经会阴动态三维超声对便秘的产后女性盆底解剖结构重塑的观察

doi:10.13418/j.issn.1001-165x.2017.06.008

中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (6): 633-636.doi: 10.13418/j.issn.1001-165x.2017.06.008

经会阴动态三维超声对便秘的产后女性盆底解剖结构重塑的观察

穆靓¹，刘莉¹，　韦爱华¹，　南淑良¹，　郝睿¹，　李玢²，　胡盈 ²

1.西安交通大学医学院第三附属医院陕西省人民医院超声诊断中心，西安 710068；　
2.西安交通大学医学院第三附属医院陕西省人民医院妇产病院，西安 710068

收稿日期:2017-08-09 出版日期:2017-11-25 发布日期:2017-12-30
通讯作者: 刘莉，副主任医师，硕士生导师，Tel:13359189598,E-mail：lilizxg@163.com
作者简介:穆靓（1985-），女，陕西人，主治医师，博士在读，主要从事盆底及泌尿系超声工作，E-mail：muliangwangyue@163.com
基金资助:
国家自然科学基金青年项目 (81501238)；陕西省科技厅科学技术研究发展计划项目(2014K11-03-09-06)

Characteristics of anatomic remodeling of pelvic diaphragm hiatus in postpartum women with constipation detected dynamically by transperineal three-dimensional ultrasonography

MU Liang¹, LIU Li¹, WEI Ai-hua¹, NAN Shu-liang¹, HAO Rui¹, LI Bin², HU Ying²

1. Ultrasound Diagnosis Center, The Third Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Provincial People's Hospital, Xi'an 710068, China; 2. Department of Gynecology & Obstetrics, The Third Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Provincial People's Hospital, Xi'an 710068， China

Received:2017-08-09 Online:2017-11-25 Published:2017-12-30

摘要/Abstract

摘要：

目的　经会阴盆底三维超声动态观察便秘产妇的肛提肌裂孔解剖形态重塑及功能改变。方法　选取2014年7月至2017年6月在我院妇产科定期行产后复查的女性110例（产后组），其中有便秘症状45例（便秘产妇），无便秘症状65例（无便秘产妇），同期选取未育的无便秘症状健康妇女100例（对照组）。所有妇女均进行经会阴盆底三维超声检查，观察并测量比较各组妇女的盆底解剖形态结构及特征，测量各组妇女在静息状态、缩肛动作和Valsalva动作3种状态下的肛提肌裂孔面积、周长及肛提肌厚度。结果　产后妇女盆底组织结构疏松，对照组妇女肛提肌裂孔结构完整紧凑。在静息状态、缩肛动作及Valsalva动作3种状态下，产后组妇女的肛提肌裂孔面积、周长及肛提肌厚度均明显大于对照组妇女，差异均有统计学意义（P＜0.05）。产后组便秘产妇在3种状态下的肛提肌裂孔面积及周长均明显大于无便秘产妇(P＜0.05)；在缩肛动作时便秘产妇的肛提肌厚度明显薄于无便秘产妇(P＜0.05)，在静息状态及Valsalva动作时，便秘产妇与无便秘产妇的肛提肌厚度比较，差异均无统计学意义(P＞0.05)。结论产后妇女盆底解剖结构发生重塑，经会阴三维超声能有效观察产后女性尤其便秘产妇盆底解剖结构与功能的变化。

关键词: , 三维超声, 　产后女性, 　便秘, 　盆底解剖, 　重塑

Abstract:

Objective　To have a dynamic observation about the morphological characteristics of pelvic diaphragm hiatus in postpartum women with constipation by transperineal three-dimensional ultrasonography.　Methods　From Jul.2014 to Jun. 2017, 110 postpartum women underwent transperineal 3-D ultrasound investigation at Department of Obstetrics and Gynecology，including 45 postpartum women with constipation and the other 65 postpartum women without constipation．In the mean time，100 normal nulliparous healthy women without constipation were chosen as control group．The morphological characteristics of pelvic diaphragm hiatus，the perimeter and area of pelvic diaphragm hiatus，levatorani thickness were measured at rest, on maximum pelvic floor contraction and maximum Valsalva by 3-D ultrasound, respectively. Results Loose connective tissue was observed in postpartum women．The perimeter and area of pelvic diaphragm hiatus and levatorani thickness were significantly increased than those in control group, at rest, on maximum pelvic floor contraction and maximum Valsalva respectively (P＜0.05).And the perimeter and area of pelvic diaphragm hiatus in postpartum women with constipation were increased than those without constipation at three maneuvers，respectively (P＜0.05)．Levatorani thickness in postpartum women with constipation was significantly thinner than those without constipation at maximum pelvic floor contraction (P＜0.05), but there was no significant difference between postpartum women with constipation and without constipation at rest and on maximum Valsalva in pubovisceral muscle thickness (P＞0.05)．Conclusions Pelvic diaphragm hiatus anatomic remodeling is identified in postpartum women. Transperineal three-dimensional ultrasonography is of great value for　pelvic diaphragm hiatus change in postpartum women ,especially those with constipation．

Key words: 3D ultrasonography, 　Postpartum women, 　Constipation, 　Pelvic floor, 　 Remodel

穆靓,刘莉,韦爱华,南淑良,郝睿,李玢,胡盈. 经会阴动态三维超声对便秘的产后女性盆底解剖结构重塑的观察[J]. 中国临床解剖学杂志, 2017, 35(6): 633-636.

MU Liang, LIU Li, WEI Ai-hua, NAN Shu-liang, HAO Rui, LI Bin, HU Ying. Characteristics of anatomic remodeling of pelvic diaphragm hiatus in postpartum women with constipation detected dynamically by transperineal three-dimensional ultrasonography[J]. Chinese Journal Of Clinical Anatomy, 2017, 35(6): 633-636.

参考文献

[1] Zhu L, Lang J, Liu C, et al． The epidemiological study of women with urinary incontinence and risk factors for stress urinary incontinence in China [J]. Menopause, 2009, 16(4): 831-836.
[2] Dietz HP, Shek C, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three -dimensional pelvic floor ultrasound [J].Ultrasound Obstet Gynecol, 2005, 25(6):580-585.
[3] Dietz HP. Clinical consequences of levator trauma[J]. Ultrasound Obstet Gynecol, 2012, 39(4)：367-371.
[4] Minassian VA, Devore E, Hagan K, et al. Severity of urinary incontinence and effect on quality of life in women by incontinence type[J]. Obstet Gynecol, 2013, 121(5):1083-1090.
[5] Garcia-Mejido JA, Gutierrez L, Fernandez-Palacin A, et a1．Levator ani muscle injuries associated with vaginal vacuum assisted delivery determined by 3/4D transperineal ultrasound [J]．J Matern Fetal Neonatal Med, 2017, 30(16)：1891-1896．
[6] Siafarikas F, Staer-Jensen J, Hilde G，et al．The levator ani muscle during pregnancy and major levator ani muscle defects diagnosed postpartum: a three- and four-dimensional transperineal ultrasound study [J]．BJOG，2015，122（8）：1083-1091．
[7] Rostaminia G, Peck JD, Quiroz LH, et a1．Characteristics associated with pelvic organ prolapse in women with significant levator ani muscle deficiency[J]．Int Urogynecol J, 2016, 27(2)：261-267．
[8] Yang SH, Huang WC, Yang SY, et a1．Validation of new ultrasound parameters for quantifying pelvic floor muscle contraction[J]．Ultrasound Obstet Gynecol, 2009，33(4)：465-471．
[9] Majida M, Braekken IH, Bo K，et al．Validation of three-dimensional perineal ultrasound and magnetic resonance imaging measurements of the pubovisceral muscle at rest[J]．Ultrasound Obstet Gynecol, 2010, 35(6)：715-722.
[10]Vergeldt TF, Notten KJ, Stoker J, et al．Comparison of translabial three-dimensional ultrasound with magnetic resonance imaging for measurement of levator hiatal biometry at rest [J]．Ultrasound Obstet Gynecol，2016，47(5)：636-641.
[11]夏珣, 郭飞燕, 段钢, 等．未育女性盆底断层超声与 MRI 影像解剖及其临床意义[J]．中国临床解剖学杂志，2013，31(4):422-426．
[12]Leanbo A，Camilleri M．Chronic constipation[J]．N Engl J Med，2003，349(14)：1360-1368．
[13]Diez-Itza I，Arrue M，Ibanez L，et al. Postpartum impairment of pelvic floor muscle function: factors involved and association with prolapse[J].Int Urogynecol J, 2011, 22 (12):1505-1511．
[14]Guzman Roas R，Kamisan Atan I，Shek KL，et a1．The prevalence of abnormal posterior compartment anatomy and its association with obstructed defecation symptoms in urogynecological patients [J]．Int Urogynecol J，2016，27(6)：939-944．
[15]Dietz HP, Abbu A, Shek KL. The levator-urethra gap measurement: a more objective means of determining levator avulsion[J]. Ultrasound Obstet Gynecol, 2008, 32(7): 941-945.

经会阴动态三维超声对便秘的产后女性盆底解剖结构重塑的观察

Characteristics of anatomic remodeling of pelvic diaphragm hiatus in postpartum women with constipation detected dynamically by transperineal three-dimensional ultrasonography

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