight between the groups(all P>0.05);Av-erage Young's modulus values(Emean)of the puborectalis muscle at rest and at constriction were lower in the vaginal delivery group than in the cesarean delivery group(all P<0.05);The electromyography values at five different stages were lower in the vaginal delivery group than in the cesarean delivery group(P<0.05);Correlation analysis showed a positive correlation between the mean value of the pre-resting stage and the mean value of the bilateral puborectalis muscle Emean at rest(r=0.450,P<0.05),as well as a positive correlation between the mean value of post-resting stage and the mean value of bilateral puborec-talis Emean at rest(r=0.422,P<0.05);The bladder neck mobility and urethral rotation angle in the vaginal delivery group were greater than those in the cesarean delivery group(both P<0.05).The parameters of the anal sphincter defect(anteroposterior di-ameter,transverse diameter,circumference,area)in three different states were larger in the vaginal delivery group than in the cesarean section group(all P<0.05).The incidence of postpartum bladder prolapse and excessive perineal motion was higher in the vaginal delivery group than in the cesarean delivery group(both P<0.05);There were no significant differences in the inci-dence of postpartum urethral funnel formation,uterine prolapse and rectal prolapse between the vaginal delivery group and the cesarean delivery group(all P>0.05).Conclusions:In the early postpartum period,the pelvic floor muscles in the cesarean de-livery group have greater hardness and tension compared to the vaginal delivery group,which may lead to the occurrence of urgency urinary incontinence.However,cesarean delivery has a certain protective effect on bladder prolapse,and the appropri-ate delivery mode should be chosen according to individual circumstances of pregnant women in practical applications.
基金项目
江苏省精准诊疗药物创制工程研究中心开放课题(SDGC2242)
国家科技期刊平台
NSTL
万方数据