经会阴四维超声成像对自然分娩后产妇盆底功能异常的评价

目的探讨经会阴四维超声对产后盆底组织解剖结构改变及早期盆底功能障碍（PFD）的图像特征。方法对2010年1月至2012年9月在北京妇产医院自然分娩的产妇于产后第42天依照超声检查提示有无盆底组织异常进行分组,进行临床妇科检查及经会阴四维超声检查。其中盆底功能障碍组产妇53例,对照组产妇19例（超声检查未发现盆底组织异常）。对两组72例产妇均检测静息及Valsalva动作两个时态图像;膀胱颈、子宫颈、直肠肛管形态及两时态相对活动度;三维图像重建后的肛提肌裂孔平面上测量肛提肌裂孔长径、面积及耻骨直肠肌厚度;观察耻骨直肠肌的形态及连续性;记录两组产妇临床及超声检查结果并进行比较。结果 72例自然分娩后第42天产妇临床及经会阴四维超声检查和测量结果：（1）盆底功能障碍组53例,经会阴四维超声检出膀胱颈活动度增加38例（71.70%,38/53）,阴道前壁脱垂15例（28.30%,15/53）,子宫脱垂4例（7.55%,4/53）,直肠前壁膨出17例（32.07%,17/53）,耻骨直肠肌撕裂8例（15.09%,8/53）;临床检查发现产妇压力性尿失禁15例（28.30%,15/53）,阴道前壁脱垂5例（9.43%,5/53）,子宫脱垂4例（7.55%,4/53）,未检出直肠膨出和耻骨直肠肌撕裂。对照组19例产妇经会阴四维超声检查均未见异常表现;临床检查发现压力性尿失禁3例。（2）经会阴四维超声测量结果：盆底功能障碍组产妇Valsalva动作肛提肌裂孔面积测值[（23.33±1.61）cm2]与对照组测值[（19.73±1.74）cm2]比较明显增大;盆底功能障碍组产妇膀胱颈活动度增加[（23.67±1.72）cm2]、阴道前壁脱垂[（25.87±2.28）cm2]、子宫脱垂[（27.95±3.89）cm2]和直肠膨出[（23.68±2.50）cm2]的产妇Valsalva动作时肛提肌裂孔面积均较对照组测值明显增大。结论产后经会阴四维超声可早期发现临床检查中不易发现的轻度盆底功能障碍及肛提肌损伤,

Evaluation of pelvic floor function after spontoneous labor by transperinaeum four-dimensional ultrasound

Objective To investigate the image of postpartum 4 dimensional（4D） transperineal ultrasonography to evaluate the pelvic structures and diagnose the pelvic floor dysfunction（PFD）. Methods Seventy-two postpartum women were randomly recruited who underwent vaginal delivery in Beijing Obstetrics and Gynecology Hospital from January 2010 to September 2012. Transperineal ultrasound was performed at 42 days after childbirth. The study group included 53 women with PFD and the control group included 19 women without PFD in 4D ultrasound. The shapes, positions and mobilities of bladder neck, cervix and anorectum were detected on the sagittal plane of pelvic floor, and the the hiatal length and area and the thickness of poborectalis musle were measured on the rendered axial planes of pelvic floor during both rest and Valsalva maneuver. The integrity of puborectalis muscle was evaluated on the rendered axial palnes. The results of transperineal ultrasoundwere compared with those of clinical examinations. Results In study group, bladder neck descent（BND） were increased in 38 cases of 53（71.70%, 38/53）. For 15 cases（28.30%, 15/53） of cystocele, 4 cases（7.55%, 4/53） of uterine prolapse, 17 cases（32.07%, 17/53） of rectocele and 8 cases（15.09%, 8/53） of puborectalis muscle, injuries were detected by transperineal ultrasound, while 15 cases of stress urinary incontinence（SUI）, 5 cases of cystocele and 4 cases of uterine prolapse were found by clinical examinations. No case of rectocele and puborectalis muscle injuries was diagnosed by clinical examinations. No pelvic abnormality was found by 4D ultrasond in the control group and 3 cases of SUI were found by clinical examinations. The hiatal area during Valsalva maneuver of study group [（23.33±1.61） cm2] was significantly larger than that of control group [（19.73±1.74） cm2]. In the cases of increased BND, cystocele, uterine prolapse and rectocele, the hiatal area during Valsalva maneuver were also significantly larger than that of contr