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目的:研究分娩方式对女性前盆腔形态结构与功能的远期影响。方法:将64例产后5年以上的女性分为经阴道分娩组(32例)和选择性剖宫产组(32例),通过病史采集、妇科检查评估压力性尿失禁(SUI)的患病情况,行经会阴盆底超声检查获取其在静息状态及Valsalva状态下的前盆腔脏器形态结构图像并测量与SUI相关的参数。结果:经阴道分娩组远期SUI患病率和膀胱膨出发生率高于选择性剖宫产组(P<0.05)。经阴道分娩组的尿道旋转角大于选择性剖宫产组(P<0.05)。静息状态下膀胱颈至耻骨联合下缘的距离和膀胱尿道后角、Valsalva状态下膀胱颈至耻骨联合下缘的距离(BSD)和膀胱尿道后角、膀胱颈移动度、逼尿肌厚度的差异无统计学意义(P>0.05)。结论:不同分娩方式对女性前盆腔脏器结构与功能的远期影响存在差异,经阴道分娩女性远期SUI患病率增高可能与膀胱膨出及尿道活动度增加有关。
Objective: To study the long-term effects of mode of delivery on the morphology and function of pre-pelvic cavity in women. Methods: Sixty-four women who had been born more than 5 years postpartum were divided into vaginal delivery group (32 cases) and selective cesarean section group (32 cases) by medical history collection and gynecological examination to assess the prevalence of stress urinary incontinence (SUI) , The pelvic organ morphological images at rest and Valsalva state were obtained through the perineal pelvic ultrasonography and the SUI-related parameters were measured. Results: The prevalence of SUI and cystocele in vaginal delivery group was higher than that in selective cesarean section group (P <0.05). The urethral rotation angle in the vaginal delivery group was greater than that in the selective cesarean section group (P <0.05). Distance between bladder neck and pubic symphysis lower margin and distance from bladder urethra at resting state, distance from bladder neck to lower pubic symphysis under Valsalva condition (BSD) and bladder urethra, bladder neck mobility, detrusor muscle thickness The difference was not statistically significant (P> 0.05). CONCLUSION: The long-term effects of different modes of delivery on the structure and function of the anterior pelvic organ in females are different. The increased prevalence of SUI in women with vaginal delivery may be related to the increased cystocele and urethral mobility.