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

Abstract

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

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.

References

[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.

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

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