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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2017, Vol. 14 ›› Issue (06) : 452 -457. doi: 10.3877/cma.j.issn.1672-6448.2017.06.011

所属专题： 文献；

妇产科超声影像学

盆底超声检查评估不同分娩方式对产后妇女耻骨直肠肌收缩功能的影响
陈华1, 王慧芳1,†(), 王瑾1, 陈梦华1, 郭娟1, 邓晓双1   
  1. 1. 518035　深圳市第二人民医院　深圳大学第一附属医院超声科
  • 收稿日期:2017-04-06 出版日期:2017-06-01
  • 通信作者: 王慧芳
  • 基金资助:
    深圳市卫生计生系统科研项目(201607022，201601027)

Assessment of the influencesof different delivery methods of contractibility of the puborectalis in postpartum women by pelvic ultrasound

Hua Chen1, Huifang Wang1,†(), Jin Wang1, Menghua Chen1, Juan Guo1, Xiaoshuang Deng1   

  1. 1. Department of Ultrasonography, the Second People′s Hospital of Shenzhen, the First Affiliated Hospital of Shenzhen University, Shenzhen 518035, China
  • Received:2017-04-06 Published:2017-06-01
  • Corresponding author: Huifang Wang
  • About author:
    Corresponding author: Wang Huifang, Email:
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引用本文：

陈华, 王慧芳, 王瑾, 陈梦华, 郭娟, 邓晓双. 盆底超声检查评估不同分娩方式对产后妇女耻骨直肠肌收缩功能的影响[J]. 中华医学超声杂志（电子版）, 2017, 14(06): 452-457.

Hua Chen, Huifang Wang, Jin Wang, Menghua Chen, Juan Guo, Xiaoshuang Deng. Assessment of the influencesof different delivery methods of contractibility of the puborectalis in postpartum women by pelvic ultrasound[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(06): 452-457.

目的

采用盆底超声检查评估不同分娩方式以及产后不同时间段盆底耻骨直肠肌（PR）收缩功能的恢复情况，探讨分娩方式对PR收缩功能的影响。

方法

选取2016年9~12月于深圳大学第一附属医院超声科检查且能有效完成盆底收缩动作的初产妇168名。100名产妇经阴道分娩，其中32名为产后42~60 d，45名为产后61~90 d，23名为产后>90 d；68名产妇为剖宫产，24名为产后42~60 d，23名为产后61~90 d，21名为产后>90 d。所有受检者均接受静息和收缩状态时经会阴二维超声检查：测量前、中及后份PR厚度并计算PR增厚率。采用独立样本t检验比较经阴道分娩组与剖宫产组产后42~60 d、产后61~90 d、产后>90 d产妇双侧PR增厚率差异。

结果

经阴道分娩组产后42~60 d产妇右侧PR前部、中部、后部增厚率分别为（35.57±19.80）%、（31.46±20.96）%、（24.18±21.51）%，左侧PR前部、中部、后部增厚率分别为（25.23±14.36）%、（21.25±13.79）%、（20.60±11.58）%；剖宫产组产后42~60 d产妇右侧PR前部、中部、后部增厚率分别为（30.27±19.22）%、（29.50±17.21）%、（28.25±14.92）%，左侧PR前部、中部、后部增厚率分别为（33.02±20.65）%、（30.56±20.11）%、（28.64±14.84）%。经阴道分娩组产后61~90 d产妇右侧PR前部、中部、后部增厚率分别为（29.62±16.93）%、（24.94±14.56）%、（19.26±11.12）%，左侧PR前部、中部、后部增厚率分别为（20.17±15.70）%、（19.95±13.07）%、（22.19±14.50）%，剖宫产组产后61~90 d产妇右侧PR前部、中部、后部增厚率分别为（30.82±15.65）%、（17.70±10.34）%、（19.30±7.02）%，左侧PR前部、中部、后部增厚率分别为（18.33±11.61）%、（16.46±10.51）%、（16.62±11.69）%。经阴道分娩组产后>90 d产妇右侧PR前部、中部、后部增厚率分别为（33.56±19.79）%、（25.18±11.80）%、（17.44±11.41）%，左侧PR前部、中部、后部增厚率分别为（28.06±10.93）%、（22.25±11.82）%、（22.15±12.69）%，剖宫产组产后>90 d产妇右侧PR前部、中部、后部增厚率分别为（46.36±20.65）%、（17.00±10.34）%、（10.86±3.40）%，左侧PR前部、中部、后部增厚率分别为（22.54±13.81）%、（13.90±10.51）%、（18.24±11.17）%。经阴道分娩组与剖宫产组产后42~60 d、产后61~90 d、产后>90 d产妇双侧各段PR增厚率差异均无统计学意义（产后42~60 d：右侧，t=0.87、P=0.34，t=0.32、P=0.75，t=0.68、P=0.50；左侧，t=1.48、P=0.15，t=1.82、P=0.08，t=1.36、P=0.12；产后61~90 d：右侧，t=0.22、P=0.83，t=1.64、P=0.11，t=0.01、P=0.99；左侧，t=0.43、P=0.67，t=0.79、P=0.44，t=1.13、P=0.27；产后>90 d：右侧，t=0.73、P=0.48，t=1.22、P=0.23，t=0.868、P=0.40；左侧，t=0.89、P=0.41，t=1.79、P=0.89，t=0.79、P=0.44）。

结论

剖宫产和经阴道分娩这2种分娩方式对产后各时段PR收缩功能影响差异无统计学意义，剖宫产对PR收缩功能的保护作用有限 。

关键词: 超声检查, 耻骨直肠肌, 剖宫产术, 自然分娩
Objective

To assess the recovery of contraction function of puborectalis (PR) in women at different periods after delivery with different delivery modes, and to discuss the effect of delivery mode on PR contraction.

Methods

Between September 2016 and December 2016, 168 primiparas who underwent ultrasound examination at the First Affiliated Hospital of Shenzhen University were enrolled. All participants were able to accomplish Valsalva maneuver. Participants were divided into two groups according to delivery modes: the vaginal delivery group and the cesarean section group. This two groups were further divided into three groups according to their periods after delivery: 42-60 days after delivery (group 1), 61-90 days after delivery (group 2) and more than 90 days after delivery (group 3). Two dimensional translabial ultrasound examination were performed in all participants both at rest and in maximal contraction status. Thickness of anterior, middle and posterior parts of PR were measured and thickening rate was calculated. Data were evaluated by t-test and comparisons were made between the vaginal delivery groups and cesarean section groups, respectively.

Results

In the vaginal delivery group 1, the thickening rate of the anterior, middle and posterior parts of right-side PR were (35.57±19.80)%, (31.46±20.96)% and (24.18±21.51)%, while the thickening rate of left-side PR were (25.23±14.36)%, (21.25±13.79)% and (20.60±11.58)%, respectively. In the cesarean section group 1, the thickening rate of the anterior, middle and posterior parts of right-side PR were (30.27±19.22)%, (29.50±17.21)% and (28.25±14.92)%, while the thickening rate of left-side PR were (33.02±20.65)%, (30.56±20.11)% and (28.64±14.84)%, respectively. In the vaginal delivery group 2, the thickening rate of the anterior, middle and posterior parts of right-side PR were (29.62±16.93)%, (24.94±14.56)% and (19.26±11.12)% , while the thickening rate of left-side PR were (20.17±15.70)%, (19.95±13.07)% and (22.19±14.50)%, respectively. In the cesarean section group 2, the thickening rate of the anterior, middle and posterior parts of right-side PR were (30.82±15.65)%, (17.70±10.34)% and (19.30±7.02)%, while the thickening rate of left-side PR were (18.33±11.61)%, (16.46±10.51)% and (16.62±11.69)%, respectively. In the vaginal delivery group 3, the thickening rate of the anterior, middle and posterior parts of right-side PR were (33.56±19.79)%, (25.18±11.80)% and (17.44±11.41)%, while the thickening rate of left-side PR were (28.06±10.93)%, (22.25±11.82)% and (22.15±12.69)%, respectively. In the cesarean section group 3, the thickening rate of the anterior, middle and posterior parts of right-side PR were (46.36±20.65)%, (17.00±10.34)% and (10.86±3.40)%, while the thickening rate of left-side PR were (22.54±13.81)%, (13.90±10.51)% and (18.24±11.17)%, respectively. There were no statistically difference of the thickening rate of PR in both side between the vaginal delivery subgroups and the cesarean section subgroups (For group 1, right side: t=0.87, P=0.34; t=0.32, P=0.75; t=0.68, P=0.50; left side: t=1.48, P=0.15; t=1.82, P=0.08; t=1.36, P=0.12. For group 2, right side: t=0.22, P=0.83; t=1.64, P=0.11; t=0.01, P=0.99; left side: t=0.43, P=0.67; t=0.79, P=0.44; t=1.13, P=0.27. For group 3, right side: t=0.73, P=0.48; t=1.22, P=0.23; t=0.868, P=0.40. left side: t=0.89, P=0.41; t=1.79, P=0.89; t=0.79, P=0.44).

Conclusion

There was no significant differences between the impact of two delivery modes on the contraction function of the PR, and the protective effect of caesarean section on the contraction function of the PR was limited.

Key words: Ultrasonography, Puborectalis, Cesarean section, Natural childbirth
图1，2 静息状态（图1）和收缩状态（图2）左、右侧PR厚度的测量。于尿道水平（前部）、阴道水平（中部）及直肠水平（后部）处分别测量左、右侧PR的厚度，计算PR最大收缩状态下的增厚率（?T）：?T=（Tc - Tr）/ Tr（Tr表示静息状态下PR的厚度、Tc最大收缩状态下PR的厚度）
表1 经阴道分娩组与剖宫产组产妇一般资料比较（±s）
组别 例数 产后42~60 d 产后61~90 d 产后>90 d
例数 年龄（岁） 体重指数（kg/m2） 例数 年龄（岁） 体重指数（kg/m2） 例数 年龄（岁） 体重指数（kg/m2）
经阴道分娩组 100 32 27.81±3.07 22.20±2.95 45 27.89±2.84 21.88±2.56 23 27.87±3.36 22.61±2.86
剖宫产组 68 24 29.33±2.54 21.76±2.28 23 29.13±2.17 22.60±2.68 21 30.58±5.14 22.95±3.09
t值 ? ? 1.78 0.53 ? 1.55 1.0 ? 1.89 0.33
P值 ? ? 0.08 0.60 ? 0.13 0.32 ? 0.07 0.74
表2 经阴道分娩组与剖宫产组产后42~60 d产妇双侧各段PR增厚率比较（%，±s）
组别 例数 右侧PR 左侧PR
前部 中部 后部 前部 中部 后部
经阴道分娩组 32 35.57±19.80 31.46±20.96 24.18±21.51 25.23±14.36 21.25±13.79 20.60±11.58
剖宫产组 24 30.27±19.22 29.50±17.21 28.25±14.92 33.02±20.65 30.56±20.11 28.64±14.84
t值 ? 0.87 0.32 0.68 1.48 1.82 1.36
P值 ? 0.34 0.75 0.50 0.15 0.08 0.12
表3 经阴道分娩组与剖宫产组产后61~90 d产妇双侧各段PR增厚率比较（%，±s）
组别 例数 右侧PR 左侧PR
前部 中部 后部 前部 中部 后部
经阴道分娩组 45 29.62±16.93 24.94±14.56 19.26±11.12 20.17±15.70 19.95±13.07 22.19±14.50
剖宫产组 23 30.82±15.65 17.70±10.34 19.30±7.02 18.33±11.61 16.46±10.51 16.62±11.69
t值 ? 0.22 1.64 0.01 0.43 0.79 1.13
P值 ? 0.83 0.11 0.99 0.67 0.44 0.27
表4 经阴道分娩组与剖宫产组产后>90 d产妇双侧各段PR增厚率比较（%，±s）
组别 例数 右侧PR 左侧PR
前部 中部 后部 前部 中部 后部
经阴道分娩组 23 33.56±19.79 25.18±11.80 17.44±11.41 28.06±10.93 22.25±11.82 22.15±12.69
剖宫产组 21 46.36±20.65 17.00±10.34 10.86±3.40 22.54±13.81 13.90±10.51 18.24±11.17
t值 ? 0.73 1.22 0.868 0.89 1.79 0.79
P值 ? 0.48 0.23 0.40 0.41 0.89 0.44
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