探讨二维超声测量腹直肌间距（IRD）联合实时剪切波弹性成像（SWE）定量评估腹直肌弹性及其对腹直肌分离的评估价值。

选取2019年3月至12月在广东药科大学附属第一医院进行产前检查并足月分娩的初产妇36人作为研究组，同时院内招募未育女性36人作为对照组。应用二维超声获取脐水平、脐上5 cm水平、脐下5 cm水平的IRD，应用SWE定量评估同一水平双侧腹直肌杨氏模量［平均值（Emean）、最大值（Emax）、最小值（Emin）］。对照组由3位超声检查工作年限分别为＜10年、10~20年、＞20年的医师完成，采用单因素方差分析比较不同工作年限超声医师获取IRD及SWE参数的差异。研究组于妊娠晚期及产后6~8周分别进行不同水平IRD测量及SWE评估，采用两独立样本t检验比较妊娠晚期及产后6~8周两者的差异。

对照组中3位超声检查工作年限为＜10年、10~20年及＞20年的医师获取脐水平、脐上5 cm水平、脐下5 cm水平IRD及SWE参数比较，差异均无统计学意义（P均＞0.05）；研究组IRD测值比较，妊娠晚期及产后IRD测量显示IRD₀＞IRD₊₅＞IRD_-5，妊娠晚期测量IRD₀、IRD₊₅、IRD_-5分别为（3.00±0.53）cm、（2.87±0.57）cm、（2.53±0.33）cm，产后6~8周测量IRD₀、IRD₊₅、IRD_-5分别为（2.39±0.54）cm、（2.09±0.31）cm、（1.96±0.25）cm，产后6~8周不同脐水平IRD测值均小于妊娠晚期相应水平IRD，差异均具有统计学意义（t=2.965、3.791、4.226，P均＜0.001）；研究组腹直肌SWE参数均值比较，左右双侧腹直肌脐水平、脐上5 cm及脐下5 cm的腹直肌SWE参数（Emean、Emax、Emin）比较，产后SWE参数均小于妊娠晚期，差异均具有统计学意义（P均＜0.001）。

二维超声测量腹直肌间距联合SWE评估腹直肌弹性，可提供腹直肌分离的多维度科学证据，其操作简单、便捷，可能成为妊娠晚期及产后早期综合评估腹直肌分离程度及评价腹直肌分离临床疗效的常规手段。

To evaluate the value of measurement of inter-rectus distance (IRD) by two-dimensional ultrasound and shear wave elastography (SWE) in quantitative evaluation of rectus abdominis elasticity in the diastasis recti abdominis.

Thirty-six parturients who underwent prenatal examination and full-term delivery at the First Affiliated Hospital of Guangdong Pharmaceutical University from March to December 2019 were selected as a study group, and 36 infertile women were recruited as a control group. Two-dimensional ultrasound was used to obtain IRD at the umbilical level, 5 cm above the umbilical level, and 5 cm below the umbilical level. SWE was used to quantitatively evaluate Young's modulus of bilateral rectus abdominis at the same levels [average (Emean), maximum (Emax), and minimum (Emin)]. The control group was examined by three physicians who had experience of＜10 years, 10~20 years, and＞20 years, respectively. One-way ANOVA was used to analyze the differences of IRD and SWE parameters obtained by ultrasound doctors with different working years. In the study group, different levels of IRD and SWE were measured and evaluated in the third trimester and 6-8 weeks postpartum, and two independent samples t-test were used for statistical analysis to compare their differences in the third trimester and 6-8 weeks postpartum.

In the control group, there was no significant difference in IRD or SWE parameters at the umbilical level, 5 cm above the umbilical level, and 5 cm below the umbilical level among the three doctors whose had experience of＜10 years, 10~20 years, and＞20 years (P＞0.05). Measurement of late pregnancy and postpartum IRD in the study group showed the following: IRD₀＞IRD₊₅＞IRD_-5, IRD₀ (3.00±0.53) cm, IRD₊₅ (2.87±0.57) cm, and IRD_-5 (2.53±0.33) cm at late pregnancy; and IRD₀ (2.39±0.54) cm, IRD₊₅ (2.09±0.31) cm, and IRD_-5 (1.96±0.25) cm at 6-8 weeks postpartum. The results showed that the measured values of IRD at different umbilical levels at 6-8 weeks postpartum were significantly lower than those at late pregnancy (t=2.965, 3.791, and 4.226, respectively; P＜0.001). Comparison of the mean values of SWE parameters of rectus abdominis muscle in the study group showed that the SWE parameters (Emean, Emax, and Emin) of the left and right bilateral rectus abdominis at late pregnancy were significantly lower than those at 6-8 weeks postpartum (P＜0.001).

Two-dimensional ultrasonic measurement of the distance between the rectus abdominis and real-time SWE can provide multi-dimensional scientific evidence for diastasis recti abdominis. Two-dimensional ultrasound combined with real-time SWE is simple and convenient to operate, and may become a routine method for comprehensive evaluation of the degree of abdominis separation and the clinical effect of abdominis separation in the late pregnancy and early postpartum.