龚阳 康萍 胡江华 陈徐 曾慧 李霞 周婷

【摘要】目的：探讨剖宫产术对孕妇产后盆底结构功能、性功能及相关激素的影响。方法：选取2009年3月至2014年6月间我院妇产科收治的剖宫产和阴道分娩健康孕妇各368名为研究对象。分别于产前、产后6周和12周，利用盆底肌力评分标准、会阴超声检查、女性性功能量表测定和比较两组孕妇盆底结构功能和性功能的改变，并检测性功能相关激素的水平。结果：与产前相比，产后6周阴道分娩组的盆底肌力、膀胱颈角度和旋转角度异常率均明显增高（P<0.05）；剖宫产组的盆底肌力异常率却无明显改变（P>0.05），而且阴道分娩组的盆底肌力异常率明显也高于剖宫产组（P<0.05）；但产后12周剖宫产组的膀胱颈角度和旋转角度异常率与产前比较无明显差别（P>0.05）；与阴道分娩组相比，产后6周和12周剖宫产组的膀胱颈角度和旋转角度异常率均明显降低（P<0.05）；与产前相比，阴道分娩组孕妇产后6周和12周性功能各方面指标均有所下降；而剖宫产组孕妇仅产后6周，性唤起、性高潮和性生活满意度明显降低（P<0.05），但在产后12周，上述三个维度与产前比较并无明显差别（P>0.05）；与阴道分娩组比较，剖宫产组产后6周和12周六个维度的得分值均明显增高（P<0.05）；另外，两组孕妇的性功能相关激素E2、P4、FSH、LH和NPY的水平也明显低于产前（P<0.05）；而且，产后12周剖宫产组的NPY水平明显也低于与阴道分娩组（P<0.05），但其余指标两组间比较均无显著差别（P>0.05）。结论：剖宫产术对孕妇产后短期内性功能和盆腔结构的影响小于阴道分娩，且能够明显降低NPY水平。

【关键词】剖宫产；盆底结构功能；性功能；性激素

Effects of cesarean section on maternal postpartum pelvic floor function， structure function and correlation hormoneGONG Yang1， KANG Ping2， HU Jianghua2， CHEN Xu1△， ZENG Hui1， LI Xia1， ZHOU Ting1. 1.Department of Obstetrics， Peoples Hospital of Chongzhou City， Chengdu 611230， Sichuan， China； 2.Department of Obstetrics and Gynecology， Rehabilitation Hospital of Sichuan， Chengdu 611135， Sichuan， China

【Abstract】Objectives： To explore the effects of cesarean section on maternal postpartum pelvic floor function， structure function and correlation hormone. Methods： Healthy pregnant women who received cesarean section or vaginal delivery from March 2009 to June 2014 in our hospital were selected as the research object， each group of 368 cases. The pelvic floor muscle strength score， perineal sonography， female sexual function and the related hormone levels of two groups were measured and compared in the prenatal， postnatal 6 weeks and 12 weeks. Results： Compared with the prenatal， the abnormal rate of pelvic floor muscle strength of the bladder neck and the rotation were significantly increased at the postnatal 6 weeks in vaginal delivery group （P<0.05）； while the abnormal rate of pelvic floor muscle strength showed no significant change in the cesarean section group （P>0.05）， and the abnormal rate of pelvic floor muscle strength of vaginal delivery group was also higher than that of cesarean section group （P<0.05）； compared with 12 weeks postpartum， at prenatal， the abnormal rate of bladder neck angle and rotation angle also showed no significant difference in cesarean section group （P>0.05）； Compared with prenatal， the sexual function indexes in the vaginal delivery group at 6 and 12 weeks postpartum were all significantly decreased； while in the cesarean section group only sexual arousal， orgasm and sexual satisfaction decreased significantly at 6 weeks postpartum （P<0.05）； Compared with prenatal， the three indexes at 12 weeks postpartum showed no significant difference （P>0.05）； Compared with the vaginal delivery group， 6 indexes were significantly increased in the cesarean section group at 6 week postpartum （P<0.05）； Moreover， the level of NPY was significantly lower than that of vaginal delivery group at 12 weeks postpartum in cesarean section group （P<0.05）， but other indexes between the two groups showed no significant difference （P>0.05）. Conclusion： Cesarean section has less impact on the pelvic structure and sexual function than vaginal delivery in the short term， and can significantly decrease the level of NPY.

【Key words】Cesarean section； Pelvic floor structure and function； Sexual function； Sexual hormone

【中图分类号】R717【文献标志码】A

研究报道显示，妊娠和分娩是影响女性盆底结构功能和性功能的主要因素[1]。阴道分娩和剖宫产均具有各自不同的优缺点，但是两种分娩方式究竟对盆底结构功能、性功能及相关激素究竟有何影响尚未明确，且存在明显争议[2，3]。据此本研究以我院诊治的健康剖宫产和阴道分娩孕妇为研究对象，测定和比较两组分娩方式对盆底肌力评分、膀胱颈角度和旋转角度、产后性功能及相关激素改变。……