产后盆底结构改变及康复治疗效果的超声量化评估

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摘要目的通过经会阴超声检查了解产后女性的盆底结构改变，评估康复治疗效果，为分娩导致的盆底功能障碍性疾病的防治提供直观、可靠的影像学依据。方法选取2013年1月～2015年12月在我院就诊的自然分娩后6～8 周的60 例初产妇作为实验组，并将实验组随机分为康复治疗组（30 例）和常规治疗组（30 例），同期选取30例无症状的未生育女性作为对照组。康复治疗组接受一疗程盆底肌肉训练治疗，常规治疗组接受常规宣教、自然恢复治疗。经会阴超声分别于静息期、张力期进行检查，分别获得产后6、14 周实验组及未生育女性两种状态的超声数据：膀胱颈位置（BN）、宫颈位置（CX）、直肠壶腹位置（RA）、肛提肌裂孔平面肌性部分的长度（LAL），计算膀胱颈、宫颈、直肠壶腹由静息期至张力期的位移[膀胱颈移动度（BND）、宫颈移动度（CXD）、直肠壶腹（RAD）移动度]以及肛提肌应变率（LAS）。结果实验组的BND、CXD、LAS 均高于对照组，差异有统计学意义（P＜0.05）；对照组与实验组的RAD 比较，差异无统计学差异（P＞0.05）。康复治疗组的BND、CXD、LAS 均低于常规治疗组，差异有统计学意义（P＜0.05）；康复治疗组与常规治疗组的RAD 比较，差异无统计学差异（P＞0.05）。结论妊娠及分娩可能导致以膀胱颈和宫颈为代表的前中腔室移动度及LAS 增加，后腔室移动度无明显改变；盆底康复治疗对产后盆底恢复效果显著。

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关键词 ：超声, 盆底结构改变, 康复治疗

Abstract：Objective To investigate the changes of pelvic floor structure in postpartum women through the perineal ultrasound,evaluate the effect of rehabilitation therapy,and provide an intuitive and reliable imaging basis for the prevention and treatment of pelvic floor dysfunction caused by delivery.Methods From January 2013 to December 2015,60 primiparas who underwent natural delivery in our hospital were selected as the experimental group,the experimental group was randomly divided into the rehabilitation treatment group (30 cases) and the conventional treatment group (30 cases),and 30 asymptomatic and nulliparous women at the same time were selected as the control group.The rehabilitation treatment group received a course of pelvic floor muscle training,and the conventional treatment group received routine education and natural recovery.The perineal ultrasound was examined at rest and tension,respectively.Ultrasound data were obtained for the experimental group at 6 and 14 weeks after delivery and nulliparous women: bladder neck position (BN),cervical position (CX),and rectal ampulla position (RA),length of the muscular part of the ani levator muscle plane (LAL),to calculate the displacement of the bladder neck,cervix,rectum ampulla from rest period to tension period (bladder neck descent [BND],cervical descent [CXD],rectal ampulla descent [RAD]) and levator ani strain rate (LAS).Results The BND,CXD and LAS of the experimental group were higher than those of the control group,and the differences were statistically significant(P＜0.05).There was no significant difference in RAD between the control group and the experimental group (P＞0.05).The BND,CXD and LAS in the rehabilitation treatment group were lower than those in the conventional treatment group,and the differences were statistically significant (P＜0.05).There was no significant difference in RAD between the rehabilitation treatment group and the conventional treatment group (P＞0.05).Conclusion Pregnancy and delivery may lead to increased mobility of the anterior and middle chamber,represented by the bladder neck and cervix,and LAS,no significant changes in posterior chamber mobility.Pelvic floor rehabilitation treatment has significant effect on postpartum pelvic floor recovery.

Key words： Ultrasound Pelvic floor structural changes Rehabilitation therapy

基金资助:广东省韶关市卫生计生科研项目（Y18023）；广东省韶关市科技计划项目（2018sn107）

作者简介: 陈惠英（1988-），女，广东韶关人，毕业于汕头大学医学院妇产科专业，硕士，主治医师，研究方向：盆底功能障碍性疾病、女性内分泌疾病

引用本文:

陈惠英；许红雁；钟永红；黄笑英；何剑芬；周新卫. 产后盆底结构改变及康复治疗效果的超声量化评估[J]. 中国当代医药, 2020, 27(1): 124-127.
CHEN Hui-ying1 XU Hong-yan； ZHONG Yong-hong； HUANG Xiao-ying； HE Jian-fen； ZHOU Xin-wei. Ultrasonic quantitative evaluation of postpartum pelvic floor structural changes and rehabilitation therapy effect. 中国当代医药, 2020, 27(1): 124-127.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2020/V27/I1/124

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