切换至 "中华医学电子期刊资源库"
高级检索
中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2016, Vol. 13 ›› Issue (03) : 209 -212. doi: 10.3877/cma.j.issn.1672-6448.2016.03.009

所属专题： 文献；

妇产科超声影像学

不同方式分娩后女性肛提肌损伤的断层超声观察
白云1, 徐莲1, 刘菲菲1, 胡兵1(), 李勤1, 应涛1,†()   
  1. 1. 200233　上海交通大学附属第六人民医院超声医学科　上海超声医学研究所
  • 收稿日期:2015-11-23 出版日期:2016-03-01
  • 通信作者: 胡兵, 应涛
  • 基金资助:
    上海市自然科学基金资助项目(13ZR1431300)

Tomographic ultrasound evaluation of avulsion of the levator ani in postpartum women according to delivery mode

Yun Bai1, Lian Xu1, Feifei Liu1, Tao Ying1,†()   

  1. 1. Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People′s Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, China
  • Received:2015-11-23 Published:2016-03-01
  • Corresponding author: Tao Ying
  • About author:
    Corresponding author: Ying Tao, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

白云, 徐莲, 刘菲菲, 胡兵, 李勤, 应涛. 不同方式分娩后女性肛提肌损伤的断层超声观察[J]. 中华医学超声杂志（电子版）, 2016, 13(03): 209-212.

Yun Bai, Lian Xu, Feifei Liu, Tao Ying. Tomographic ultrasound evaluation of avulsion of the levator ani in postpartum women according to delivery mode[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(03): 209-212.

目的

利用经会阴盆底三维超声断层成像（TUI）技术观察不同分娩方式后女性盆底肛提肌的损伤情况，并分析产科因素与女性肛提肌损伤的关系。

方法

对2013年4月至2014年2月在上海交通大学附属第六人民医院分娩的154名产后6~8周产妇（经阴道自然分娩组85名，经阴道产钳助产组15名，剖宫产组50名）进行盆底三维超声观察。应用TUI技术观察产妇肛提肌损伤情况。采用t检验比较肛提肌损伤组与肛提肌未损伤组产妇年龄、孕前体重指数、超声检查时体重指数、新生儿出生体重及第二产程时间差异。

结果

经阴道自然分娩组9名产妇发生肛提肌撕脱，损伤率为10.58%（9/85）；经阴道产钳助产组8名产妇发生肛提肌撕脱，损伤率为53.33%（8/15）；剖宫产组产妇无一例发生肛提肌撕脱。肛提肌损伤组产妇第二产程时间长于肛提肌无损伤组产妇，且差异有统计学意义[（90.00±30.10）min与（40.71±26.53）min比较，t=3.24，P<0.05]；而肛提肌损伤组与肛提肌无损伤组产妇年龄、孕前体重指数、超声检查时体重指数及新生儿出生体重差异均无统计学意义。

结论

TUI技术观察下，经阴道产钳助产产妇的肛提肌损伤率明显高于剖宫产及经阴道自然分娩产妇；肛提肌损伤与第二产程时间长有关。

关键词: 断层超声成像技术, 肛提肌, 分娩方式
Objective

Tomographic ultrasound imaging (TUI) was applied to observe the levator ani injury in postpartum women according to delivery mode. It was also analyzed about the influence of obstetric factors on the levator ani injury.

Methods

Translabial 3D ultrasound observation was performed on 154 rimiparas (spontaneous vaginal delivery in 85 cases, forceps delivery in 15 cases, cesarean delivery in 50 cases) from Shanghai Jiaotong University Affiliated Sixth People′s Hospital during April, 2013 to February, 2014. TUI was applied to evaluate the situation of levator ani injury. The t-test was used to analyze the differences between the injured levator ani group and the normal levator ani group including postpartum women′s ages, body mass index (BMI) before pregnancy, BMI on ultrasound examination, children birth weight and the time of second stage during labor.

Results

Nine cases of the levator ani muscle avulsion were observed in spontaneous vaginal delivery group (the avulsion incidence rate was 10.58%, 9/85), and 8 cases of the levator ani muscle avulsion were found in forceps delivery group (the avulsion incidence rate was 53.33%, 8/15). No levator ani muscle avulsion was shown in the cesarean delivery group. The second stage of labor was obvious longer in avulsion group compared with the normal group, it had significant statistical difference between the two groups [(90.00±30.10) min vs (40.71±26.53) min, t=3.24, P<0.05]. However, age, BMI before pregnancy, BMI on ultrasound examination and children birth weight had no significant statistical difference between the two groups.

Conclusions

On TUI, the avulsion incidence rate in forceps delivery was apparently higher than that in spontaneous vaginal delivery and in cesarean delivery. There is a probabe relation between levator avulsion and longer second stage of labor.

Key words: Tomographic ultrasound imaging, Levator ani muscle, Delivery mode
表1 经阴道自然分娩组、经阴道产钳助产组、剖宫产组产妇一般资料比较（±s）
组别 例数 年龄（岁） 孕前体重指数（kg/m2） 超声检查时体重指数（kg/m2） 产后时间（d） 新生儿出生体重（g）
经阴道自然分娩组 85 29.18±4.04 20.56±3.02 22.49±3.02 52.64±6.35 3297.68±340.18
经阴道产钳助产组 15 29.20±4.44 20.24±2.20 22.80±2.83 51.33±4.22 3222.33±453.90
剖宫产组 50 28.78±2.94 20.93±3.02 22.74±2.78 54.04±5.32 3390.70±488.58
F值 ? 3.05 2.79 1.06 2.57 2.89
P值 ? >0.05 >0.05 >0.05 >0.05 >0.05
图1 左侧肛提肌损伤的断层超声成像表现。第3~5平面内，肛提肌在右侧耻骨支的附着处回声连续，左侧附着处有异常回声插入（箭头所示），诊断为左侧肛提肌损伤
图2 右侧肛提肌损伤的断层超声成像表现。第3~5平面内，肛提肌在左侧耻骨支的附着处回声连续，右侧附着处有异常回声插入（箭头所示），诊断为右侧肛提肌损伤
图3 双侧肛提肌损伤的断层超声成像表现。第3~5平面内，肛提肌在双侧耻骨支的附着处有异常回声插入（箭头所示），诊断为双侧肛提肌损伤
表2 肛提肌损伤组与未损伤组产妇产科因素比较（±s）
组别 例数 产妇年龄（岁） 孕前体重指数（kg/m2） 超声检查时体重指数（kg/m2） 新生儿出生体质量（g） 第二产程时间（min）
肛提肌损伤组 17 28.76±3.94 20.02±2.35 22.32±2.74 3306.47±379.52 90.00±30.10
肛提肌未损伤组 17 29.15±4.13 20.62±3.08 22.58±3.04 3282.26±355.53 40.71±26.53
t值 ? 0.79 1.18 0.85 0.76 3.24
P值 ? >0.05 >0.05 >0.05 >0.05 <0.05
[1]
Volloyhaug I, Wong V, Shek KL, et al.Does levator avulsion cause distension of the genital hiatus and perineal body? [J]. Int Urogynecol J, 2013, 24(7): 1161-1165.
[2]
应涛, 李勤, 邵春娟, 等. 盆底器官脱垂女性盆膈裂孔的三维超声影像学观察 [J]. 中华超声影像学杂志, 2011, 20(8): 688-691.
[3]
Shek KL, Dietz HP. Pelvic floor ultrasonography: an update [J]. Minerva Ginecol, 2013, 65(1): 1-20.
[4]
Dietz HP. Ultrasound imaging of the pelvic floor. Part Ⅱ: three-dimensional or volume imaging [J]. Ultrasound Obstet Gynecol, 2004, 23(6): 615-625.
[5]
刘菲菲, 白云, 应涛, 等. 女性膀胱脱垂亚型的超声影像学初步研究 [J]. 中华超声影像学杂志, 2015, 24(2): 132-135.
[6]
徐莲, 刘菲菲, 应涛, 等. 断层超声评估产后耻骨直肠肌损伤 [J]. 中国医学影像技术, 2013, 29: 1683-1686.
[7]
Dietz HP, Bernardo MJ, Kirby A, et al. Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound [J]. Int Urogynecol J, 2011, 22(6): 699-704.
[8]
Dietz HP. Pelvic floor trauma in childbirth [J]. Aust N Z J Obstet Gynaecol, 2013, 53(3): 220-230.
[9]
DeLancey JO, Kearney R, Chou Q, et al. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery [J]. Obstet Gynecol, 2003, 101(1): 46-53.
[10]
Dietz HP, Moegni F, Shek KL. Diagnosis of levator avulsion injury: a comparison of three methods [J]. Ultrasound Obstet Gynecol, 2012, 40(6): 693-698.
[11]
Dietz HP, Shek KL, Chantarasorn V, et al. Do women notice the effect of childbirth-related pelvic floor trauma? [J]. Aust N Z J Obstet Gynaecol, 2012, 52(3): 277-281.
[12]
陶均佳, 应涛, 杨少玲, 等. 分娩期女性盆膈裂孔三维超声影像学观察 [J]. 中华超声影像学杂志, 2014, (11): 962-965.
[13]
Araujo Junior E, de Freitas RC, Di Bella ZI, et al. Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil [J]. Rev Bras Ginecol Obstet, 2013, 35(3): 117-122.
[14]
Shek KL, Dietz HP. Intrapartum risk factors for levator trauma [J]. BJOG, 2010, 117(12): 1485-1492.
[15]
Liu F, Xu L, Ying T, et al. Three-dimensional ultrasound appearance of pelvic floor in nulliparous women and postpartum women one week after their first delivery [J]. Int J Med Sci, 2014, 11(3): 234-239.
[16]
Dietz HP. Levator trauma in labor: a challenge for obstetricians, surgeons and sonologists [J]. Ultrasound Obstet Gynecol, 2007, 29(4): 368-371.
[17]
张依妮, 郭洪花. 不同分娩体位在第二产程应用的研究进展 [J]. 中华护理杂志, 2013, 48(3): 281-283.
[1] 朱霞, 高艳多, 许彩, 唐婉, 谢磊, 葛倩, 陈芬芳, 赵胜. 盆底三维超声评价产次及分娩方式对肛提肌裂孔面积的影响[J]. 中华医学超声杂志（电子版）, 2022, 19(09): 920-925.
[2] 何莎, 赵胜, 范建华, 高艳多, 黄君红, 戢秀勤, 朱霞. 盆底超声评价不同产次及分娩方式对耻骨直肠肌厚度改变的影响[J]. 中华医学超声杂志（电子版）, 2022, 19(01): 17-22.
[3] 俞琤, 陈蕾, 张丽丹, 冯婷. 二胎分娩方式与肛提肌裂孔面积的相关性[J]. 中华医学超声杂志（电子版）, 2021, 18(05): 462-466.
[4] 刘丽, 刘静华, 蒋莹, 郑洪平, 林李梅, 宋金爽, 徐烨. 经会阴三维超声断层成像评估盆腔器官脱垂患者肛提肌损伤的康复疗效[J]. 中华医学超声杂志（电子版）, 2019, 16(01): 54-60.
[5] 成平, 王丹, 刘雪玲, 李鸣凤, 韦芳. 盆底超声在女性产后膀胱膨出诊断中的应用价值[J]. 中华医学超声杂志（电子版）, 2018, 15(11): 818-821.
[6] 严雨霖, 窦超然, 李勤, 郗艳, 王霞, 胡兵, 应涛. 断层超声成像及磁共振成像技术对产后女性肛提肌撕脱的评价[J]. 中华医学超声杂志（电子版）, 2018, 15(10): 790-795.
[7] 魏小华, 周芳芳, 赵倩, 曹敏, 雷春梅. 孕产妇住院时间影响因素分析[J]. 中华妇幼临床医学杂志(电子版), 2018, 14(04): 435-440.
[8] 邓褫夺, 林学祥, 李俊锐, 武少清. 肛提肌外腹会阴联合术与传统会阴联合术治疗低位直肠癌的远期随访研究[J]. 中华普外科手术学杂志(电子版), 2022, 16(01): 36-39.
[9] 吴晓琳, 张彬, 任力娟, 刘爽, 王东文. 肛提肌损伤的多学科研究进展[J]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(02): 153-157.
[10] 罗其发, 陈江鸿, 王文生, 陈国庆, 王宸禹, 李立奇, 李祥生, 马丹. 改良的腹腔镜辅助下ELAPE手术临床效果观察[J]. 中华结直肠疾病电子杂志, 2022, 11(03): 198-204.
[11] 陈琴, 李华山. 直肠内挂线术治疗肛提肌以上脓肿的临床经验撷要[J]. 中华结直肠疾病电子杂志, 2020, 09(04): 335-339.
[12] 韩加刚, 王振军. 直肠癌ELAPE手术会阴操作的神经保护[J]. 中华结直肠疾病电子杂志, 2019, 08(01): 12-15.
[13] 方大俊, 郑勤田. 子痫前期终止妊娠的时机和方式[J]. 中华产科急救电子杂志, 2021, 10(03): 151-154.
[14] 李偲琦, 杨鑫, 汪文磊. 盆底超声在评估女性产后盆底结构及功能变化上的临床价值[J]. 中华介入放射学电子杂志, 2021, 09(02): 183-187.
[15] 代培芬, 王贻英. 妊娠合并心力衰竭孕妇分娩方式及妊娠结局分析[J]. 中华心脏与心律电子杂志, 2018, 06(03): 146-148.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号