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目的采用经阴道二维超声观察初产妇盆底外、中、内三腔室的相对位置及运动情况。方法选取2012年10月-2015年4月在上海中医药大学附属曙光医院生殖医学中心经阴道自然分娩的80例初产妇为观察组,同期另80例未育女性为对照组。分别于静息期、缩肛期、张力期采用经阴道二维超声测量受试者盆底外(尿道膀胱连接部,UVJ)、中(宫颈外口,CV)、内(肛管直肠连接部,ARJ)三腔室相对于耻骨联合下缘水平参考线的垂直距离(UVJ-VD、CV-VD、ARJ-VD),计算缩肛期、张力期3个距离相对于静息期的运动情况,比较组间差异。结果观察组不同时期的UVJ-VD和CV-VD均显著低于对照组(P<0.05),而ARJ-VD与对照组比较差异无统计学意义(P>0.05)。两组缩肛期、张力期具有相同的运动趋势:缩肛期的△-UVJVD、△-CV-VD、△-ARJ-VD均为正值,即UVJ-VD、CV-VD、ARJ-VD均相对于静息期增加,朝头腹侧运动;张力期的△-UVJ-VD、△-CV-VD、△-ARJ-VD均为负值,即UVJ-VD、CV-VD、ARJ-VD相对于静息期减小,朝足背侧运动。观察组缩肛期朝头腹侧运动的幅度小于对照组,而张力期朝足背侧运动的幅度大于对照组(P<0.05)。结论经阴道二维超声可清晰观察女性盆底器官的位置和运动状态,初产妇的盆底支持系统存在一定程度的受损,其外、中腔室存在一定程度的扩大,缩肛期朝头腹侧运动的幅度增大,张力期朝足背侧的运动幅度减小。
Objective To observe the relative position and movement of the third, third and fourth chamber of the pelvic floor by transvaginal two-dimensional ultrasonography. Methods From October 2012 to April 2015, 80 cases of primiparous women were randomly divided into observation group (n = 80) and vaginal delivery group (n = 80). At the resting stage, the contracting period and the tonic period, transvaginal two-dimensional ultrasonography was used to measure the changes of pelvic floor (urethral bladder junction, UVJ), middle (cervix outside mouth, CV), internal (anorectal junction, ARJ) to the vertical reference line of the lower pubic symphysis (UVJ-VD, CV-VD, ARJ-VD). Differences between groups. Results The levels of UVJ-VD and CV-VD in the observation group were significantly lower than those in the control group (P <0.05). There was no significant difference between the ARJ-VD group and the control group (P> 0.05). The two groups of anal and tension phase have the same movement tendency: △ -UVJVD, △ -CV-VD and △ -ARJ-VD in the period of anal reduction are positive, that is, UVJ-VD, CV-VD and ARJ-VD All increased with respect to the resting period and moved toward the ventral ventral surface. The values of △ -UVJ-VD, △ -CV-VD and △ -ARJ-VD in the tension phase were negative, that is, UVJ-VD, CV-VD and ARJ-VD Decreased relative to the resting period toward the dorsal side. In the observation group, the amplitude of head-ventral motion in the period of contraction was smaller than that of the control group, while the dorsal-dorsal motion of the observation group was larger than that in the control group (P <0.05). Conclusion Transvaginal two-dimensional ultrasound can clearly observe the position and movement of female pelvic floor organs. The pelvic floor support system of primipara is impaired to a certain extent. In addition, there is a certain degree of enlargement of the central cavity, The amplitude of ventral motion increases, and the amplitude of motion toward the dorsal side of tension decreases.